Obamacare 2024 Rates for Outagamie County, Wisconsin
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Obamacare is also known as the Affordable Care Act. This page gives you an overview of the rates for individual and family health insurance plans available from , the marketplace for Appleton, 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, 109 Plans and 2024 Rates for Outagamie County, Wisconsin
Below, you’ll find a summary of the 109 plans for Outagamie County, Wisconsin and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.
Obamacare Rates and Providers for Other Years
2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 |
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Chorus Community Health PlansLocal: 1-844-201-4672 | Toll Free: 1-844-201-4672 | TTY: 1-844-531-4856 |
Toc - Plan #1 Chorus Community Health Plans | ||||||||||||||||||||
Silver
(EPO) Chorus Standard Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$440.17 $499.58 $562.52 $786.12 $1,194.59 |
$776.89 $836.30 $899.24 $1,122.84 |
$1,113.61 $1,173.02 $1,235.96 $1,459.56 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$880.34 $999.16 $1,125.04 $1,572.24 $2,389.18 |
$1,217.06 $1,335.88 $1,461.76 $1,908.96 |
$1,553.78 $1,672.60 $1,798.48 $2,245.68 |
Toc - Plan #2 Chorus Community Health Plans | ||||||||||||||||||||
Silver
(EPO) Chorus Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$407.16 $462.11 $520.33 $727.16 $1,105.00 |
$718.63 $773.58 $831.80 $1,038.63 |
$1,030.10 $1,085.05 $1,143.27 $1,350.10 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$814.32 $924.22 $1,040.66 $1,454.32 $2,210.00 |
$1,125.79 $1,235.69 $1,352.13 $1,765.79 |
$1,437.26 $1,547.16 $1,663.60 $2,077.26 |
Toc - Plan #3 Chorus Community Health Plans | ||||||||||||||||||||
Gold
(EPO) Chorus Gold |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$477.14 $541.54 $609.77 $852.16 $1,294.94 |
$842.15 $906.55 $974.78 $1,217.17 |
$1,207.16 $1,271.56 $1,339.79 $1,582.18 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$954.28 $1,083.08 $1,219.54 $1,704.32 $2,589.88 |
$1,319.29 $1,448.09 $1,584.55 $2,069.33 |
$1,684.30 $1,813.10 $1,949.56 $2,434.34 |
Toc - Plan #4 Chorus Community Health Plans | ||||||||||||||||||||
Expanded Bronze
(EPO) Chorus Bronze HDHP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$368.42 $418.15 $470.83 $657.99 $999.87 |
$650.26 $699.99 $752.67 $939.83 |
$932.10 $981.83 $1,034.51 $1,221.67 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$736.84 $836.30 $941.66 $1,315.98 $1,999.74 |
$1,018.68 $1,118.14 $1,223.50 $1,597.82 |
$1,300.52 $1,399.98 $1,505.34 $1,879.66 |
Toc - Plan #5 Chorus Community Health Plans | ||||||||||||||||||||
Silver
(EPO) Chorus Silver Select |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$425.64 $483.09 $543.96 $760.18 $1,155.17 |
$751.25 $808.70 $869.57 $1,085.79 |
$1,076.86 $1,134.31 $1,195.18 $1,411.40 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$851.28 $966.18 $1,087.92 $1,520.36 $2,310.34 |
$1,176.89 $1,291.79 $1,413.53 $1,845.97 |
$1,502.50 $1,617.40 $1,739.14 $2,171.58 |
Toc - Plan #6 Chorus Community Health Plans | ||||||||||||||||||||
Catastrophic
(EPO) Chorus Catastrophic |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$283.03 $321.23 $361.70 $505.48 $768.12 |
$499.54 $537.74 $578.21 $721.99 |
$716.05 $754.25 $794.72 $938.50 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$566.06 $642.46 $723.40 $1,010.96 $1,536.24 |
$782.57 $858.97 $939.91 $1,227.47 |
$999.08 $1,075.48 $1,156.42 $1,443.98 |
Toc - Plan #7 Chorus Community Health Plans | ||||||||||||||||||||
Expanded Bronze
(EPO) Chorus Bronze Copay |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$382.07 $433.64 $488.27 $682.36 $1,036.90 |
$674.34 $725.91 $780.54 $974.63 |
$966.61 $1,018.18 $1,072.81 $1,266.90 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$764.14 $867.28 $976.54 $1,364.72 $2,073.80 |
$1,056.41 $1,159.55 $1,268.81 $1,656.99 |
$1,348.68 $1,451.82 $1,561.08 $1,949.26 |
Toc - Plan #8 Chorus Community Health Plans | ||||||||||||||||||||
Silver
(EPO) Chorus Silver Copay |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$478.90 $543.54 $612.02 $855.30 $1,299.71 |
$845.25 $909.89 $978.37 $1,221.65 |
$1,211.60 $1,276.24 $1,344.72 $1,588.00 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$957.80 $1,087.08 $1,224.04 $1,710.60 $2,599.42 |
$1,324.15 $1,453.43 $1,590.39 $2,076.95 |
$1,690.50 $1,819.78 $1,956.74 $2,443.30 |
Toc - Plan #9 Chorus Community Health Plans | ||||||||||||||||||||
Bronze
(EPO) Chorus Clear Bronze |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$317.36 $360.20 $405.58 $566.80 $861.30 |
$560.14 $602.98 $648.36 $809.58 |
$802.92 $845.76 $891.14 $1,052.36 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$634.72 $720.40 $811.16 $1,133.60 $1,722.60 |
$877.50 $963.18 $1,053.94 $1,376.38 |
$1,120.28 $1,205.96 $1,296.72 $1,619.16 |
Toc - Plan #10 Chorus Community Health Plans | ||||||||||||||||||||
Silver
(EPO) Chorus Core Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$397.47 $451.12 $507.96 $709.87 $1,078.72 |
$701.53 $755.18 $812.02 $1,013.93 |
$1,005.59 $1,059.24 $1,116.08 $1,317.99 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$794.94 $902.24 $1,015.92 $1,419.74 $2,157.44 |
$1,099.00 $1,206.30 $1,319.98 $1,723.80 |
$1,403.06 $1,510.36 $1,624.04 $2,027.86 |
Toc - Plan #11 Chorus Community Health Plans | ||||||||||||||||||||
Gold
(EPO) Chorus Core Gold |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$466.58 $529.56 $596.27 $833.29 $1,266.27 |
$823.50 $886.48 $953.19 $1,190.21 |
$1,180.42 $1,243.40 $1,310.11 $1,547.13 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$933.16 $1,059.12 $1,192.54 $1,666.58 $2,532.54 |
$1,290.08 $1,416.04 $1,549.46 $2,023.50 |
$1,647.00 $1,772.96 $1,906.38 $2,380.42 |
Toc - Plan #12 Chorus Community Health Plans | ||||||||||||||||||||
Expanded Bronze
(EPO) Chorus Core Bronze |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$330.13 $374.69 $421.89 $589.59 $895.94 |
$582.67 $627.23 $674.43 $842.13 |
$835.21 $879.77 $926.97 $1,094.67 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$660.26 $749.38 $843.78 $1,179.18 $1,791.88 |
$912.80 $1,001.92 $1,096.32 $1,431.72 |
$1,165.34 $1,254.46 $1,348.86 $1,684.26 |
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HealthPartnersLocal: 1-952-883-5900 | Toll Free: 1-855-813-3887 | TTY: 1-952-883-6060 |
Toc - Plan #13 HealthPartners | ||||||||||||||||||||
Gold
(PPO) Robin Oak $1,000 w/Copay P-S Gold |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$994.20 $1,128.42 $1,270.58 $1,775.64 $2,698.26 |
$1,374.48 $1,508.70 $1,650.86 $2,155.92 |
$1,754.76 $1,888.98 $2,031.14 $2,536.20 |
Toc - Plan #14 HealthPartners | ||||||||||||||||||||
Gold
(PPO) Robin Oak $1,500 w/Copay P-S Gold |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$961.00 $1,090.74 $1,228.16 $1,716.34 $2,608.16 |
$1,328.58 $1,458.32 $1,595.74 $2,083.92 |
$1,696.16 $1,825.90 $1,963.32 $2,451.50 |
Toc - Plan #15 HealthPartners | ||||||||||||||||||||
Silver
(PPO) Robin Select $3,600 Plus Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$773.54 $877.96 $988.58 $1,381.54 $2,099.38 |
$1,069.42 $1,173.84 $1,284.46 $1,677.42 |
$1,365.30 $1,469.72 $1,580.34 $1,973.30 |
Toc - Plan #16 HealthPartners | ||||||||||||||||||||
Silver
(PPO) Robin Select $5,900 w/Copay P-S Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$772.80 $877.12 $987.64 $1,380.22 $2,097.38 |
$1,068.40 $1,172.72 $1,283.24 $1,675.82 |
$1,364.00 $1,468.32 $1,578.84 $1,971.42 |
Toc - Plan #17 HealthPartners | ||||||||||||||||||||
Expanded Bronze
(PPO) Robin Select $6,350 Plus Bronze |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$595.10 $675.44 $760.54 $1,062.84 $1,615.10 |
$822.73 $903.07 $988.17 $1,290.47 |
$1,050.36 $1,130.70 $1,215.80 $1,518.10 |
Toc - Plan #18 HealthPartners | ||||||||||||||||||||
Expanded Bronze
(PPO) Robin Select $7,500 w/Copay P-S Bronze |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$600.10 $681.12 $766.92 $1,071.78 $1,628.68 |
$829.64 $910.66 $996.46 $1,301.32 |
$1,059.18 $1,140.20 $1,226.00 $1,530.86 |
Toc - Plan #19 HealthPartners | ||||||||||||||||||||
Silver
(PPO) Robin Select $3,800 HSA Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$376.56 $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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$753.12 $854.80 $962.48 $1,345.08 $2,043.96 |
$1,041.19 $1,142.87 $1,250.55 $1,633.15 |
$1,329.26 $1,430.94 $1,538.62 $1,921.22 |
Toc - Plan #20 HealthPartners | ||||||||||||||||||||
Expanded Bronze
(PPO) Robin Select $8,000 HSA Bronze |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$568.94 $645.74 $727.10 $1,016.12 $1,544.10 |
$786.56 $863.36 $944.72 $1,233.74 |
$1,004.18 $1,080.98 $1,162.34 $1,451.36 |
Toc - Plan #21 HealthPartners | ||||||||||||||||||||
Catastrophic
(PPO) Robin Select $9,450 Catastrophic |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$450.68 $511.52 $575.96 $804.92 $1,223.14 |
$623.07 $683.91 $748.35 $977.31 |
$795.46 $856.30 $920.74 $1,149.70 |
ADVERTISEMENT
QuartzLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973 |
Toc - Plan #22 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$476.66 $541.00 $609.16 $851.30 $1,293.63 |
$841.30 $905.64 $973.80 $1,215.94 |
$1,205.94 $1,270.28 $1,338.44 $1,580.58 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$953.32 $1,082.00 $1,218.32 $1,702.60 $2,587.26 |
$1,317.96 $1,446.64 $1,582.96 $2,067.24 |
$1,682.60 $1,811.28 $1,947.60 $2,431.88 |
Toc - Plan #23 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$480.37 $545.21 $613.91 $857.93 $1,303.71 |
$847.85 $912.69 $981.39 $1,225.41 |
$1,215.33 $1,280.17 $1,348.87 $1,592.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$960.74 $1,090.42 $1,227.82 $1,715.86 $2,607.42 |
$1,328.22 $1,457.90 $1,595.30 $2,083.34 |
$1,695.70 $1,825.38 $1,962.78 $2,450.82 |
Toc - Plan #24 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$507.79 $576.33 $648.94 $906.90 $1,378.12 |
$896.24 $964.78 $1,037.39 $1,295.35 |
$1,284.69 $1,353.23 $1,425.84 $1,683.80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,015.58 $1,152.66 $1,297.88 $1,813.80 $2,756.24 |
$1,404.03 $1,541.11 $1,686.33 $2,202.25 |
$1,792.48 $1,929.56 $2,074.78 $2,590.70 |
Toc - Plan #25 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$377.81 $428.81 $482.84 $674.76 $1,025.37 |
$666.83 $717.83 $771.86 $963.78 |
$955.85 $1,006.85 $1,060.88 $1,252.80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$755.62 $857.62 $965.68 $1,349.52 $2,050.74 |
$1,044.64 $1,146.64 $1,254.70 $1,638.54 |
$1,333.66 $1,435.66 $1,543.72 $1,927.56 |
Toc - Plan #26 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$367.71 $417.34 $469.92 $656.72 $997.95 |
$649.00 $698.63 $751.21 $938.01 |
$930.29 $979.92 $1,032.50 $1,219.30 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$735.42 $834.68 $939.84 $1,313.44 $1,995.90 |
$1,016.71 $1,115.97 $1,221.13 $1,594.73 |
$1,298.00 $1,397.26 $1,502.42 $1,876.02 |
Toc - Plan #27 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$519.87 $590.04 $664.39 $928.48 $1,410.91 |
$917.57 $987.74 $1,062.09 $1,326.18 |
$1,315.27 $1,385.44 $1,459.79 $1,723.88 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1,039.74 $1,180.08 $1,328.78 $1,856.96 $2,821.82 |
$1,437.44 $1,577.78 $1,726.48 $2,254.66 |
$1,835.14 $1,975.48 $2,124.18 $2,652.36 |
Toc - Plan #28 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$436.76 $495.71 $558.17 $780.04 $1,185.34 |
$770.87 $829.82 $892.28 $1,114.15 |
$1,104.98 $1,163.93 $1,226.39 $1,448.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$873.52 $991.42 $1,116.34 $1,560.08 $2,370.68 |
$1,207.63 $1,325.53 $1,450.45 $1,894.19 |
$1,541.74 $1,659.64 $1,784.56 $2,228.30 |
Toc - Plan #29 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$453.94 $515.21 $580.12 $810.72 $1,231.97 |
$801.20 $862.47 $927.38 $1,157.98 |
$1,148.46 $1,209.73 $1,274.64 $1,505.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$907.88 $1,030.42 $1,160.24 $1,621.44 $2,463.94 |
$1,255.14 $1,377.68 $1,507.50 $1,968.70 |
$1,602.40 $1,724.94 $1,854.76 $2,315.96 |
Toc - Plan #30 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$457.47 $519.22 $584.64 $817.03 $1,241.56 |
$807.43 $869.18 $934.60 $1,166.99 |
$1,157.39 $1,219.14 $1,284.56 $1,516.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$914.94 $1,038.44 $1,169.28 $1,634.06 $2,483.12 |
$1,264.90 $1,388.40 $1,519.24 $1,984.02 |
$1,614.86 $1,738.36 $1,869.20 $2,333.98 |
Toc - Plan #31 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$483.58 $548.86 $618.01 $863.67 $1,312.43 |
$853.52 $918.80 $987.95 $1,233.61 |
$1,223.46 $1,288.74 $1,357.89 $1,603.55 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$967.16 $1,097.72 $1,236.02 $1,727.34 $2,624.86 |
$1,337.10 $1,467.66 $1,605.96 $2,097.28 |
$1,707.04 $1,837.60 $1,975.90 $2,467.22 |
Toc - Plan #32 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$470.68 $534.22 $601.53 $840.63 $1,277.42 |
$830.75 $894.29 $961.60 $1,200.70 |
$1,190.82 $1,254.36 $1,321.67 $1,560.77 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$941.36 $1,068.44 $1,203.06 $1,681.26 $2,554.84 |
$1,301.43 $1,428.51 $1,563.13 $2,041.33 |
$1,661.50 $1,788.58 $1,923.20 $2,401.40 |
Toc - Plan #33 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$359.80 $408.37 $459.82 $642.60 $976.49 |
$635.05 $683.62 $735.07 $917.85 |
$910.30 $958.87 $1,010.32 $1,193.10 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$719.60 $816.74 $919.64 $1,285.20 $1,952.98 |
$994.85 $1,091.99 $1,194.89 $1,560.45 |
$1,270.10 $1,367.24 $1,470.14 $1,835.70 |
Toc - Plan #34 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$350.18 $397.45 $447.52 $625.41 $950.38 |
$618.06 $665.33 $715.40 $893.29 |
$885.94 $933.21 $983.28 $1,161.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$700.36 $794.90 $895.04 $1,250.82 $1,900.76 |
$968.24 $1,062.78 $1,162.92 $1,518.70 |
$1,236.12 $1,330.66 $1,430.80 $1,786.58 |
Toc - Plan #35 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$334.22 $379.33 $427.12 $596.90 $907.05 |
$589.89 $635.00 $682.79 $852.57 |
$845.56 $890.67 $938.46 $1,108.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$668.44 $758.66 $854.24 $1,193.80 $1,814.10 |
$924.11 $1,014.33 $1,109.91 $1,449.47 |
$1,179.78 $1,270.00 $1,365.58 $1,705.14 |
Toc - Plan #36 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$495.09 $561.92 $632.72 $884.22 $1,343.65 |
$873.83 $940.66 $1,011.46 $1,262.96 |
$1,252.57 $1,319.40 $1,390.20 $1,641.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$990.18 $1,123.84 $1,265.44 $1,768.44 $2,687.30 |
$1,368.92 $1,502.58 $1,644.18 $2,147.18 |
$1,747.66 $1,881.32 $2,022.92 $2,525.92 |
Toc - Plan #37 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$430.15 $488.21 $549.72 $768.24 $1,167.41 |
$759.21 $817.27 $878.78 $1,097.30 |
$1,088.27 $1,146.33 $1,207.84 $1,426.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$860.30 $976.42 $1,099.44 $1,536.48 $2,334.82 |
$1,189.36 $1,305.48 $1,428.50 $1,865.54 |
$1,518.42 $1,634.54 $1,757.56 $2,194.60 |
Toc - Plan #38 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$460.04 $522.14 $587.93 $821.63 $1,248.54 |
$811.97 $874.07 $939.86 $1,173.56 |
$1,163.90 $1,226.00 $1,291.79 $1,525.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$920.08 $1,044.28 $1,175.86 $1,643.26 $2,497.08 |
$1,272.01 $1,396.21 $1,527.79 $1,995.19 |
$1,623.94 $1,748.14 $1,879.72 $2,347.12 |
Toc - Plan #39 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$314.94 $357.45 $402.48 $562.47 $854.73 |
$555.86 $598.37 $643.40 $803.39 |
$796.78 $839.29 $884.32 $1,044.31 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$629.88 $714.90 $804.96 $1,124.94 $1,709.46 |
$870.80 $955.82 $1,045.88 $1,365.86 |
$1,111.72 $1,196.74 $1,286.80 $1,606.78 |
Toc - Plan #40 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$447.64 $508.07 $572.08 $799.48 $1,214.89 |
$790.08 $850.51 $914.52 $1,141.92 |
$1,132.52 $1,192.95 $1,256.96 $1,484.36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$895.28 $1,016.14 $1,144.16 $1,598.96 $2,429.78 |
$1,237.72 $1,358.58 $1,486.60 $1,941.40 |
$1,580.16 $1,701.02 $1,829.04 $2,283.84 |
Toc - Plan #41 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$487.93 $553.79 $623.56 $871.43 $1,324.22 |
$861.19 $927.05 $996.82 $1,244.69 |
$1,234.45 $1,300.31 $1,370.08 $1,617.95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$975.86 $1,107.58 $1,247.12 $1,742.86 $2,648.44 |
$1,349.12 $1,480.84 $1,620.38 $2,116.12 |
$1,722.38 $1,854.10 $1,993.64 $2,489.38 |
Toc - Plan #42 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$342.30 $388.50 $437.45 $611.33 $928.98 |
$604.15 $650.35 $699.30 $873.18 |
$866.00 $912.20 $961.15 $1,135.03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$684.60 $777.00 $874.90 $1,222.66 $1,857.96 |
$946.45 $1,038.85 $1,136.75 $1,484.51 |
$1,208.30 $1,300.70 $1,398.60 $1,746.36 |
Toc - Plan #43 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$248.52 $282.07 $317.61 $443.85 $674.48 |
$438.64 $472.19 $507.73 $633.97 |
$628.76 $662.31 $697.85 $824.09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$497.04 $564.14 $635.22 $887.70 $1,348.96 |
$687.16 $754.26 $825.34 $1,077.82 |
$877.28 $944.38 $1,015.46 $1,267.94 |
ADVERTISEMENT
Molina HealthcareLocal: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
Toc - Plan #44 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Gold 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$470.22 $533.70 $600.94 $839.81 $1,276.17 |
$829.94 $893.42 $960.66 $1,199.53 |
$1,189.66 $1,253.14 $1,320.38 $1,559.25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$940.44 $1,067.40 $1,201.88 $1,679.62 $2,552.34 |
$1,300.16 $1,427.12 $1,561.60 $2,039.34 |
$1,659.88 $1,786.84 $1,921.32 $2,399.06 |
Toc - Plan #45 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Silver 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$399.21 $453.10 $510.19 $712.99 $1,083.46 |
$704.61 $758.50 $815.59 $1,018.39 |
$1,010.01 $1,063.90 $1,120.99 $1,323.79 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$798.42 $906.20 $1,020.38 $1,425.98 $2,166.92 |
$1,103.82 $1,211.60 $1,325.78 $1,731.38 |
$1,409.22 $1,517.00 $1,631.18 $2,036.78 |
Toc - Plan #46 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Gold 8 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$485.37 $550.90 $620.31 $866.88 $1,317.31 |
$856.68 $922.21 $991.62 $1,238.19 |
$1,227.99 $1,293.52 $1,362.93 $1,609.50 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$970.74 $1,101.80 $1,240.62 $1,733.76 $2,634.62 |
$1,342.05 $1,473.11 $1,611.93 $2,105.07 |
$1,713.36 $1,844.42 $1,983.24 $2,476.38 |
Toc - Plan #47 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Silver 8 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$389.83 $442.45 $498.20 $696.23 $1,057.99 |
$688.05 $740.67 $796.42 $994.45 |
$986.27 $1,038.89 $1,094.64 $1,292.67 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$779.66 $884.90 $996.40 $1,392.46 $2,115.98 |
$1,077.88 $1,183.12 $1,294.62 $1,690.68 |
$1,376.10 $1,481.34 $1,592.84 $1,988.90 |
Toc - Plan #48 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Silver 12 with First 4 Primary Care Visits Free |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$393.02 $446.08 $502.29 $701.94 $1,066.67 |
$693.68 $746.74 $802.95 $1,002.60 |
$994.34 $1,047.40 $1,103.61 $1,303.26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$786.04 $892.16 $1,004.58 $1,403.88 $2,133.34 |
$1,086.70 $1,192.82 $1,305.24 $1,704.54 |
$1,387.36 $1,493.48 $1,605.90 $2,005.20 |
Toc - Plan #49 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Gold 1 with Adult Vision Services |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$472.91 $536.75 $604.38 $844.62 $1,283.48 |
$834.69 $898.53 $966.16 $1,206.40 |
$1,196.47 $1,260.31 $1,327.94 $1,568.18 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$945.82 $1,073.50 $1,208.76 $1,689.24 $2,566.96 |
$1,307.60 $1,435.28 $1,570.54 $2,051.02 |
$1,669.38 $1,797.06 $1,932.32 $2,412.80 |
Toc - Plan #50 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Silver 1 with Adult Vision Services |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$401.65 $455.87 $513.30 $717.34 $1,090.07 |
$708.91 $763.13 $820.56 $1,024.60 |
$1,016.17 $1,070.39 $1,127.82 $1,331.86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$803.30 $911.74 $1,026.60 $1,434.68 $2,180.14 |
$1,110.56 $1,219.00 $1,333.86 $1,741.94 |
$1,417.82 $1,526.26 $1,641.12 $2,049.20 |
ADVERTISEMENT
Anthem Blue Cross and Blue ShieldLocal: 1-855-748-1813 | Toll Free: 1-855-748-1813 |
Toc - Plan #51 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway/Lean 0% for HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$296.41 $336.43 $378.81 $529.39 $804.46 |
$523.16 $563.18 $605.56 $756.14 |
$749.91 $789.93 $832.31 $982.89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$592.82 $672.86 $757.62 $1,058.78 $1,608.92 |
$819.57 $899.61 $984.37 $1,285.53 |
$1,046.32 $1,126.36 $1,211.12 $1,512.28 |
Toc - Plan #52 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway/Lean 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$297.55 $337.72 $380.27 $531.42 $807.55 |
$525.18 $565.35 $607.90 $759.05 |
$752.81 $792.98 $835.53 $986.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$595.10 $675.44 $760.54 $1,062.84 $1,615.10 |
$822.73 $903.07 $988.17 $1,290.47 |
$1,050.36 $1,130.70 $1,215.80 $1,518.10 |
Toc - Plan #53 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(HMO) Anthem Bronze Pathway/Lean 9450 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$282.60 $320.75 $361.16 $504.72 $766.98 |
$498.79 $536.94 $577.35 $720.91 |
$714.98 $753.13 $793.54 $937.10 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$565.20 $641.50 $722.32 $1,009.44 $1,533.96 |
$781.39 $857.69 $938.51 $1,225.63 |
$997.58 $1,073.88 $1,154.70 $1,441.82 |
Toc - Plan #54 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway/Lean 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$347.13 $393.99 $443.63 $619.97 $942.11 |
$612.68 $659.54 $709.18 $885.52 |
$878.23 $925.09 $974.73 $1,151.07 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$694.26 $787.98 $887.26 $1,239.94 $1,884.22 |
$959.81 $1,053.53 $1,152.81 $1,505.49 |
$1,225.36 $1,319.08 $1,418.36 $1,771.04 |
Toc - Plan #55 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway/Lean 4100 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$347.31 $394.20 $443.86 $620.30 $942.60 |
$613.00 $659.89 $709.55 $885.99 |
$878.69 $925.58 $975.24 $1,151.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$694.62 $788.40 $887.72 $1,240.60 $1,885.20 |
$960.31 $1,054.09 $1,153.41 $1,506.29 |
$1,226.00 $1,319.78 $1,419.10 $1,771.98 |
Toc - Plan #56 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway/Lean 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$339.16 $384.95 $433.45 $605.74 $920.48 |
$598.62 $644.41 $692.91 $865.20 |
$858.08 $903.87 $952.37 $1,124.66 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$678.32 $769.90 $866.90 $1,211.48 $1,840.96 |
$937.78 $1,029.36 $1,126.36 $1,470.94 |
$1,197.24 $1,288.82 $1,385.82 $1,730.40 |
Toc - Plan #57 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(HMO) Anthem Gold Pathway/Lean 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$371.42 $421.56 $474.67 $663.36 $1,008.03 |
$655.56 $705.70 $758.81 $947.50 |
$939.70 $989.84 $1,042.95 $1,231.64 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$742.84 $843.12 $949.34 $1,326.72 $2,016.06 |
$1,026.98 $1,127.26 $1,233.48 $1,610.86 |
$1,311.12 $1,411.40 $1,517.62 $1,895.00 |
Toc - Plan #58 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway/Lean 0 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$302.24 $343.04 $386.26 $539.80 $820.28 |
$533.45 $574.25 $617.47 $771.01 |
$764.66 $805.46 $848.68 $1,002.22 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$604.48 $686.08 $772.52 $1,079.60 $1,640.56 |
$835.69 $917.29 $1,003.73 $1,310.81 |
$1,066.90 $1,148.50 $1,234.94 $1,542.02 |
Toc - Plan #59 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(HMO) Anthem Silver Pathway/Lean 5900/40% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$338.87 $384.62 $433.08 $605.22 $919.69 |
$598.11 $643.86 $692.32 $864.46 |
$857.35 $903.10 $951.56 $1,123.70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$677.74 $769.24 $866.16 $1,210.44 $1,839.38 |
$936.98 $1,028.48 $1,125.40 $1,469.68 |
$1,196.22 $1,287.72 $1,384.64 $1,728.92 |
Toc - Plan #60 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(HMO) Anthem Gold Pathway/Lean 1500/25% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$378.36 $429.44 $483.54 $675.75 $1,026.87 |
$667.81 $718.89 $772.99 $965.20 |
$957.26 $1,008.34 $1,062.44 $1,254.65 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$756.72 $858.88 $967.08 $1,351.50 $2,053.74 |
$1,046.17 $1,148.33 $1,256.53 $1,640.95 |
$1,335.62 $1,437.78 $1,545.98 $1,930.40 |
Toc - Plan #61 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(HMO) Anthem Bronze Pathway/Lean 7500/50% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$296.66 $336.71 $379.13 $529.83 $805.14 |
$523.60 $563.65 $606.07 $756.77 |
$750.54 $790.59 $833.01 $983.71 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$593.32 $673.42 $758.26 $1,059.66 $1,610.28 |
$820.26 $900.36 $985.20 $1,286.60 |
$1,047.20 $1,127.30 $1,212.14 $1,513.54 |
Toc - Plan #62 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(POS) Anthem Bronze Blue Preferred/Broad 0 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$383.51 $435.28 $490.13 $684.95 $1,040.85 |
$676.90 $728.67 $783.52 $978.34 |
$970.29 $1,022.06 $1,076.91 $1,271.73 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$767.02 $870.56 $980.26 $1,369.90 $2,081.70 |
$1,060.41 $1,163.95 $1,273.65 $1,663.29 |
$1,353.80 $1,457.34 $1,567.04 $1,956.68 |
Toc - Plan #63 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(POS) Anthem Silver Blue Preferred/Broad 4100 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$453.95 $515.23 $580.15 $810.75 $1,232.02 |
$801.22 $862.50 $927.42 $1,158.02 |
$1,148.49 $1,209.77 $1,274.69 $1,505.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$907.90 $1,030.46 $1,160.30 $1,621.50 $2,464.04 |
$1,255.17 $1,377.73 $1,507.57 $1,968.77 |
$1,602.44 $1,725.00 $1,854.84 $2,316.04 |
Toc - Plan #64 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Bronze
(POS) Anthem Bronze Blue Preferred/Broad 9450 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$347.53 $394.45 $444.14 $620.69 $943.20 |
$613.39 $660.31 $710.00 $886.55 |
$879.25 $926.17 $975.86 $1,152.41 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$695.06 $788.90 $888.28 $1,241.38 $1,886.40 |
$960.92 $1,054.76 $1,154.14 $1,507.24 |
$1,226.78 $1,320.62 $1,420.00 $1,773.10 |
Toc - Plan #65 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(POS) Anthem Bronze Blue Preferred/Broad 0% for HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$364.55 $413.76 $465.89 $651.09 $989.39 |
$643.43 $692.64 $744.77 $929.97 |
$922.31 $971.52 $1,023.65 $1,208.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$729.10 $827.52 $931.78 $1,302.18 $1,978.78 |
$1,007.98 $1,106.40 $1,210.66 $1,581.06 |
$1,286.86 $1,385.28 $1,489.54 $1,859.94 |
Toc - Plan #66 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(POS) Anthem Bronze Blue Preferred/Broad 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$365.95 $415.35 $467.68 $653.59 $993.19 |
$645.90 $695.30 $747.63 $933.54 |
$925.85 $975.25 $1,027.58 $1,213.49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$731.90 $830.70 $935.36 $1,307.18 $1,986.38 |
$1,011.85 $1,110.65 $1,215.31 $1,587.13 |
$1,291.80 $1,390.60 $1,495.26 $1,867.08 |
Toc - Plan #67 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(POS) Anthem Silver Blue Preferred/Broad 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$443.29 $503.13 $566.52 $791.72 $1,203.09 |
$782.41 $842.25 $905.64 $1,130.84 |
$1,121.53 $1,181.37 $1,244.76 $1,469.96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$886.58 $1,006.26 $1,133.04 $1,583.44 $2,406.18 |
$1,225.70 $1,345.38 $1,472.16 $1,922.56 |
$1,564.82 $1,684.50 $1,811.28 $2,261.68 |
Toc - Plan #68 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(POS) Anthem Gold Blue Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$485.43 $550.96 $620.38 $866.98 $1,317.46 |
$856.78 $922.31 $991.73 $1,238.33 |
$1,228.13 $1,293.66 $1,363.08 $1,609.68 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$970.86 $1,101.92 $1,240.76 $1,733.96 $2,634.92 |
$1,342.21 $1,473.27 $1,612.11 $2,105.31 |
$1,713.56 $1,844.62 $1,983.46 $2,476.66 |
Toc - Plan #69 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Expanded Bronze
(POS) Anthem Bronze Blue Preferred/Broad 7500/50% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$364.88 $414.14 $466.32 $651.68 $990.28 |
$644.01 $693.27 $745.45 $930.81 |
$923.14 $972.40 $1,024.58 $1,209.94 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$729.76 $828.28 $932.64 $1,303.36 $1,980.56 |
$1,008.89 $1,107.41 $1,211.77 $1,582.49 |
$1,288.02 $1,386.54 $1,490.90 $1,861.62 |
Toc - Plan #70 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(POS) Anthem Silver Blue Preferred/Broad 5900/40% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$442.93 $502.73 $566.06 $791.07 $1,202.11 |
$781.77 $841.57 $904.90 $1,129.91 |
$1,120.61 $1,180.41 $1,243.74 $1,468.75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$885.86 $1,005.46 $1,132.12 $1,582.14 $2,404.22 |
$1,224.70 $1,344.30 $1,470.96 $1,920.98 |
$1,563.54 $1,683.14 $1,809.80 $2,259.82 |
Toc - Plan #71 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Gold
(POS) Anthem Gold Blue Preferred/Broad 1500/25% Standard |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$494.55 $561.31 $632.03 $883.27 $1,342.21 |
$872.88 $939.64 $1,010.36 $1,261.60 |
$1,251.21 $1,317.97 $1,388.69 $1,639.93 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$989.10 $1,122.62 $1,264.06 $1,766.54 $2,684.42 |
$1,367.43 $1,500.95 $1,642.39 $2,144.87 |
$1,745.76 $1,879.28 $2,020.72 $2,523.20 |
Toc - Plan #72 Anthem Blue Cross and Blue Shield | ||||||||||||||||||||
Silver
(POS) Anthem Silver Blue Preferred/Broad 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-748-1813
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$453.70 $514.95 $579.83 $810.31 $1,231.34 |
$800.78 $862.03 $926.91 $1,157.39 |
$1,147.86 $1,209.11 $1,273.99 $1,504.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$907.40 $1,029.90 $1,159.66 $1,620.62 $2,462.68 |
$1,254.48 $1,376.98 $1,506.74 $1,967.70 |
$1,601.56 $1,724.06 $1,853.82 $2,314.78 |
ADVERTISEMENT
Network HealthLocal: 1-920-720-1400x1400 | Toll Free: 1-855-275-1400 | TTY: 1-800-947-3529 |
Toc - Plan #73 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze 20 HDHP + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$294.49 $334.24 $376.35 $525.95 $799.23 |
$519.77 $559.52 $601.63 $751.23 |
$745.05 $784.80 $826.91 $976.51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$588.98 $668.48 $752.70 $1,051.90 $1,598.46 |
$814.26 $893.76 $977.98 $1,277.18 |
$1,039.54 $1,119.04 $1,203.26 $1,502.46 |
Toc - Plan #74 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze Essential + Dental + Vision + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$273.66 $310.60 $349.74 $488.75 $742.71 |
$483.01 $519.95 $559.09 $698.10 |
$692.36 $729.30 $768.44 $907.45 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$547.32 $621.20 $699.48 $977.50 $1,485.42 |
$756.67 $830.55 $908.83 $1,186.85 |
$966.02 $1,039.90 $1,118.18 $1,396.20 |
Toc - Plan #75 Network Health | ||||||||||||||||||||
Silver
(HMO) Prestige Silver Essential + Dental + Vision + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$429.76 $487.78 $549.23 $767.55 $1,166.37 |
$758.53 $816.55 $878.00 $1,096.32 |
$1,087.30 $1,145.32 $1,206.77 $1,425.09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$859.52 $975.56 $1,098.46 $1,535.10 $2,332.74 |
$1,188.29 $1,304.33 $1,427.23 $1,863.87 |
$1,517.06 $1,633.10 $1,756.00 $2,192.64 |
Toc - Plan #76 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold Essential + Dental + Vision + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$383.03 $434.74 $489.51 $684.08 $1,039.53 |
$676.05 $727.76 $782.53 $977.10 |
$969.07 $1,020.78 $1,075.55 $1,270.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$766.06 $869.48 $979.02 $1,368.16 $2,079.06 |
$1,059.08 $1,162.50 $1,272.04 $1,661.18 |
$1,352.10 $1,455.52 $1,565.06 $1,954.20 |
Toc - Plan #77 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold 50 + Dental + Vision + 1 Free PCP Visit |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$409.97 $465.32 $523.94 $732.21 $1,112.66 |
$723.60 $778.95 $837.57 $1,045.84 |
$1,037.23 $1,092.58 $1,151.20 $1,359.47 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$819.94 $930.64 $1,047.88 $1,464.42 $2,225.32 |
$1,133.57 $1,244.27 $1,361.51 $1,778.05 |
$1,447.20 $1,557.90 $1,675.14 $2,091.68 |
Toc - Plan #78 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Signature Prestige Bronze Copay + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$296.57 $336.61 $379.02 $529.68 $804.89 |
$523.45 $563.49 $605.90 $756.56 |
$750.33 $790.37 $832.78 $983.44 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$593.14 $673.22 $758.04 $1,059.36 $1,609.78 |
$820.02 $900.10 $984.92 $1,286.24 |
$1,046.90 $1,126.98 $1,211.80 $1,513.12 |
Toc - Plan #79 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze Plus |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$291.81 $331.21 $372.93 $521.17 $791.97 |
$515.05 $554.45 $596.17 $744.41 |
$738.29 $777.69 $819.41 $967.65 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$583.62 $662.42 $745.86 $1,042.34 $1,583.94 |
$806.86 $885.66 $969.10 $1,265.58 |
$1,030.10 $1,108.90 $1,192.34 $1,488.82 |
Toc - Plan #80 Network Health | ||||||||||||||||||||
Silver
(HMO) Prestige Silver |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$425.97 $483.47 $544.39 $760.78 $1,156.07 |
$751.84 $809.34 $870.26 $1,086.65 |
$1,077.71 $1,135.21 $1,196.13 $1,412.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$851.94 $966.94 $1,088.78 $1,521.56 $2,312.14 |
$1,177.81 $1,292.81 $1,414.65 $1,847.43 |
$1,503.68 $1,618.68 $1,740.52 $2,173.30 |
Toc - Plan #81 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$384.54 $436.45 $491.44 $686.78 $1,043.62 |
$678.71 $730.62 $785.61 $980.95 |
$972.88 $1,024.79 $1,079.78 $1,275.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$769.08 $872.90 $982.88 $1,373.56 $2,087.24 |
$1,063.25 $1,167.07 $1,277.05 $1,667.73 |
$1,357.42 $1,461.24 $1,571.22 $1,961.90 |
ADVERTISEMENT
Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-844-472-2442 |
Toc - Plan #82 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Copay Bronze $0 Ded / $2250 Rx Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$301.75 $342.48 $385.63 $538.91 $818.93 |
$532.58 $573.31 $616.46 $769.74 |
$763.41 $804.14 $847.29 $1,000.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$603.50 $684.96 $771.26 $1,077.82 $1,637.86 |
$834.33 $915.79 $1,002.09 $1,308.65 |
$1,065.16 $1,146.62 $1,232.92 $1,539.48 |
Toc - Plan #83 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Copay Gold $0 Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$471.34 $534.96 $602.36 $841.79 $1,279.18 |
$831.90 $895.52 $962.92 $1,202.35 |
$1,192.46 $1,256.08 $1,323.48 $1,562.91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$942.68 $1,069.92 $1,204.72 $1,683.58 $2,558.36 |
$1,303.24 $1,430.48 $1,565.28 $2,044.14 |
$1,663.80 $1,791.04 $1,925.84 $2,404.70 |
Toc - Plan #84 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $3000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$410.53 $465.94 $524.65 $733.19 $1,114.16 |
$724.58 $779.99 $838.70 $1,047.24 |
$1,038.63 $1,094.04 $1,152.75 $1,361.29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$821.06 $931.88 $1,049.30 $1,466.38 $2,228.32 |
$1,135.11 $1,245.93 $1,363.35 $1,780.43 |
$1,449.16 $1,559.98 $1,677.40 $2,094.48 |
Toc - Plan #85 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $1800 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$444.82 $504.86 $568.47 $794.43 $1,207.21 |
$785.10 $845.14 $908.75 $1,134.71 |
$1,125.38 $1,185.42 $1,249.03 $1,474.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$889.64 $1,009.72 $1,136.94 $1,588.86 $2,414.42 |
$1,229.92 $1,350.00 $1,477.22 $1,929.14 |
$1,570.20 $1,690.28 $1,817.50 $2,269.42 |
Toc - Plan #86 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $4000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$405.03 $459.70 $517.62 $723.37 $1,099.23 |
$714.87 $769.54 $827.46 $1,033.21 |
$1,024.71 $1,079.38 $1,137.30 $1,343.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$810.06 $919.40 $1,035.24 $1,446.74 $2,198.46 |
$1,119.90 $1,229.24 $1,345.08 $1,756.58 |
$1,429.74 $1,539.08 $1,654.92 $2,066.42 |
Toc - Plan #87 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5000 Ded / $5000 Rx Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$343.28 $389.61 $438.70 $613.08 $931.64 |
$605.88 $652.21 $701.30 $875.68 |
$868.48 $914.81 $963.90 $1,138.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$686.56 $779.22 $877.40 $1,226.16 $1,863.28 |
$949.16 $1,041.82 $1,140.00 $1,488.76 |
$1,211.76 $1,304.42 $1,402.60 $1,751.36 |
Toc - Plan #88 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Catastrophic
(EPO) CGHC Catastrophic $9450 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$194.10 $220.29 $248.05 $346.65 $526.76 |
$342.58 $368.77 $396.53 $495.13 |
$491.06 $517.25 $545.01 $643.61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$388.20 $440.58 $496.10 $693.30 $1,053.52 |
$536.68 $589.06 $644.58 $841.78 |
$685.16 $737.54 $793.06 $990.26 |
Toc - Plan #89 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $9450 ($35 PCP Copay) - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$288.36 $327.28 $368.51 $514.99 $782.58 |
$508.95 $547.87 $589.10 $735.58 |
$729.54 $768.46 $809.69 $956.17 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$576.72 $654.56 $737.02 $1,029.98 $1,565.16 |
$797.31 $875.15 $957.61 $1,250.57 |
$1,017.90 $1,095.74 $1,178.20 $1,471.16 |
Toc - Plan #90 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7500 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$300.54 $341.11 $384.08 $536.75 $815.65 |
$530.45 $571.02 $613.99 $766.66 |
$760.36 $800.93 $843.90 $996.57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$601.08 $682.22 $768.16 $1,073.50 $1,631.30 |
$830.99 $912.13 $998.07 $1,303.41 |
$1,060.90 $1,142.04 $1,227.98 $1,533.32 |
Toc - Plan #91 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $3200 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$469.19 $532.52 $599.61 $837.96 $1,273.36 |
$828.11 $891.44 $958.53 $1,196.88 |
$1,187.03 $1,250.36 $1,317.45 $1,555.80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$938.38 $1,065.04 $1,199.22 $1,675.92 $2,546.72 |
$1,297.30 $1,423.96 $1,558.14 $2,034.84 |
$1,656.22 $1,782.88 $1,917.06 $2,393.76 |
Toc - Plan #92 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3200 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$426.27 $483.81 $544.76 $761.30 $1,156.88 |
$752.36 $809.90 $870.85 $1,087.39 |
$1,078.45 $1,135.99 $1,196.94 $1,413.48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$852.54 $967.62 $1,089.52 $1,522.60 $2,313.76 |
$1,178.63 $1,293.71 $1,415.61 $1,848.69 |
$1,504.72 $1,619.80 $1,741.70 $2,174.78 |
Toc - Plan #93 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Bronze $6000 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$296.03 $335.98 $378.32 $528.70 $803.40 |
$522.49 $562.44 $604.78 $755.16 |
$748.95 $788.90 $831.24 $981.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$592.06 $671.96 $756.64 $1,057.40 $1,606.80 |
$818.52 $898.42 $983.10 $1,283.86 |
$1,044.98 $1,124.88 $1,209.56 $1,510.32 |
Toc - Plan #94 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze Standard $7500 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$291.94 $331.34 $373.09 $521.39 $792.30 |
$515.27 $554.67 $596.42 $744.72 |
$738.60 $778.00 $819.75 $968.05 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$583.88 $662.68 $746.18 $1,042.78 $1,584.60 |
$807.21 $886.01 $969.51 $1,266.11 |
$1,030.54 $1,109.34 $1,192.84 $1,489.44 |
Toc - Plan #95 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver Standard $5900 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$359.71 $408.26 $459.70 $642.42 $976.23 |
$634.88 $683.43 $734.87 $917.59 |
$910.05 $958.60 $1,010.04 $1,192.76 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$719.42 $816.52 $919.40 $1,284.84 $1,952.46 |
$994.59 $1,091.69 $1,194.57 $1,560.01 |
$1,269.76 $1,366.86 $1,469.74 $1,835.18 |
Toc - Plan #96 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold Standard $1500 - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$422.20 $479.19 $539.56 $754.03 $1,145.83 |
$745.18 $802.17 $862.54 $1,077.01 |
$1,068.16 $1,125.15 $1,185.52 $1,399.99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$844.40 $958.38 $1,079.12 $1,508.06 $2,291.66 |
$1,167.38 $1,281.36 $1,402.10 $1,831.04 |
$1,490.36 $1,604.34 $1,725.08 $2,154.02 |
Toc - Plan #97 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5650 Ded / $6000 Rx Ded - Envision Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$343.17 $389.48 $438.55 $612.88 $931.32 |
$605.68 $651.99 $701.06 $875.39 |
$868.19 $914.50 $963.57 $1,137.90 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$686.34 $778.96 $877.10 $1,225.76 $1,862.64 |
$948.85 $1,041.47 $1,139.61 $1,488.27 |
$1,211.36 $1,303.98 $1,402.12 $1,750.78 |
Toc - Plan #98 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $1800 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$447.66 $508.09 $572.10 $799.51 $1,214.93 |
$790.12 $850.55 $914.56 $1,141.97 |
$1,132.58 $1,193.01 $1,257.02 $1,484.43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$895.32 $1,016.18 $1,144.20 $1,599.02 $2,429.86 |
$1,237.78 $1,358.64 $1,486.66 $1,941.48 |
$1,580.24 $1,701.10 $1,829.12 $2,283.94 |
Toc - Plan #99 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Gold $3000 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$413.35 $469.14 $528.25 $738.22 $1,121.80 |
$729.55 $785.34 $844.45 $1,054.42 |
$1,045.75 $1,101.54 $1,160.65 $1,370.62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$826.70 $938.28 $1,056.50 $1,476.44 $2,243.60 |
$1,142.90 $1,254.48 $1,372.70 $1,792.64 |
$1,459.10 $1,570.68 $1,688.90 $2,108.84 |
Toc - Plan #100 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $4000 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$407.85 $462.90 $521.22 $728.40 $1,106.88 |
$719.85 $774.90 $833.22 $1,040.40 |
$1,031.85 $1,086.90 $1,145.22 $1,352.40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$815.70 $925.80 $1,042.44 $1,456.80 $2,213.76 |
$1,127.70 $1,237.80 $1,354.44 $1,768.80 |
$1,439.70 $1,549.80 $1,666.44 $2,080.80 |
Toc - Plan #101 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5650 Ded / $6000 Rx Ded - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$345.94 $392.63 $442.10 $617.84 $938.86 |
$610.58 $657.27 $706.74 $882.48 |
$875.22 $921.91 $971.38 $1,147.12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$691.88 $785.26 $884.20 $1,235.68 $1,877.72 |
$956.52 $1,049.90 $1,148.84 $1,500.32 |
$1,221.16 $1,314.54 $1,413.48 $1,764.96 |
Toc - Plan #102 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC Silver $5000 Ded / $5000 Rx Ded - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$346.07 $392.78 $442.26 $618.06 $939.20 |
$610.80 $657.51 $706.99 $882.79 |
$875.53 $922.24 $971.72 $1,147.52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$692.14 $785.56 $884.52 $1,236.12 $1,878.40 |
$956.87 $1,050.29 $1,149.25 $1,500.85 |
$1,221.60 $1,315.02 $1,413.98 $1,765.58 |
Toc - Plan #103 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Bronze $9450 ($35 PCP Copay) - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$291.11 $330.40 $372.02 $519.90 $790.04 |
$513.80 $553.09 $594.71 $742.59 |
$736.49 $775.78 $817.40 $965.28 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$582.22 $660.80 $744.04 $1,039.80 $1,580.08 |
$804.91 $883.49 $966.73 $1,262.49 |
$1,027.60 $1,106.18 $1,189.42 $1,485.18 |
Toc - Plan #104 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Bronze
(EPO) CGHC Bronze $6000 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$298.79 $339.12 $381.84 $533.62 $810.89 |
$527.36 $567.69 $610.41 $762.19 |
$755.93 $796.26 $838.98 $990.76 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$597.58 $678.24 $763.68 $1,067.24 $1,621.78 |
$826.15 $906.81 $992.25 $1,295.81 |
$1,054.72 $1,135.38 $1,220.82 $1,524.38 |
Toc - Plan #105 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC HSA Bronze $7500 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$303.30 $344.24 $387.61 $541.68 $823.14 |
$535.32 $576.26 $619.63 $773.70 |
$767.34 $808.28 $851.65 $1,005.72 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$606.60 $688.48 $775.22 $1,083.36 $1,646.28 |
$838.62 $920.50 $1,007.24 $1,315.38 |
$1,070.64 $1,152.52 $1,239.26 $1,547.40 |
Toc - Plan #106 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) CGHC HSA Silver $3200 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$429.10 $487.02 $548.37 $766.35 $1,164.55 |
$757.35 $815.27 $876.62 $1,094.60 |
$1,085.60 $1,143.52 $1,204.87 $1,422.85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$858.20 $974.04 $1,096.74 $1,532.70 $2,329.10 |
$1,186.45 $1,302.29 $1,424.99 $1,860.95 |
$1,514.70 $1,630.54 $1,753.24 $2,189.20 |
Toc - Plan #107 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC HSA Gold $3200 - Envision Network (Vision Exam) |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$472.04 $535.75 $603.25 $843.04 $1,281.08 |
$833.14 $896.85 $964.35 $1,204.14 |
$1,194.24 $1,257.95 $1,325.45 $1,565.24 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$944.08 $1,071.50 $1,206.50 $1,686.08 $2,562.16 |
$1,305.18 $1,432.60 $1,567.60 $2,047.18 |
$1,666.28 $1,793.70 $1,928.70 $2,408.28 |
Toc - Plan #108 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) CGHC Copay Bronze $0 Ded / $2250 Rx Ded - Envision Network (Vision Exam) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$304.51 $345.61 $389.15 $543.84 $826.41 |
$537.45 $578.55 $622.09 $776.78 |
$770.39 $811.49 $855.03 $1,009.72 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$609.02 $691.22 $778.30 $1,087.68 $1,652.82 |
$841.96 $924.16 $1,011.24 $1,320.62 |
$1,074.90 $1,157.10 $1,244.18 $1,553.56 |
Toc - Plan #109 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) CGHC Copay Gold $0 Ded - Envision Network (Vision Exam) |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$474.19 $538.20 $606.00 $846.89 $1,286.93 |
$836.94 $900.95 $968.75 $1,209.64 |
$1,199.69 $1,263.70 $1,331.50 $1,572.39 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$948.38 $1,076.40 $1,212.00 $1,693.78 $2,573.86 |
$1,311.13 $1,439.15 $1,574.75 $2,056.53 |
$1,673.88 $1,801.90 $1,937.50 $2,419.28 |
‡Source: HealthCare.gov has released sample rates for all counties in the 36 states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Outagamie County here.
Outagamie County is in “Rating Area 11” of Wisconsin.
Currently, there are 109 plans offered in Rating Area 11.