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Providers for Zip Code 30028

Obamacare 2016 Marketplace Rates For Cumming, GA

Thursday, April 18th, 2024


The health insurance rates listed below are for calendar year 2016.

2016 Rates and Providers

(click here for 2014)

(click here for 2015)

This page gives you an overview of the rates for individual and family health insurance plans available from HealthCare.gov, the marketplace for Cumming, GA.

Obamacare Providers, Plans and 2016 Rates for Forsyth County

Forsyth County is in “Rating Area 3” of Georgia.

Currently, there are 6 providers offering 73 plans to Rating Area 3.

Below, you’ll find a summary of plans and rates for each of these providers. This chart is designed to give you a preview of your health insurance options. For detailed information on available subsidies to make your coverage affordable, you must complete an application at HealthCare.gov or contact the provider directly.

The table below shows premiums for the following scenarios for:

  • Individual
  • Couple
  • Couple with 1 2 or 3 children
  • Individual with 1 2 or 3 children
  • A child alone

Each scenario is covered for age

  • Age 21, 30, 40, 50
  • Age 60 (Individual and Couple only)

For each plan, there are links that go to the insurance provider's website in a new window. You can find links to:

  • a summary of plan benefits and costs,
  • a plan brochure, and
  • a "Provider Directory" -- where you can find out which doctors and hospitals in the Cumming, GA area accept this insurance coverage as within the plan's "network".
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UnitedHealthcare of Georgia, Inc.

Local: 1-877-604-0569 | Toll Free: 1-877-604-0569

Plan: (HMO) Gold Compass 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-604-0569 - Provider Directory for This Plan: (UnitedHealthcare of Georgia, Inc.)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$329.21
$373.64
$420.72
$587.95
$893.45
$658.42
$747.28
$841.44
$1175.90
$1786.90
$867.46
$956.32
$1050.48
$1384.94
$1076.50
$1165.36
$1259.52
$1593.98
$1285.54
$1374.40
$1468.56
$1803.02
$538.25
$582.68
$629.76
$796.99
$747.29
$791.72
$838.80
$1006.03
$956.33
$1000.76
$1047.84
$1215.07
$209.04

Plan: (HMO) Gold Compass HSA 1600

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-604-0569 - Provider Directory for This Plan: (UnitedHealthcare of Georgia, Inc.)

Deductible: Individual: $1,600 : Family: $4,800
Out of Pocket Maximum per year: Individual: $3,500 : Family: $6,850

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$307.35
$348.83
$392.77
$548.90
$834.11
$614.70
$697.66
$785.54
$1097.80
$1668.22
$809.86
$892.82
$980.70
$1292.96
$1005.02
$1087.98
$1175.86
$1488.12
$1200.18
$1283.14
$1371.02
$1683.28
$502.51
$543.99
$587.93
$744.06
$697.67
$739.15
$783.09
$939.22
$892.83
$934.31
$978.25
$1134.38
$195.16

Plan: (HMO) Silver Compass 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-604-0569 - Provider Directory for This Plan: (UnitedHealthcare of Georgia, Inc.)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$283.83
$322.14
$362.72
$506.90
$770.29
$567.66
$644.28
$725.44
$1013.80
$1540.58
$747.89
$824.51
$905.67
$1194.03
$928.12
$1004.74
$1085.90
$1374.26
$1108.35
$1184.97
$1266.13
$1554.49
$464.06
$502.37
$542.95
$687.13
$644.29
$682.60
$723.18
$867.36
$824.52
$862.83
$903.41
$1047.59
$180.23

Plan: (HMO) Silver Compass HSA 3600

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-604-0569 - Provider Directory for This Plan: (UnitedHealthcare of Georgia, Inc.)

Deductible: Individual: $3,600 : Family: $7,200
Out of Pocket Maximum per year: Individual: $3,600 : Family: $7,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$283.83
$322.14
$362.72
$506.90
$770.29
$567.66
$644.28
$725.44
$1013.80
$1540.58
$747.89
$824.51
$905.67
$1194.03
$928.12
$1004.74
$1085.90
$1374.26
$1108.35
$1184.97
$1266.13
$1554.49
$464.06
$502.37
$542.95
$687.13
$644.29
$682.60
$723.18
$867.36
$824.52
$862.83
$903.41
$1047.59
$180.23

Plan: (HMO) Silver Compass 5000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-604-0569 - Provider Directory for This Plan: (UnitedHealthcare of Georgia, Inc.)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$273.52
$310.43
$349.54
$488.48
$742.30
$547.04
$620.86
$699.08
$976.96
$1484.60
$720.72
$794.54
$872.76
$1150.64
$894.40
$968.22
$1046.44
$1324.32
$1068.08
$1141.90
$1220.12
$1498.00
$447.20
$484.11
$523.22
$662.16
$620.88
$657.79
$696.90
$835.84
$794.56
$831.47
$870.58
$1009.52
$173.68

Plan: (HMO) Bronze Compass 4200

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-604-0569 - Provider Directory for This Plan: (UnitedHealthcare of Georgia, Inc.)

Deductible: Individual: $4,200 : Family: $8,400
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$240.93
$273.44
$307.89
$430.28
$653.85
$481.86
$546.88
$615.78
$860.56
$1307.70
$634.84
$699.86
$768.76
$1013.54
$787.82
$852.84
$921.74
$1166.52
$940.80
$1005.82
$1074.72
$1319.50
$393.91
$426.42
$460.87
$583.26
$546.89
$579.40
$613.85
$736.24
$699.87
$732.38
$766.83
$889.22
$152.98

Plan: (HMO) Bronze Compass 6400

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-604-0569 - Provider Directory for This Plan: (UnitedHealthcare of Georgia, Inc.)

Deductible: Individual: $6,400 : Family: $12,800
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$247.53
$280.93
$316.33
$442.07
$671.76
$495.06
$561.86
$632.66
$884.14
$1343.52
$652.23
$719.03
$789.83
$1041.31
$809.40
$876.20
$947.00
$1198.48
$966.57
$1033.37
$1104.17
$1355.65
$404.70
$438.10
$473.50
$599.24
$561.87
$595.27
$630.67
$756.41
$719.04
$752.44
$787.84
$913.58
$157.17

Plan: (HMO) Bronze Compass HSA 5200

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-604-0569 - Provider Directory for This Plan: (UnitedHealthcare of Georgia, Inc.)

Deductible: Individual: $5,200 : Family: $10,400
Out of Pocket Maximum per year: Individual: $6,500 : Family: $12,900

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$240.93
$273.44
$307.89
$430.28
$653.85
$481.86
$546.88
$615.78
$860.56
$1307.70
$634.84
$699.86
$768.76
$1013.54
$787.82
$852.84
$921.74
$1166.52
$940.80
$1005.82
$1074.72
$1319.50
$393.91
$426.42
$460.87
$583.26
$546.89
$579.40
$613.85
$736.24
$699.87
$732.38
$766.83
$889.22
$152.98

Plan: (HMO) Catastrophic Compass 6850

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-604-0569 - Provider Directory for This Plan: (UnitedHealthcare of Georgia, Inc.)

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$198.44
$225.21
$253.59
$354.39
$538.53
$396.88
$450.42
$507.18
$708.78
$1077.06
$522.88
$576.42
$633.18
$834.78
$648.88
$702.42
$759.18
$960.78
$774.88
$828.42
$885.18
$1086.78
$324.44
$351.21
$379.59
$480.39
$450.44
$477.21
$505.59
$606.39
$576.44
$603.21
$631.59
$732.39
$126.00
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Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.

Local: 1-855-738-6652 | Toll Free: 1-855-738-6652

Plan: (HMO) BCBSHP Catastrophic Pathway X HMO 6850 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$147.67
$167.61
$188.72
$263.74
$400.78
$295.34
$335.22
$377.44
$527.48
$801.56
$389.11
$428.99
$471.21
$621.25
$482.88
$522.76
$564.98
$715.02
$576.65
$616.53
$658.75
$808.79
$241.44
$261.38
$282.49
$357.51
$335.21
$355.15
$376.26
$451.28
$428.98
$448.92
$470.03
$545.05
$93.77

Plan: (HMO) BCBSHP Bronze Pathway X HMO 0 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $6,400 : Family: $12,800
Out of Pocket Maximum per year: Individual: $6,400 : Family: $12,800

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$223.39
$253.55
$285.49
$398.97
$606.28
$446.78
$507.10
$570.98
$797.94
$1212.56
$588.63
$648.95
$712.83
$939.79
$730.48
$790.80
$854.68
$1081.64
$872.33
$932.65
$996.53
$1223.49
$365.24
$395.40
$427.34
$540.82
$507.09
$537.25
$569.19
$682.67
$648.94
$679.10
$711.04
$824.52
$141.85

Plan: (HMO) BCBSHP Bronze Pathway X HMO 20 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $4,700 : Family: $9,400
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$220.22
$249.95
$281.44
$393.31
$597.68
$440.44
$499.90
$562.88
$786.62
$1195.36
$580.28
$639.74
$702.72
$926.46
$720.12
$779.58
$842.56
$1066.30
$859.96
$919.42
$982.40
$1206.14
$360.06
$389.79
$421.28
$533.15
$499.90
$529.63
$561.12
$672.99
$639.74
$669.47
$700.96
$812.83
$139.84

Plan: (HMO) BCBSHP Bronze Pathway X HMO 5200 20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $5,200 : Family: $10,400
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$217.79
$247.19
$278.34
$388.97
$591.08
$435.58
$494.38
$556.68
$777.94
$1182.16
$573.88
$632.68
$694.98
$916.24
$712.18
$770.98
$833.28
$1054.54
$850.48
$909.28
$971.58
$1192.84
$356.09
$385.49
$416.64
$527.27
$494.39
$523.79
$554.94
$665.57
$632.69
$662.09
$693.24
$803.87
$138.30

Plan: (HMO) BCBSHP Silver Pathway X HMO 3500 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$268.32
$304.54
$342.91
$479.22
$728.22
$536.64
$609.08
$685.82
$958.44
$1456.44
$707.02
$779.46
$856.20
$1128.82
$877.40
$949.84
$1026.58
$1299.20
$1047.78
$1120.22
$1196.96
$1469.58
$438.70
$474.92
$513.29
$649.60
$609.08
$645.30
$683.67
$819.98
$779.46
$815.68
$854.05
$990.36
$170.38

Plan: (HMO) BCBSHP Silver Pathway X HMO 10 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $3,200 : Family: $6,400
Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$248.54
$282.09
$317.63
$443.89
$674.54
$497.08
$564.18
$635.26
$887.78
$1349.08
$654.90
$722.00
$793.08
$1045.60
$812.72
$879.82
$950.90
$1203.42
$970.54
$1037.64
$1108.72
$1361.24
$406.36
$439.91
$475.45
$601.71
$564.18
$597.73
$633.27
$759.53
$722.00
$755.55
$791.09
$917.35
$157.82

Plan: (HMO) BCBSHP Silver Pathway X HMO 3000 10

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$248.32
$281.84
$317.35
$443.50
$673.94
$496.64
$563.68
$634.70
$887.00
$1347.88
$654.32
$721.36
$792.38
$1044.68
$812.00
$879.04
$950.06
$1202.36
$969.68
$1036.72
$1107.74
$1360.04
$406.00
$439.52
$475.03
$601.18
$563.68
$597.20
$632.71
$758.86
$721.36
$754.88
$790.39
$916.54
$157.68

Plan: (HMO) BCBSHP Bronze Pathway X HMO 30 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$216.42
$245.64
$276.58
$386.53
$587.36
$432.84
$491.28
$553.16
$773.06
$1174.72
$570.27
$628.71
$690.59
$910.49
$707.70
$766.14
$828.02
$1047.92
$845.13
$903.57
$965.45
$1185.35
$353.85
$383.07
$414.01
$523.96
$491.28
$520.50
$551.44
$661.39
$628.71
$657.93
$688.87
$798.82
$137.43

Plan: (HMO) BCBSHP Bronze Pathway X HMO 5500 40

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$209.33
$237.59
$267.52
$373.86
$568.12
$418.66
$475.18
$535.04
$747.72
$1136.24
$551.58
$608.10
$667.96
$880.64
$684.50
$741.02
$800.88
$1013.56
$817.42
$873.94
$933.80
$1146.48
$342.25
$370.51
$400.44
$506.78
$475.17
$503.43
$533.36
$639.70
$608.09
$636.35
$666.28
$772.62
$132.92

Plan: (HMO) BCBSHP Silver Pathway X HMO 2000 25

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$247.55
$280.97
$316.37
$442.12
$671.85
$495.10
$561.94
$632.74
$884.24
$1343.70
$652.29
$719.13
$789.93
$1041.43
$809.48
$876.32
$947.12
$1198.62
$966.67
$1033.51
$1104.31
$1355.81
$404.74
$438.16
$473.56
$599.31
$561.93
$595.35
$630.75
$756.50
$719.12
$752.54
$787.94
$913.69
$157.19

Plan: (HMO) BCBSHP Silver Pathway X HMO 3500 25

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $5,200 : Family: $10,400

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$238.34
$270.52
$304.60
$425.68
$646.85
$476.68
$541.04
$609.20
$851.36
$1293.70
$628.03
$692.39
$760.55
$1002.71
$779.38
$843.74
$911.90
$1154.06
$930.73
$995.09
$1063.25
$1305.41
$389.69
$421.87
$455.95
$577.03
$541.04
$573.22
$607.30
$728.38
$692.39
$724.57
$758.65
$879.73
$151.35

Plan: (HMO) Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess a Multi State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $6,300 : Family: $12,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$255.94
$290.49
$327.09
$457.11
$694.62
$511.88
$580.98
$654.18
$914.22
$1389.24
$674.40
$743.50
$816.70
$1076.74
$836.92
$906.02
$979.22
$1239.26
$999.44
$1068.54
$1141.74
$1401.78
$418.46
$453.01
$489.61
$619.63
$580.98
$615.53
$652.13
$782.15
$743.50
$778.05
$814.65
$944.67
$162.52

Plan: (HMO) Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess a Multi State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-738-6652 - Provider Directory for This Plan: (Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.)

Deductible: Individual: $1,150 : Family: $2,300
Out of Pocket Maximum per year: Individual: $4,900 : Family: $9,800

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$356.59
$404.73
$455.72
$636.87
$967.79
$713.18
$809.46
$911.44
$1273.74
$1935.58
$939.61
$1035.89
$1137.87
$1500.17
$1166.04
$1262.32
$1364.30
$1726.60
$1392.47
$1488.75
$1590.73
$1953.03
$583.02
$631.16
$682.15
$863.30
$809.45
$857.59
$908.58
$1089.73
$1035.88
$1084.02
$1135.01
$1316.16
$226.43
ADVERTISEMENT

Ambetter of Peach State Inc.

Local: 1-877-687-1180 | Toll Free:

TTY: 1-877-941-9231

Plan: (HMO) Ambetter Secure Care 1 (2016) with 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$258.17
$293.01
$329.93
$461.07
$700.64
$516.34
$586.02
$659.86
$922.14
$1401.28
$680.27
$749.95
$823.79
$1086.07
$844.20
$913.88
$987.72
$1250.00
$1008.13
$1077.81
$1151.65
$1413.93
$422.10
$456.94
$493.86
$625.00
$586.03
$620.87
$657.79
$788.93
$749.96
$784.80
$821.72
$952.86
$163.93

Plan: (HMO) Ambetter Balanced Care 1 (2016)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$198.91
$225.75
$254.19
$355.23
$539.81
$397.82
$451.50
$508.38
$710.46
$1079.62
$524.12
$577.80
$634.68
$836.76
$650.42
$704.10
$760.98
$963.06
$776.72
$830.40
$887.28
$1089.36
$325.21
$352.05
$380.49
$481.53
$451.51
$478.35
$506.79
$607.83
$577.81
$604.65
$633.09
$734.13
$126.30

Plan: (HMO) Ambetter Balanced Care 2 (2016)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$195.58
$221.98
$249.94
$349.30
$530.79
$391.16
$443.96
$499.88
$698.60
$1061.58
$515.35
$568.15
$624.07
$822.79
$639.54
$692.34
$748.26
$946.98
$763.73
$816.53
$872.45
$1071.17
$319.77
$346.17
$374.13
$473.49
$443.96
$470.36
$498.32
$597.68
$568.15
$594.55
$622.51
$721.87
$124.19

Plan: (HMO) Ambetter Balanced Care 10 (2016)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$205.17
$232.85
$262.19
$366.41
$556.80
$410.34
$465.70
$524.38
$732.82
$1113.60
$540.61
$595.97
$654.65
$863.09
$670.88
$726.24
$784.92
$993.36
$801.15
$856.51
$915.19
$1123.63
$335.44
$363.12
$392.46
$496.68
$465.71
$493.39
$522.73
$626.95
$595.98
$623.66
$653.00
$757.22
$130.27

Plan: (HMO) Ambetter Essential Care 1 (2016)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $6,800 : Family: $13,600
Out of Pocket Maximum per year: Individual: $6,800 : Family: $13,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$173.09
$196.45
$221.20
$309.13
$469.75
$346.18
$392.90
$442.40
$618.26
$939.50
$456.09
$502.81
$552.31
$728.17
$566.00
$612.72
$662.22
$838.08
$675.91
$722.63
$772.13
$947.99
$283.00
$306.36
$331.11
$419.04
$392.91
$416.27
$441.02
$528.95
$502.82
$526.18
$550.93
$638.86
$109.91

Plan: (HMO) Ambetter Essential Care 5 (2016) with 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $6,800 : Family: $13,600
Out of Pocket Maximum per year: Individual: $6,800 : Family: $13,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$179.35
$203.55
$229.20
$320.30
$486.73
$358.70
$407.10
$458.40
$640.60
$973.46
$472.58
$520.98
$572.28
$754.48
$586.46
$634.86
$686.16
$868.36
$700.34
$748.74
$800.04
$982.24
$293.23
$317.43
$343.08
$434.18
$407.11
$431.31
$456.96
$548.06
$520.99
$545.19
$570.84
$661.94
$113.88

Plan: (HMO) Ambetter Balanced Care 1 (2016) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$203.85
$231.36
$260.50
$364.05
$553.21
$407.70
$462.72
$521.00
$728.10
$1106.42
$537.14
$592.16
$650.44
$857.54
$666.58
$721.60
$779.88
$986.98
$796.02
$851.04
$909.32
$1116.42
$333.29
$360.80
$389.94
$493.49
$462.73
$490.24
$519.38
$622.93
$592.17
$619.68
$648.82
$752.37
$129.44

Plan: (HMO) Ambetter Balanced Care 2 (2016) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$200.44
$227.49
$256.15
$357.97
$543.97
$400.88
$454.98
$512.30
$715.94
$1087.94
$528.15
$582.25
$639.57
$843.21
$655.42
$709.52
$766.84
$970.48
$782.69
$836.79
$894.11
$1097.75
$327.71
$354.76
$383.42
$485.24
$454.98
$482.03
$510.69
$612.51
$582.25
$609.30
$637.96
$739.78
$127.27

Plan: (HMO) Ambetter Balanced Care 10 (2016) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$210.26
$238.64
$268.70
$375.51
$570.62
$420.52
$477.28
$537.40
$751.02
$1141.24
$554.03
$610.79
$670.91
$884.53
$687.54
$744.30
$804.42
$1018.04
$821.05
$877.81
$937.93
$1151.55
$343.77
$372.15
$402.21
$509.02
$477.28
$505.66
$535.72
$642.53
$610.79
$639.17
$669.23
$776.04
$133.51

Plan: (HMO) Ambetter Essential Care 1 (2016) + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $6,800 : Family: $13,600
Out of Pocket Maximum per year: Individual: $6,800 : Family: $13,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$177.39
$201.33
$226.69
$316.80
$481.41
$354.78
$402.66
$453.38
$633.60
$962.82
$467.42
$515.30
$566.02
$746.24
$580.06
$627.94
$678.66
$858.88
$692.70
$740.58
$791.30
$971.52
$290.03
$313.97
$339.33
$429.44
$402.67
$426.61
$451.97
$542.08
$515.31
$539.25
$564.61
$654.72
$112.64

Plan: (HMO) Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $6,800 : Family: $13,600
Out of Pocket Maximum per year: Individual: $6,800 : Family: $13,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$183.80
$208.61
$234.89
$328.26
$498.82
$367.60
$417.22
$469.78
$656.52
$997.64
$484.31
$533.93
$586.49
$773.23
$601.02
$650.64
$703.20
$889.94
$717.73
$767.35
$819.91
$1006.65
$300.51
$325.32
$351.60
$444.97
$417.22
$442.03
$468.31
$561.68
$533.93
$558.74
$585.02
$678.39
$116.71

Plan: (HMO) Ambetter Balanced Care 1 (2016) + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$216.65
$245.88
$276.86
$386.91
$587.95
$433.30
$491.76
$553.72
$773.82
$1175.90
$570.86
$629.32
$691.28
$911.38
$708.42
$766.88
$828.84
$1048.94
$845.98
$904.44
$966.40
$1186.50
$354.21
$383.44
$414.42
$524.47
$491.77
$521.00
$551.98
$662.03
$629.33
$658.56
$689.54
$799.59
$137.56

Plan: (HMO) Ambetter Balanced Care 2 (2016) + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$213.02
$241.77
$272.23
$380.44
$578.12
$426.04
$483.54
$544.46
$760.88
$1156.24
$561.30
$618.80
$679.72
$896.14
$696.56
$754.06
$814.98
$1031.40
$831.82
$889.32
$950.24
$1166.66
$348.28
$377.03
$407.49
$515.70
$483.54
$512.29
$542.75
$650.96
$618.80
$647.55
$678.01
$786.22
$135.26

Plan: (HMO) Ambetter Balanced Care 10 (2016) + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$223.46
$253.62
$285.57
$399.09
$606.45
$446.92
$507.24
$571.14
$798.18
$1212.90
$588.81
$649.13
$713.03
$940.07
$730.70
$791.02
$854.92
$1081.96
$872.59
$932.91
$996.81
$1223.85
$365.35
$395.51
$427.46
$540.98
$507.24
$537.40
$569.35
$682.87
$649.13
$679.29
$711.24
$824.76
$141.89

Plan: (HMO) Ambetter Essential Care 1 (2016) + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $6,800 : Family: $13,600
Out of Pocket Maximum per year: Individual: $6,800 : Family: $13,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$188.53
$213.97
$240.93
$336.69
$511.64
$377.06
$427.94
$481.86
$673.38
$1023.28
$496.77
$547.65
$601.57
$793.09
$616.48
$667.36
$721.28
$912.80
$736.19
$787.07
$840.99
$1032.51
$308.24
$333.68
$360.64
$456.40
$427.95
$453.39
$480.35
$576.11
$547.66
$573.10
$600.06
$695.82
$119.71

Plan: (HMO) Ambetter Essential Care 5 (2016) with 3 Free PCP Visits + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Ambetter of Peach State Inc.)

Deductible: Individual: $6,800 : Family: $13,600
Out of Pocket Maximum per year: Individual: $6,800 : Family: $13,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$195.34
$221.70
$249.64
$348.87
$530.14
$390.68
$443.40
$499.28
$697.74
$1060.28
$514.72
$567.44
$623.32
$821.78
$638.76
$691.48
$747.36
$945.82
$762.80
$815.52
$871.40
$1069.86
$319.38
$345.74
$373.68
$472.91
$443.42
$469.78
$497.72
$596.95
$567.46
$593.82
$621.76
$720.99
$124.04
ADVERTISEMENT

Aetna Health Inc. (a GA corp.)

Local: 1-877-336-3915 | Toll Free: 1-877-336-3915

Plan: (HMO) Coventry Gold $10 Copay HMO Atlanta

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-336-3915 - Provider Directory for This Plan: (Aetna Health Inc. (a GA corp.))

Deductible: Individual: $1,400 : Family: $2,800
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$292.82
$332.35
$374.22
$522.97
$794.71
$585.64
$664.70
$748.44
$1045.94
$1589.42
$771.58
$850.64
$934.38
$1231.88
$957.52
$1036.58
$1120.32
$1417.82
$1143.46
$1222.52
$1306.26
$1603.76
$478.76
$518.29
$560.16
$708.91
$664.70
$704.23
$746.10
$894.85
$850.64
$890.17
$932.04
$1080.79
$185.94

Plan: (HMO) Coventry Silver $10 Copay HMO Atlanta

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-336-3915 - Provider Directory for This Plan: (Aetna Health Inc. (a GA corp.))

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$234.23
$265.85
$299.34
$418.33
$635.70
$468.46
$531.70
$598.68
$836.66
$1271.40
$617.20
$680.44
$747.42
$985.40
$765.94
$829.18
$896.16
$1134.14
$914.68
$977.92
$1044.90
$1282.88
$382.97
$414.59
$448.08
$567.07
$531.71
$563.33
$596.82
$715.81
$680.45
$712.07
$745.56
$864.55
$148.74

Plan: (HMO) Coventry Silver $10 Copay 2750 HMO Atlanta

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-336-3915 - Provider Directory for This Plan: (Aetna Health Inc. (a GA corp.))

Deductible: Individual: $2,750 : Family: $5,500
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$221.78
$251.72
$283.43
$396.10
$601.91
$443.56
$503.44
$566.86
$792.20
$1203.82
$584.39
$644.27
$707.69
$933.03
$725.22
$785.10
$848.52
$1073.86
$866.05
$925.93
$989.35
$1214.69
$362.61
$392.55
$424.26
$536.93
$503.44
$533.38
$565.09
$677.76
$644.27
$674.21
$705.92
$818.59
$140.83

Plan: (HMO) Coventry Bronze $15 Copay HMO Atlanta

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-336-3915 - Provider Directory for This Plan: (Aetna Health Inc. (a GA corp.))

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$196.14
$222.62
$250.67
$350.31
$532.34
$392.28
$445.24
$501.34
$700.62
$1064.68
$516.83
$569.79
$625.89
$825.17
$641.38
$694.34
$750.44
$949.72
$765.93
$818.89
$874.99
$1074.27
$320.69
$347.17
$375.22
$474.86
$445.24
$471.72
$499.77
$599.41
$569.79
$596.27
$624.32
$723.96
$124.55

Plan: (HMO) Coventry Bronze Deductible Only HSA Eligible HMO Atlanta

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-336-3915 - Provider Directory for This Plan: (Aetna Health Inc. (a GA corp.))

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$190.52
$216.24
$243.48
$340.27
$517.07
$381.04
$432.48
$486.96
$680.54
$1034.14
$502.02
$553.46
$607.94
$801.52
$623.00
$674.44
$728.92
$922.50
$743.98
$795.42
$849.90
$1043.48
$311.50
$337.22
$364.46
$461.25
$432.48
$458.20
$485.44
$582.23
$553.46
$579.18
$606.42
$703.21
$120.98

Plan: (HMO) Coventry Catastrophic HMO Atlanta

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-336-3915 - Provider Directory for This Plan: (Aetna Health Inc. (a GA corp.))

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$151.90
$172.41
$194.13
$271.30
$412.26
$303.80
$344.82
$388.26
$542.60
$824.52
$400.26
$441.28
$484.72
$639.06
$496.72
$537.74
$581.18
$735.52
$593.18
$634.20
$677.64
$831.98
$248.36
$268.87
$290.59
$367.76
$344.82
$365.33
$387.05
$464.22
$441.28
$461.79
$483.51
$560.68
$96.46
ADVERTISEMENT

Alliant Health Plans

Local: 1-800-811-4793 | Toll Free: 1-800-811-4793

Plan: (PPO) SoloCare - 0040002

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$407.31
$462.30
$520.54
$727.46
$1105.44
$814.62
$924.60
$1041.08
$1454.92
$2210.88
$1073.26
$1183.24
$1299.72
$1713.56
$1331.90
$1441.88
$1558.36
$1972.20
$1590.54
$1700.52
$1817.00
$2230.84
$665.95
$720.94
$779.18
$986.10
$924.59
$979.58
$1037.82
$1244.74
$1183.23
$1238.22
$1296.46
$1503.38
$258.64

Plan: (PPO) SoloCare - 0040003

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$396.41
$449.93
$506.61
$707.99
$1075.86
$792.82
$899.86
$1013.22
$1415.98
$2151.72
$1044.54
$1151.58
$1264.94
$1667.70
$1296.26
$1403.30
$1516.66
$1919.42
$1547.98
$1655.02
$1768.38
$2171.14
$648.13
$701.65
$758.33
$959.71
$899.85
$953.37
$1010.05
$1211.43
$1151.57
$1205.09
$1261.77
$1463.15
$251.72

Plan: (PPO) SoloCare - 0040007

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $1,750 : Family: $3,500
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$309.19
$350.93
$395.14
$552.21
$839.14
$618.38
$701.86
$790.28
$1104.42
$1678.28
$814.71
$898.19
$986.61
$1300.75
$1011.04
$1094.52
$1182.94
$1497.08
$1207.37
$1290.85
$1379.27
$1693.41
$505.52
$547.26
$591.47
$748.54
$701.85
$743.59
$787.80
$944.87
$898.18
$939.92
$984.13
$1141.20
$196.33

Plan: (PPO) SoloCare - 0040010

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$309.01
$350.72
$394.91
$551.89
$838.65
$618.02
$701.44
$789.82
$1103.78
$1677.30
$814.24
$897.66
$986.04
$1300.00
$1010.46
$1093.88
$1182.26
$1496.22
$1206.68
$1290.10
$1378.48
$1692.44
$505.23
$546.94
$591.13
$748.11
$701.45
$743.16
$787.35
$944.33
$897.67
$939.38
$983.57
$1140.55
$196.22

Plan: (PPO) SoloCare - 0040015

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$309.28
$351.04
$395.26
$552.38
$839.39
$618.56
$702.08
$790.52
$1104.76
$1678.78
$814.95
$898.47
$986.91
$1301.15
$1011.34
$1094.86
$1183.30
$1497.54
$1207.73
$1291.25
$1379.69
$1693.93
$505.67
$547.43
$591.65
$748.77
$702.06
$743.82
$788.04
$945.16
$898.45
$940.21
$984.43
$1141.55
$196.39

Plan: (PPO) SoloCare - 0040017

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$307.59
$349.11
$393.10
$549.36
$834.80
$615.18
$698.22
$786.20
$1098.72
$1669.60
$810.50
$893.54
$981.52
$1294.04
$1005.82
$1088.86
$1176.84
$1489.36
$1201.14
$1284.18
$1372.16
$1684.68
$502.91
$544.43
$588.42
$744.68
$698.23
$739.75
$783.74
$940.00
$893.55
$935.07
$979.06
$1135.32
$195.32

Plan: (PPO) SoloCare - 0040019

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $6,200 : Family: $12,400
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$252.97
$287.12
$323.30
$451.81
$686.56
$505.94
$574.24
$646.60
$903.62
$1373.12
$666.58
$734.88
$807.24
$1064.26
$827.22
$895.52
$967.88
$1224.90
$987.86
$1056.16
$1128.52
$1385.54
$413.61
$447.76
$483.94
$612.45
$574.25
$608.40
$644.58
$773.09
$734.89
$769.04
$805.22
$933.73
$160.64

Plan: (PPO) SoloCare - 0040021

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-811-4793 - Provider Directory for This Plan: (Alliant Health Plans)

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$298.39
$338.67
$381.34
$532.93
$809.83
$596.78
$677.34
$762.68
$1065.86
$1619.66
$786.26
$866.82
$952.16
$1255.34
$975.74
$1056.30
$1141.64
$1444.82
$1165.22
$1245.78
$1331.12
$1634.30
$487.87
$528.15
$570.82
$722.41
$677.35
$717.63
$760.30
$911.89
$866.83
$907.11
$949.78
$1101.37
$189.48
ADVERTISEMENT

Kaiser Foundation Health Plan of Georgia

Local: 1-800-494-5314 | Toll Free: 1-800-494-5314

Plan: (HMO) KP GA Gold 500/20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$309.65
$351.30
$395.65
$552.59
$839.88
$619.30
$702.60
$791.30
$1105.18
$1679.76
$815.97
$899.27
$987.97
$1301.85
$1012.64
$1095.94
$1184.64
$1498.52
$1209.31
$1292.61
$1381.31
$1695.19
$506.32
$547.97
$592.32
$749.26
$702.99
$744.64
$788.99
$945.93
$899.66
$941.31
$985.66
$1142.60
$196.67

Plan: (HMO) KP GA Gold 1000/20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$301.25
$341.77
$384.91
$537.60
$817.10
$602.50
$683.54
$769.82
$1075.20
$1634.20
$793.83
$874.87
$961.15
$1266.53
$985.16
$1066.20
$1152.48
$1457.86
$1176.49
$1257.53
$1343.81
$1649.19
$492.58
$533.10
$576.24
$728.93
$683.91
$724.43
$767.57
$920.26
$875.24
$915.76
$958.90
$1111.59
$191.33

Plan: (HMO) KP GA Silver 1500/30

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$264.01
$299.52
$337.33
$471.14
$716.08
$528.02
$599.04
$674.66
$942.28
$1432.16
$695.70
$766.72
$842.34
$1109.96
$863.38
$934.40
$1010.02
$1277.64
$1031.06
$1102.08
$1177.70
$1445.32
$431.69
$467.20
$505.01
$638.82
$599.37
$634.88
$672.69
$806.50
$767.05
$802.56
$840.37
$974.18
$167.68

Plan: (HMO) KP GA Silver 2500/30

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$251.60
$285.43
$321.47
$448.99
$682.41
$503.20
$570.86
$642.94
$897.98
$1364.82
$662.99
$730.65
$802.73
$1057.77
$822.78
$890.44
$962.52
$1217.56
$982.57
$1050.23
$1122.31
$1377.35
$411.39
$445.22
$481.26
$608.78
$571.18
$605.01
$641.05
$768.57
$730.97
$764.80
$800.84
$928.36
$159.79

Plan: (HMO) KP GA Silver 2750/20%/HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $2,750 : Family: $5,500
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$250.87
$284.61
$320.53
$447.68
$680.43
$501.74
$569.22
$641.06
$895.36
$1360.86
$661.07
$728.55
$800.39
$1054.69
$820.40
$887.88
$959.72
$1214.02
$979.73
$1047.21
$1119.05
$1373.35
$410.20
$443.94
$479.86
$607.01
$569.53
$603.27
$639.19
$766.34
$728.86
$762.60
$798.52
$925.67
$159.33

Plan: (HMO) KP GA Bronze 4000/20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$211.43
$239.87
$270.15
$377.31
$573.47
$422.86
$479.74
$540.30
$754.62
$1146.94
$557.14
$614.02
$674.58
$888.90
$691.42
$748.30
$808.86
$1023.18
$825.70
$882.58
$943.14
$1157.46
$345.71
$374.15
$404.43
$511.59
$479.99
$508.43
$538.71
$645.87
$614.27
$642.71
$672.99
$780.15
$134.28

Plan: (HMO) KP GA Bronze 6000/40%/HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,450 : Family: $12,900

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$194.63
$220.81
$248.68
$347.33
$527.90
$389.26
$441.62
$497.36
$694.66
$1055.80
$512.87
$565.23
$620.97
$818.27
$636.48
$688.84
$744.58
$941.88
$760.09
$812.45
$868.19
$1065.49
$318.24
$344.42
$372.29
$470.94
$441.85
$468.03
$495.90
$594.55
$565.46
$591.64
$619.51
$718.16
$123.61

Plan: (HMO) KP GA Catastrophic 6850/0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$166.04
$188.37
$212.15
$296.30
$450.35
$332.08
$376.74
$424.30
$592.60
$900.70
$437.53
$482.19
$529.75
$698.05
$542.98
$587.64
$635.20
$803.50
$648.43
$693.09
$740.65
$908.95
$271.49
$293.82
$317.60
$401.75
$376.94
$399.27
$423.05
$507.20
$482.39
$504.72
$528.50
$612.65
$105.45

Plan: (HMO) KP GA Gold 1500/20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$298.70
$338.87
$381.65
$533.05
$810.17
$597.40
$677.74
$763.30
$1066.10
$1620.34
$787.11
$867.45
$953.01
$1255.81
$976.82
$1057.16
$1142.72
$1445.52
$1166.53
$1246.87
$1332.43
$1635.23
$488.41
$528.58
$571.36
$722.76
$678.12
$718.29
$761.07
$912.47
$867.83
$908.00
$950.78
$1102.18
$189.71

Plan: (HMO) KP GA Bronze 5000/50

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-494-5314 - Provider Directory for This Plan: (Kaiser Foundation Health Plan of Georgia)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$205.95
$233.65
$263.15
$367.54
$558.61
$411.90
$467.30
$526.30
$735.08
$1117.22
$542.70
$598.10
$657.10
$865.88
$673.50
$728.90
$787.90
$996.68
$804.30
$859.70
$918.70
$1127.48
$336.75
$364.45
$393.95
$498.34
$467.55
$495.25
$524.75
$629.14
$598.35
$626.05
$655.55
$759.94
$130.80
ADVERTISEMENT

Humana Employers Health Plan of Georgia, Inc.

Local: 1-877-720-4854 | Toll Free: 1-877-720-4854

TTY: 1-800-325-2028

Plan: (HMO) Humana Basic 6850/Atlanta HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Employers Health Plan of Georgia, Inc.)

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$153.75
$174.51
$196.49
$274.60
$417.28
$307.50
$349.02
$392.98
$549.20
$834.56
$405.13
$446.65
$490.61
$646.83
$502.76
$544.28
$588.24
$744.46
$600.39
$641.91
$685.87
$842.09
$251.38
$272.14
$294.12
$372.23
$349.01
$369.77
$391.75
$469.86
$446.64
$467.40
$489.38
$567.49
$97.63

Plan: (HMO) Humana Bronze 6450/Atlanta HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Employers Health Plan of Georgia, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$206.50
$234.38
$263.91
$368.81
$560.44
$413.00
$468.76
$527.82
$737.62
$1120.88
$544.13
$599.89
$658.95
$868.75
$675.26
$731.02
$790.08
$999.88
$806.39
$862.15
$921.21
$1131.01
$337.63
$365.51
$395.04
$499.94
$468.76
$496.64
$526.17
$631.07
$599.89
$627.77
$657.30
$762.20
$131.13

Plan: (HMO) Humana Bronze 4850/Atlanta HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Employers Health Plan of Georgia, Inc.)

Deductible: Individual: $4,850 : Family: $9,700
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$224.87
$255.23
$287.38
$401.62
$610.30
$449.74
$510.46
$574.76
$803.24
$1220.60
$592.53
$653.25
$717.55
$946.03
$735.32
$796.04
$860.34
$1088.82
$878.11
$938.83
$1003.13
$1231.61
$367.66
$398.02
$430.17
$544.41
$510.45
$540.81
$572.96
$687.20
$653.24
$683.60
$715.75
$829.99
$142.79

Plan: (HMO) Humana Silver 3800/Atlanta HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Employers Health Plan of Georgia, Inc.)

Deductible: Individual: $3,800 : Family: $7,600
Out of Pocket Maximum per year: Individual: $6,300 : Family: $12,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$243.50
$276.37
$311.19
$434.89
$660.86
$487.00
$552.74
$622.38
$869.78
$1321.72
$641.62
$707.36
$777.00
$1024.40
$796.24
$861.98
$931.62
$1179.02
$950.86
$1016.60
$1086.24
$1333.64
$398.12
$430.99
$465.81
$589.51
$552.74
$585.61
$620.43
$744.13
$707.36
$740.23
$775.05
$898.75
$154.62

Plan: (HMO) Humana Gold 2250/Atlanta HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Employers Health Plan of Georgia, Inc.)

Deductible: Individual: $2,250 : Family: $4,500
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$287.51
$326.32
$367.44
$513.49
$780.30
$575.02
$652.64
$734.88
$1026.98
$1560.60
$757.59
$835.21
$917.45
$1209.55
$940.16
$1017.78
$1100.02
$1392.12
$1122.73
$1200.35
$1282.59
$1574.69
$470.08
$508.89
$550.01
$696.06
$652.65
$691.46
$732.58
$878.63
$835.22
$874.03
$915.15
$1061.20
$182.57

Plan: (POS) Humana Basic 6850/National POS - OpenAccess

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Employers Health Plan of Georgia, Inc.)

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$164.91
$187.17
$210.75
$294.53
$447.57
$329.82
$374.34
$421.50
$589.06
$895.14
$434.54
$479.06
$526.22
$693.78
$539.26
$583.78
$630.94
$798.50
$643.98
$688.50
$735.66
$903.22
$269.63
$291.89
$315.47
$399.25
$374.35
$396.61
$420.19
$503.97
$479.07
$501.33
$524.91
$608.69
$104.72

Plan: (POS) Humana Bronze 6450/National POS - OpenAccess

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Employers Health Plan of Georgia, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$221.45
$251.35
$283.01
$395.51
$601.02
$442.90
$502.70
$566.02
$791.02
$1202.04
$583.52
$643.32
$706.64
$931.64
$724.14
$783.94
$847.26
$1072.26
$864.76
$924.56
$987.88
$1212.88
$362.07
$391.97
$423.63
$536.13
$502.69
$532.59
$564.25
$676.75
$643.31
$673.21
$704.87
$817.37
$140.62

Plan: (POS) Humana Silver 3800/National POS - OpenAccess

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Employers Health Plan of Georgia, Inc.)

Deductible: Individual: $3,800 : Family: $7,600
Out of Pocket Maximum per year: Individual: $6,300 : Family: $12,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$261.16
$296.42
$333.76
$466.43
$708.79
$522.32
$592.84
$667.52
$932.86
$1417.58
$688.16
$758.68
$833.36
$1098.70
$854.00
$924.52
$999.20
$1264.54
$1019.84
$1090.36
$1165.04
$1430.38
$427.00
$462.26
$499.60
$632.27
$592.84
$628.10
$665.44
$798.11
$758.68
$793.94
$831.28
$963.95
$165.84

Plan: (POS) Humana Gold 2250/National POS - OpenAccess

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Employers Health Plan of Georgia, Inc.)

Deductible: Individual: $2,250 : Family: $4,500
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$308.34
$349.97
$394.06
$550.70
$836.83
$616.68
$699.94
$788.12
$1101.40
$1673.66
$812.48
$895.74
$983.92
$1297.20
$1008.28
$1091.54
$1179.72
$1493.00
$1204.08
$1287.34
$1375.52
$1688.80
$504.14
$545.77
$589.86
$746.50
$699.94
$741.57
$785.66
$942.30
$895.74
$937.37
$981.46
$1138.10
$195.80
ADVERTISEMENT

Harken Health Insurance Company

Local: | Toll Free:

Plan: (PPO) Care Gold I

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Harken Health Insurance Company)

Deductible: Individual: $1,750 : Family: $3,500
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$284.79
$323.24
$363.96
$508.63
$772.92
$569.58
$646.48
$727.92
$1017.26
$1545.84
$750.42
$827.32
$908.76
$1198.10
$931.26
$1008.16
$1089.60
$1378.94
$1112.10
$1189.00
$1270.44
$1559.78
$465.63
$504.08
$544.80
$689.47
$646.47
$684.92
$725.64
$870.31
$827.31
$865.76
$906.48
$1051.15
$180.84

Plan: (PPO) Care Gold II

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Harken Health Insurance Company)

Deductible: Individual: $1,375 : Family: $2,750
Out of Pocket Maximum per year: Individual: $2,750 : Family: $5,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$293.20
$332.78
$374.71
$523.66
$795.75
$586.40
$665.56
$749.42
$1047.32
$1591.50
$772.58
$851.74
$935.60
$1233.50
$958.76
$1037.92
$1121.78
$1419.68
$1144.94
$1224.10
$1307.96
$1605.86
$479.38
$518.96
$560.89
$709.84
$665.56
$705.14
$747.07
$896.02
$851.74
$891.32
$933.25
$1082.20
$186.18

Plan: (PPO) Care Silver I

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Harken Health Insurance Company)

Deductible: Individual: $3,750 : Family: $7,500
Out of Pocket Maximum per year: Individual: $6,200 : Family: $12,400

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$240.25
$272.69
$307.04
$429.09
$652.04
$480.50
$545.38
$614.08
$858.18
$1304.08
$633.06
$697.94
$766.64
$1010.74
$785.62
$850.50
$919.20
$1163.30
$938.18
$1003.06
$1071.76
$1315.86
$392.81
$425.25
$459.60
$581.65
$545.37
$577.81
$612.16
$734.21
$697.93
$730.37
$764.72
$886.77
$152.56

Plan: (PPO) Care Silver II

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Harken Health Insurance Company)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$246.93
$280.27
$315.58
$441.02
$670.17
$493.86
$560.54
$631.16
$882.04
$1340.34
$650.66
$717.34
$787.96
$1038.84
$807.46
$874.14
$944.76
$1195.64
$964.26
$1030.94
$1101.56
$1352.44
$403.73
$437.07
$472.38
$597.82
$560.53
$593.87
$629.18
$754.62
$717.33
$750.67
$785.98
$911.42
$156.80

Plan: (PPO) Care Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: - Provider Directory for This Plan: (Harken Health Insurance Company)

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$208.58
$236.74
$266.57
$372.53
$566.09
$417.16
$473.48
$533.14
$745.06
$1132.18
$549.61
$605.93
$665.59
$877.51
$682.06
$738.38
$798.04
$1009.96
$814.51
$870.83
$930.49
$1142.41
$341.03
$369.19
$399.02
$504.98
$473.48
$501.64
$531.47
$637.43
$605.93
$634.09
$663.92
$769.88
$132.45

†Source: Our summary of lowest costs and numbers of providers is based on a government report released September 25, 2013. For more detailed information about specific plans and providers, see HealthCare.gov.

‡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 Forsyth County here.

 

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