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Providers for Zip Code 85339

LegalConsumer.com/obamacare

ObamacareByZipCode.com

Obamacare 2016 Marketplace Rates For Laveen, AZ

Saturday, April 27th, 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 Laveen, AZ.

Obamacare Providers, Plans and 2016 Rates for Maricopa County

Maricopa County is in “Rating Area 4” of Arizona.

Currently, there are 10 providers offering 119 plans to Rating Area 4. †

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 Laveen, AZ area accept this insurance coverage as within the plan's "network".
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Humana Health Plan, Inc.

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

TTY: 1-800-325-2028

Plan: (HMO) Humana Basic 6850/Phoenix HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Health Plan, 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		 $132.98
$150.93
$169.95
$237.50
$360.91		 $265.96
$301.86
$339.90
$475.00
$721.82		 $350.40
$386.30
$424.34
$559.44		 $434.84
$470.74
$508.78
$643.88		 $519.28
$555.18
$593.22
$728.32		 $217.42
$235.37
$254.39
$321.94		 $301.86
$319.81
$338.83
$406.38		 $386.30
$404.25
$423.27
$490.82		 $84.44

Plan: (HMO) Humana Bronze 6450/Phoenix HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Health Plan, 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		 $178.57
$202.68
$228.21
$318.93
$484.64		 $357.14
$405.36
$456.42
$637.86
$969.28		 $470.53
$518.75
$569.81
$751.25		 $583.92
$632.14
$683.20
$864.64		 $697.31
$745.53
$796.59
$978.03		 $291.96
$316.07
$341.60
$432.32		 $405.35
$429.46
$454.99
$545.71		 $518.74
$542.85
$568.38
$659.10		 $113.39

Plan: (HMO) Humana Silver 3800/Phoenix HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Health Plan, 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		 $210.60
$239.03
$269.15
$376.13
$571.57		 $421.20
$478.06
$538.30
$752.26
$1143.14		 $554.93
$611.79
$672.03
$885.99		 $688.66
$745.52
$805.76
$1019.72		 $822.39
$879.25
$939.49
$1153.45		 $344.33
$372.76
$402.88
$509.86		 $478.06
$506.49
$536.61
$643.59		 $611.79
$640.22
$670.34
$777.32		 $133.73

Plan: (HMO) Humana Gold 2250/Phoenix HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Health Plan, 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		 $249.80
$283.52
$319.24
$446.14
$677.96		 $499.60
$567.04
$638.48
$892.28
$1355.92		 $658.22
$725.66
$797.10
$1050.90		 $816.84
$884.28
$955.72
$1209.52		 $975.46
$1042.90
$1114.34
$1368.14		 $408.42
$442.14
$477.86
$604.76		 $567.04
$600.76
$636.48
$763.38		 $725.66
$759.38
$795.10
$922.00		 $158.62

Plan: (HMO) Humana Platinum 500/Phoenix HMOx

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

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

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
Platinum 21
30
40
50
60		 $297.68
$337.87
$380.44
$531.66
$807.90		 $595.36
$675.74
$760.88
$1063.32
$1615.80		 $784.39
$864.77
$949.91
$1252.35		 $973.42
$1053.80
$1138.94
$1441.38		 $1162.45
$1242.83
$1327.97
$1630.41		 $486.71
$526.90
$569.47
$720.69		 $675.74
$715.93
$758.50
$909.72		 $864.77
$904.96
$947.53
$1098.75		 $189.03
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Blue Cross Blue Shield of Arizona, Inc.

Local: 1-866-230-4760 x4899 | Toll Free: 1-866-230-4760

TTY: 1-602-864-4823

Plan: (HMO) EverydayHealth HMO 1000 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-230-4760 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000

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		 $311.35
$353.38
$397.90
$556.07
$845.00		 $622.70
$706.76
$795.80
$1112.14
$1690.00		 $820.41
$904.47
$993.51
$1309.85		 $1018.12
$1102.18
$1191.22
$1507.56		 $1215.83
$1299.89
$1388.93
$1705.27		 $509.06
$551.09
$595.61
$753.78		 $706.77
$748.80
$793.32
$951.49		 $904.48
$946.51
$991.03
$1149.20		 $197.71

Plan: (HMO) EverydayHealth HMO 4000 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-230-4760 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
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
Silver 21
30
40
50
60		 $250.57
$284.40
$320.23
$447.52
$680.05		 $501.14
$568.80
$640.46
$895.04
$1360.10		 $660.26
$727.92
$799.58
$1054.16		 $819.38
$887.04
$958.70
$1213.28		 $978.50
$1046.16
$1117.82
$1372.40		 $409.69
$443.52
$479.35
$606.64		 $568.81
$602.64
$638.47
$765.76		 $727.93
$761.76
$797.59
$924.88		 $159.12

Plan: (HMO) EverydayHealth HMO 6000 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-230-4760 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $6,000 : Family: $12,000
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		 $209.27
$237.52
$267.45
$373.76
$567.96		 $418.54
$475.04
$534.90
$747.52
$1135.92		 $551.43
$607.93
$667.79
$880.41		 $684.32
$740.82
$800.68
$1013.30		 $817.21
$873.71
$933.57
$1146.19		 $342.16
$370.41
$400.34
$506.65		 $475.05
$503.30
$533.23
$639.54		 $607.94
$636.19
$666.12
$772.43		 $132.89

Plan: (HMO) EverydayHealth HMO 1000 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-230-4760 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000

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		 $318.73
$361.76
$407.34
$569.25
$865.04		 $637.46
$723.52
$814.68
$1138.50
$1730.08		 $839.86
$925.92
$1017.08
$1340.90		 $1042.26
$1128.32
$1219.48
$1543.30		 $1244.66
$1330.72
$1421.88
$1745.70		 $521.13
$564.16
$609.74
$771.65		 $723.53
$766.56
$812.14
$974.05		 $925.93
$968.96
$1014.54
$1176.45		 $202.40

Plan: (HMO) EverydayHealth HMO 4000 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-230-4760 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
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
Silver 21
30
40
50
60		 $256.52
$291.14
$327.83
$458.13
$696.17		 $513.04
$582.28
$655.66
$916.26
$1392.34		 $675.93
$745.17
$818.55
$1079.15		 $838.82
$908.06
$981.44
$1242.04		 $1001.71
$1070.95
$1144.33
$1404.93		 $419.41
$454.03
$490.72
$621.02		 $582.30
$616.92
$653.61
$783.91		 $745.19
$779.81
$816.50
$946.80		 $162.89

Plan: (HMO) EverydayHealth HMO 6000 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-230-4760 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $6,000 : Family: $12,000
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		 $214.23
$243.15
$273.78
$382.61
$581.41		 $428.46
$486.30
$547.56
$765.22
$1162.82		 $564.50
$622.34
$683.60
$901.26		 $700.54
$758.38
$819.64
$1037.30		 $836.58
$894.42
$955.68
$1173.34		 $350.27
$379.19
$409.82
$518.65		 $486.31
$515.23
$545.86
$654.69		 $622.35
$651.27
$681.90
$790.73		 $136.04

Plan: (HMO) Portfolio HSA HMO 1500 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-230-4760 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000

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		 $283.64
$321.93
$362.49
$506.58
$769.79		 $567.28
$643.86
$724.98
$1013.16
$1539.58		 $747.39
$823.97
$905.09
$1193.27		 $927.50
$1004.08
$1085.20
$1373.38		 $1107.61
$1184.19
$1265.31
$1553.49		 $463.75
$502.04
$542.60
$686.69		 $643.86
$682.15
$722.71
$866.80		 $823.97
$862.26
$902.82
$1046.91		 $180.11

Plan: (HMO) Portfolio HSA HMO 3250 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-230-4760 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $3,250 : Family: $6,500
Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000

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		 $210.33
$238.72
$268.79
$375.64
$570.81		 $420.66
$477.44
$537.58
$751.28
$1141.62		 $554.22
$611.00
$671.14
$884.84		 $687.78
$744.56
$804.70
$1018.40		 $821.34
$878.12
$938.26
$1151.96		 $343.89
$372.28
$402.35
$509.20		 $477.45
$505.84
$535.91
$642.76		 $611.01
$639.40
$669.47
$776.32		 $133.56

Plan: (HMO) Portfolio HSA HMO 5500 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-230-4760 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, 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
Bronze 21
30
40
50
60		 $180.56
$204.94
$230.76
$322.48
$490.04		 $361.12
$409.88
$461.52
$644.96
$980.08		 $475.78
$524.54
$576.18
$759.62		 $590.44
$639.20
$690.84
$874.28		 $705.10
$753.86
$805.50
$988.94		 $295.22
$319.60
$345.42
$437.14		 $409.88
$434.26
$460.08
$551.80		 $524.54
$548.92
$574.74
$666.46		 $114.66

Plan: (HMO) Portfolio HSA HMO 6550 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-230-4760 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $6,550 : Family: $13,100
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		 $174.06
$197.56
$222.45
$310.87
$472.39		 $348.12
$395.12
$444.90
$621.74
$944.78		 $458.65
$505.65
$555.43
$732.27		 $569.18
$616.18
$665.96
$842.80		 $679.71
$726.71
$776.49
$953.33		 $284.59
$308.09
$332.98
$421.40		 $395.12
$418.62
$443.51
$531.93		 $505.65
$529.15
$554.04
$642.46		 $110.53

Plan: (HMO) Portfolio HSA HMO 1500 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-230-4760 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000

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		 $290.37
$329.57
$371.09
$518.59
$788.05		 $580.74
$659.14
$742.18
$1037.18
$1576.10		 $765.13
$843.53
$926.57
$1221.57		 $949.52
$1027.92
$1110.96
$1405.96		 $1133.91
$1212.31
$1295.35
$1590.35		 $474.76
$513.96
$555.48
$702.98		 $659.15
$698.35
$739.87
$887.37		 $843.54
$882.74
$924.26
$1071.76		 $184.39

Plan: (HMO) Portfolio HSA HMO 3250 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-230-4760 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $3,250 : Family: $6,500
Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000

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		 $215.31
$244.38
$275.17
$384.54
$584.34		 $430.62
$488.76
$550.34
$769.08
$1168.68		 $567.34
$625.48
$687.06
$905.80		 $704.06
$762.20
$823.78
$1042.52		 $840.78
$898.92
$960.50
$1179.24		 $352.03
$381.10
$411.89
$521.26		 $488.75
$517.82
$548.61
$657.98		 $625.47
$654.54
$685.33
$794.70		 $136.72

Plan: (HMO) Portfolio HSA HMO 5500 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-230-4760 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, 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
Bronze 21
30
40
50
60		 $184.84
$209.80
$236.23
$330.13
$501.66		 $369.68
$419.60
$472.46
$660.26
$1003.32		 $487.06
$536.98
$589.84
$777.64		 $604.44
$654.36
$707.22
$895.02		 $721.82
$771.74
$824.60
$1012.40		 $302.22
$327.18
$353.61
$447.51		 $419.60
$444.56
$470.99
$564.89		 $536.98
$561.94
$588.37
$682.27		 $117.38

Plan: (HMO) Portfolio HSA HMO 6550 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-230-4760 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, Inc.)

Deductible: Individual: $6,550 : Family: $13,100
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		 $178.19
$202.24
$227.72
$318.24
$483.59		 $356.38
$404.48
$455.44
$636.48
$967.18		 $469.53
$517.63
$568.59
$749.63		 $582.68
$630.78
$681.74
$862.78		 $695.83
$743.93
$794.89
$975.93		 $291.34
$315.39
$340.87
$431.39		 $404.49
$428.54
$454.02
$544.54		 $517.64
$541.69
$567.17
$657.69		 $113.15

Plan: (HMO) SimpleHealth HMO 6850 - Alliance Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-230-4760 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, 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		 $151.07
$171.47
$193.07
$269.81
$410.00		 $302.14
$342.94
$386.14
$539.62
$820.00		 $398.07
$438.87
$482.07
$635.55		 $494.00
$534.80
$578.00
$731.48		 $589.93
$630.73
$673.93
$827.41		 $247.00
$267.40
$289.00
$365.74		 $342.93
$363.33
$384.93
$461.67		 $438.86
$459.26
$480.86
$557.60		 $95.93

Plan: (HMO) SimpleHealth HMO 6850 - Select Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-230-4760 - Provider Directory for This Plan: (Blue Cross Blue Shield of Arizona, 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		 $154.65
$175.53
$197.65
$276.21
$419.72		 $309.30
$351.06
$395.30
$552.42
$839.44		 $407.51
$449.27
$493.51
$650.63		 $505.72
$547.48
$591.72
$748.84		 $603.93
$645.69
$689.93
$847.05		 $252.86
$273.74
$295.86
$374.42		 $351.07
$371.95
$394.07
$472.63		 $449.28
$470.16
$492.28
$570.84		 $98.21
ADVERTISEMENT

Meritus Health Partners

Local: 1-602-957-2113 | Toll Free: 1-855-755-2700

TTY: 1-855-568-2800

Plan: (HMO) Meritus Neighborhood Network Silver HMO MIHS

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus Health Partners)

Deductible: Individual: $5,000 : Family: $10,000
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
Silver 21
30
40
50
60		 $173.20
$196.58
$221.34
$309.33
$470.06		 $346.40
$393.16
$442.68
$618.66
$940.12		 $456.38
$503.14
$552.66
$728.64		 $566.36
$613.12
$662.64
$838.62		 $676.34
$723.10
$772.62
$948.60		 $283.18
$306.56
$331.32
$419.31		 $393.16
$416.54
$441.30
$529.29		 $503.14
$526.52
$551.28
$639.27		 $109.98

Plan: (HMO) Meritus Community Network Silver HMO Banner

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus Health Partners)

Deductible: Individual: $5,000 : Family: $10,000
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
Silver 21
30
40
50
60		 $191.06
$216.85
$244.17
$341.23
$518.53		 $382.12
$433.70
$488.34
$682.46
$1037.06		 $503.44
$555.02
$609.66
$803.78		 $624.76
$676.34
$730.98
$925.10		 $746.08
$797.66
$852.30
$1046.42		 $312.38
$338.17
$365.49
$462.55		 $433.70
$459.49
$486.81
$583.87		 $555.02
$580.81
$608.13
$705.19		 $121.32

Plan: (HMO) Meritus Healthy Bronze Complete HMO 6800

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus Health Partners)

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		 $186.13
$211.25
$237.87
$332.42
$505.15		 $372.26
$422.50
$475.74
$664.84
$1010.30		 $490.45
$540.69
$593.93
$783.03		 $608.64
$658.88
$712.12
$901.22		 $726.83
$777.07
$830.31
$1019.41		 $304.32
$329.44
$356.06
$450.61		 $422.51
$447.63
$474.25
$568.80		 $540.70
$565.82
$592.44
$686.99		 $118.19

Plan: (HMO) Meritus Healthy Bronze HMO Banner 6800

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus Health Partners)

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		 $167.52
$190.13
$214.09
$299.19
$454.64		 $335.04
$380.26
$428.18
$598.38
$909.28		 $441.41
$486.63
$534.55
$704.75		 $547.78
$593.00
$640.92
$811.12		 $654.15
$699.37
$747.29
$917.49		 $273.89
$296.50
$320.46
$405.56		 $380.26
$402.87
$426.83
$511.93		 $486.63
$509.24
$533.20
$618.30		 $106.37

Plan: (HMO) Meritus Healthy Bronze HMO Abrazo 6800

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus Health Partners)

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		 $154.24
$175.06
$197.11
$275.47
$418.60		 $308.48
$350.12
$394.22
$550.94
$837.20		 $406.42
$448.06
$492.16
$648.88		 $504.36
$546.00
$590.10
$746.82		 $602.30
$643.94
$688.04
$844.76		 $252.18
$273.00
$295.05
$373.41		 $350.12
$370.94
$392.99
$471.35		 $448.06
$468.88
$490.93
$569.29		 $97.94

Plan: (HMO) Meritus Healthy Silver Complete HMO 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus Health Partners)

Deductible: Individual: $4,000 : Family: $8,000
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
Silver 21
30
40
50
60		 $203.58
$231.06
$260.17
$363.59
$552.51		 $407.16
$462.12
$520.34
$727.18
$1105.02		 $536.43
$591.39
$649.61
$856.45		 $665.70
$720.66
$778.88
$985.72		 $794.97
$849.93
$908.15
$1114.99		 $332.85
$360.33
$389.44
$492.86		 $462.12
$489.60
$518.71
$622.13		 $591.39
$618.87
$647.98
$751.40		 $129.27

Plan: (HMO) Meritus Healthy Silver HMO Banner 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus Health Partners)

Deductible: Individual: $4,000 : Family: $8,000
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
Silver 21
30
40
50
60		 $183.22
$207.95
$234.15
$327.23
$497.25		 $366.44
$415.90
$468.30
$654.46
$994.50		 $482.78
$532.24
$584.64
$770.80		 $599.12
$648.58
$700.98
$887.14		 $715.46
$764.92
$817.32
$1003.48		 $299.56
$324.29
$350.49
$443.57		 $415.90
$440.63
$466.83
$559.91		 $532.24
$556.97
$583.17
$676.25		 $116.34

Plan: (HMO) Meritus Healthy Silver HMO Abrazo 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus Health Partners)

Deductible: Individual: $4,000 : Family: $8,000
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
Silver 21
30
40
50
60		 $168.69
$191.46
$215.58
$301.28
$457.82		 $337.38
$382.92
$431.16
$602.56
$915.64		 $444.49
$490.03
$538.27
$709.67		 $551.60
$597.14
$645.38
$816.78		 $658.71
$704.25
$752.49
$923.89		 $275.80
$298.57
$322.69
$408.39		 $382.91
$405.68
$429.80
$515.50		 $490.02
$512.79
$536.91
$622.61		 $107.11

Plan: (HMO) Meritus Healthy Silver HMO MIHS 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus Health Partners)

Deductible: Individual: $4,000 : Family: $8,000
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
Silver 21
30
40
50
60		 $163.71
$185.81
$209.22
$292.38
$444.30		 $327.42
$371.62
$418.44
$584.76
$888.60		 $431.37
$475.57
$522.39
$688.71		 $535.32
$579.52
$626.34
$792.66		 $639.27
$683.47
$730.29
$896.61		 $267.66
$289.76
$313.17
$396.33		 $371.61
$393.71
$417.12
$500.28		 $475.56
$497.66
$521.07
$604.23		 $103.95

Plan: (HMO) Meritus Healthy Gold Complete HMO Plus 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus Health Partners)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

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		 $249.69
$283.39
$319.10
$445.94
$677.65		 $499.38
$566.78
$638.20
$891.88
$1355.30		 $657.93
$725.33
$796.75
$1050.43		 $816.48
$883.88
$955.30
$1208.98		 $975.03
$1042.43
$1113.85
$1367.53		 $408.24
$441.94
$477.65
$604.49		 $566.79
$600.49
$636.20
$763.04		 $725.34
$759.04
$794.75
$921.59		 $158.55

Plan: (HMO) Meritus Healthy Gold HMO Plus Banner 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus Health Partners)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

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		 $225.31
$255.72
$287.94
$402.40
$611.49		 $450.62
$511.44
$575.88
$804.80
$1222.98		 $593.69
$654.51
$718.95
$947.87		 $736.76
$797.58
$862.02
$1090.94		 $879.83
$940.65
$1005.09
$1234.01		 $368.38
$398.79
$431.01
$545.47		 $511.45
$541.86
$574.08
$688.54		 $654.52
$684.93
$717.15
$831.61		 $143.07

Plan: (HMO) Meritus Healthy Gold HMO Plus Abrazo 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus Health Partners)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

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		 $207.92
$235.98
$265.72
$371.34
$564.29		 $415.84
$471.96
$531.44
$742.68
$1128.58		 $547.86
$603.98
$663.46
$874.70		 $679.88
$736.00
$795.48
$1006.72		 $811.90
$868.02
$927.50
$1138.74		 $339.94
$368.00
$397.74
$503.36		 $471.96
$500.02
$529.76
$635.38		 $603.98
$632.04
$661.78
$767.40		 $132.02

Plan: (HMO) Meritus Healthy Platinum Complete HMO Plus 500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus Health Partners)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $2,000 : Family: $4,000

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
Platinum 21
30
40
50
60		 $296.16
$336.14
$378.49
$528.94
$803.77		 $592.32
$672.28
$756.98
$1057.88
$1607.54		 $780.38
$860.34
$945.04
$1245.94		 $968.44
$1048.40
$1133.10
$1434.00		 $1156.50
$1236.46
$1321.16
$1622.06		 $484.22
$524.20
$566.55
$717.00		 $672.28
$712.26
$754.61
$905.06		 $860.34
$900.32
$942.67
$1093.12		 $188.06

Plan: (HMO) Meritus Healthy Platinum HMO Plus MIHS 500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus Health Partners)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $2,000 : Family: $4,000

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
Platinum 21
30
40
50
60		 $239.32
$271.62
$305.85
$427.42
$649.51		 $478.64
$543.24
$611.70
$854.84
$1299.02		 $630.60
$695.20
$763.66
$1006.80		 $782.56
$847.16
$915.62
$1158.76		 $934.52
$999.12
$1067.58
$1310.72		 $391.28
$423.58
$457.81
$579.38		 $543.24
$575.54
$609.77
$731.34		 $695.20
$727.50
$761.73
$883.30		 $151.96

Plan: (HMO) Meritus Healthy Platinum HMO Plus Banner 500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus Health Partners)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $2,000 : Family: $4,000

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
Platinum 21
30
40
50
60		 $267.14
$303.20
$341.40
$477.11
$725.01		 $534.28
$606.40
$682.80
$954.22
$1450.02		 $703.91
$776.03
$852.43
$1123.85		 $873.54
$945.66
$1022.06
$1293.48		 $1043.17
$1115.29
$1191.69
$1463.11		 $436.77
$472.83
$511.03
$646.74		 $606.40
$642.46
$680.66
$816.37		 $776.03
$812.09
$850.29
$986.00		 $169.63

Plan: (HMO) Meritus Healthy Platinum HMO Plus Abrazo 500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus Health Partners)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $2,000 : Family: $4,000

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
Platinum 21
30
40
50
60		 $246.42
$279.68
$314.92
$440.10
$668.78		 $492.84
$559.36
$629.84
$880.20
$1337.56		 $649.31
$715.83
$786.31
$1036.67		 $805.78
$872.30
$942.78
$1193.14		 $962.25
$1028.77
$1099.25
$1349.61		 $402.89
$436.15
$471.39
$596.57		 $559.36
$592.62
$627.86
$753.04		 $715.83
$749.09
$784.33
$909.51		 $156.47

Plan: (HMO) Meritus Healthy Gold HMO Plus MIHS 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-755-2700 - Provider Directory for This Plan: (Meritus Health Partners)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

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		 $201.95
$229.21
$258.09
$360.68
$548.09		 $403.90
$458.42
$516.18
$721.36
$1096.18		 $532.13
$586.65
$644.41
$849.59		 $660.36
$714.88
$772.64
$977.82		 $788.59
$843.11
$900.87
$1106.05		 $330.18
$357.44
$386.32
$488.91		 $458.41
$485.67
$514.55
$617.14		 $586.64
$613.90
$642.78
$745.37		 $128.23
ADVERTISEMENT

Phoenix Health Plans, Inc.

Local: 1-855-463-7275 | Toll Free: 1-855-463-7275

TTY: 1-855-463-7279

Plan: (HMO) Phoenix Choice Gold HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $1,800 : Family: $3,600
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		 $205.08
$232.77
$262.09
$366.28
$556.59		 $410.16
$465.54
$524.18
$732.56
$1113.18		 $540.39
$595.77
$654.41
$862.79		 $670.62
$726.00
$784.64
$993.02		 $800.85
$856.23
$914.87
$1123.25		 $335.31
$363.00
$392.32
$496.51		 $465.54
$493.23
$522.55
$626.74		 $595.77
$623.46
$652.78
$756.97		 $130.23

Plan: (HMO) Phoenix Choice Silver HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,700 : Family: $13,400

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		 $168.63
$191.39
$215.51
$301.17
$457.66		 $337.26
$382.78
$431.02
$602.34
$915.32		 $444.34
$489.86
$538.10
$709.42		 $551.42
$596.94
$645.18
$816.50		 $658.50
$704.02
$752.26
$923.58		 $275.71
$298.47
$322.59
$408.25		 $382.79
$405.55
$429.67
$515.33		 $489.87
$512.63
$536.75
$622.41		 $107.08

Plan: (HMO) Phoenix Choice Bronze HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $6,150 : Family: $12,300
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		 $135.40
$153.68
$173.05
$241.83
$367.48		 $270.80
$307.36
$346.10
$483.66
$734.96		 $356.78
$393.34
$432.08
$569.64		 $442.76
$479.32
$518.06
$655.62		 $528.74
$565.30
$604.04
$741.60		 $221.38
$239.66
$259.03
$327.81		 $307.36
$325.64
$345.01
$413.79		 $393.34
$411.62
$430.99
$499.77		 $85.98

Plan: (HMO) Phoenix Choice Catastrophic HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, 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		 $69.99
$79.44
$89.45
$125.01
$189.96		 $139.98
$158.88
$178.90
$250.02
$379.92		 $184.43
$203.33
$223.35
$294.47		 $228.88
$247.78
$267.80
$338.92		 $273.33
$292.23
$312.25
$383.37		 $114.44
$123.89
$133.90
$169.46		 $158.89
$168.34
$178.35
$213.91		 $203.34
$212.79
$222.80
$258.36		 $44.45

Plan: (HMO) Phoenix Choice Gold HMO + Dental/Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $1,800 : Family: $3,600
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		 $215.89
$245.03
$275.90
$385.57
$585.91		 $431.78
$490.06
$551.80
$771.14
$1171.82		 $568.87
$627.15
$688.89
$908.23		 $705.96
$764.24
$825.98
$1045.32		 $843.05
$901.33
$963.07
$1182.41		 $352.98
$382.12
$412.99
$522.66		 $490.07
$519.21
$550.08
$659.75		 $627.16
$656.30
$687.17
$796.84		 $137.09

Plan: (HMO) Phoenix Choice Silver HMO + Dental/Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,700 : Family: $13,400

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		 $179.35
$203.57
$229.21
$320.32
$486.76		 $358.70
$407.14
$458.42
$640.64
$973.52		 $472.59
$521.03
$572.31
$754.53		 $586.48
$634.92
$686.20
$868.42		 $700.37
$748.81
$800.09
$982.31		 $293.24
$317.46
$343.10
$434.21		 $407.13
$431.35
$456.99
$548.10		 $521.02
$545.24
$570.88
$661.99		 $113.89

Plan: (HMO) Phoenix Choice Gold HMO Abrazo and Phoenix Children's Hospital

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $1,800 : Family: $3,600
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		 $197.59
$224.27
$252.53
$352.90
$536.27		 $395.18
$448.54
$505.06
$705.80
$1072.54		 $520.65
$574.01
$630.53
$831.27		 $646.12
$699.48
$756.00
$956.74		 $771.59
$824.95
$881.47
$1082.21		 $323.06
$349.74
$378.00
$478.37		 $448.53
$475.21
$503.47
$603.84		 $574.00
$600.68
$628.94
$729.31		 $125.47

Plan: (HMO) Phoenix Choice Silver HMO Abrazo and Phoenix Children's Hospital

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,700 : Family: $13,400

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		 $162.80
$184.77
$208.05
$290.75
$441.83		 $325.60
$369.54
$416.10
$581.50
$883.66		 $428.98
$472.92
$519.48
$684.88		 $532.36
$576.30
$622.86
$788.26		 $635.74
$679.68
$726.24
$891.64		 $266.18
$288.15
$311.43
$394.13		 $369.56
$391.53
$414.81
$497.51		 $472.94
$494.91
$518.19
$600.89		 $103.38

Plan: (HMO) Phoenix Choice Bronze HMO Abrazo and Phoenix Children's Hospital

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $6,150 : Family: $12,300
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		 $128.53
$145.88
$164.26
$229.56
$348.84		 $257.06
$291.76
$328.52
$459.12
$697.68		 $338.68
$373.38
$410.14
$540.74		 $420.30
$455.00
$491.76
$622.36		 $501.92
$536.62
$573.38
$703.98		 $210.15
$227.50
$245.88
$311.18		 $291.77
$309.12
$327.50
$392.80		 $373.39
$390.74
$409.12
$474.42		 $81.62

Plan: (HMO) Phoenix Choice Catastrophic HMO Abrazo and Phoenix Children's Hospital

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, 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		 $67.15
$76.22
$85.82
$119.94
$182.25		 $134.30
$152.44
$171.64
$239.88
$364.50		 $176.94
$195.08
$214.28
$282.52		 $219.58
$237.72
$256.92
$325.16		 $262.22
$280.36
$299.56
$367.80		 $109.79
$118.86
$128.46
$162.58		 $152.43
$161.50
$171.10
$205.22		 $195.07
$204.14
$213.74
$247.86		 $42.64

Plan: (HMO) Phoenix Choice Gold HMO Abrazo and Phoenix Children’s Hospital + Dental/Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $1,800 : Family: $3,600
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		 $208.40
$236.53
$266.33
$372.20
$565.59		 $416.80
$473.06
$532.66
$744.40
$1131.18		 $549.13
$605.39
$664.99
$876.73		 $681.46
$737.72
$797.32
$1009.06		 $813.79
$870.05
$929.65
$1141.39		 $340.73
$368.86
$398.66
$504.53		 $473.06
$501.19
$530.99
$636.86		 $605.39
$633.52
$663.32
$769.19		 $132.33

Plan: (HMO) Phoenix Choice Silver HMO Abrazo and Phoenix Children's Hospital + Dental/Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,700 : Family: $13,400

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		 $173.52
$196.95
$221.76
$309.91
$470.93		 $347.04
$393.90
$443.52
$619.82
$941.86		 $457.23
$504.09
$553.71
$730.01		 $567.42
$614.28
$663.90
$840.20		 $677.61
$724.47
$774.09
$950.39		 $283.71
$307.14
$331.95
$420.10		 $393.90
$417.33
$442.14
$530.29		 $504.09
$527.52
$552.33
$640.48		 $110.19

Plan: (HMO) Phoenix Choice Gold HMO Abrazo

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $1,800 : Family: $3,600
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		 $194.67
$220.95
$248.79
$347.68
$528.33		 $389.34
$441.90
$497.58
$695.36
$1056.66		 $512.95
$565.51
$621.19
$818.97		 $636.56
$689.12
$744.80
$942.58		 $760.17
$812.73
$868.41
$1066.19		 $318.28
$344.56
$372.40
$471.29		 $441.89
$468.17
$496.01
$594.90		 $565.50
$591.78
$619.62
$718.51		 $123.61

Plan: (HMO) Phoenix Choice Silver HMO Abrazo

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,700 : Family: $13,400

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		 $159.69
$181.25
$204.09
$285.21
$433.41		 $319.38
$362.50
$408.18
$570.42
$866.82		 $420.78
$463.90
$509.58
$671.82		 $522.18
$565.30
$610.98
$773.22		 $623.58
$666.70
$712.38
$874.62		 $261.09
$282.65
$305.49
$386.61		 $362.49
$384.05
$406.89
$488.01		 $463.89
$485.45
$508.29
$589.41		 $101.40

Plan: (HMO) Phoenix Choice Bronze HMO Abrazo

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $6,150 : Family: $12,300
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		 $126.13
$143.16
$161.19
$225.27
$342.31		 $252.26
$286.32
$322.38
$450.54
$684.62		 $332.35
$366.41
$402.47
$530.63		 $412.44
$446.50
$482.56
$610.72		 $492.53
$526.59
$562.65
$690.81		 $206.22
$223.25
$241.28
$305.36		 $286.31
$303.34
$321.37
$385.45		 $366.40
$383.43
$401.46
$465.54		 $80.09

Plan: (HMO) Phoenix Choice Catastrophic HMO Abrazo

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, 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		 $65.72
$74.60
$83.99
$117.38
$178.37		 $131.44
$149.20
$167.98
$234.76
$356.74		 $173.17
$190.93
$209.71
$276.49		 $214.90
$232.66
$251.44
$318.22		 $256.63
$274.39
$293.17
$359.95		 $107.45
$116.33
$125.72
$159.11		 $149.18
$158.06
$167.45
$200.84		 $190.91
$199.79
$209.18
$242.57		 $41.73

Plan: (HMO) Phoenix Choice Gold HMO Abrazo + Dental/Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $1,800 : Family: $3,600
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		 $205.47
$233.21
$262.59
$366.97
$557.65		 $410.94
$466.42
$525.18
$733.94
$1115.30		 $541.41
$596.89
$655.65
$864.41		 $671.88
$727.36
$786.12
$994.88		 $802.35
$857.83
$916.59
$1125.35		 $335.94
$363.68
$393.06
$497.44		 $466.41
$494.15
$523.53
$627.91		 $596.88
$624.62
$654.00
$758.38		 $130.47

Plan: (HMO) Phoenix Choice Silver HMO Abrazo + Dental/Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-463-7275 - Provider Directory for This Plan: (Phoenix Health Plans, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,700 : Family: $13,400

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		 $170.42
$193.42
$217.79
$304.36
$462.51		 $340.84
$386.84
$435.58
$608.72
$925.02		 $449.05
$495.05
$543.79
$716.93		 $557.26
$603.26
$652.00
$825.14		 $665.47
$711.47
$760.21
$933.35		 $278.63
$301.63
$326.00
$412.57		 $386.84
$409.84
$434.21
$520.78		 $495.05
$518.05
$542.42
$628.99		 $108.21
ADVERTISEMENT

Health Choice Insurance Co.

Local: 1-480-800-6700 | Toll Free: 1-855-452-4242

TTY: 1-800-367-8939

Plan: (HMO) Health Choice Essential Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-452-4242 - Provider Directory for This Plan: (Health Choice Insurance Co.)

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		 $195.99
$222.45
$250.48
$350.04
$531.92		 $391.98
$444.90
$500.96
$700.08
$1063.84		 $516.43
$569.35
$625.41
$824.53		 $640.88
$693.80
$749.86
$948.98		 $765.33
$818.25
$874.31
$1073.43		 $320.44
$346.90
$374.93
$474.49		 $444.89
$471.35
$499.38
$598.94		 $569.34
$595.80
$623.83
$723.39		 $124.45

Plan: (HMO) Health Choice Essential Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-452-4242 - Provider Directory for This Plan: (Health Choice Insurance Co.)

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		 $174.96
$198.58
$223.60
$312.48
$474.84		 $349.92
$397.16
$447.20
$624.96
$949.68		 $461.02
$508.26
$558.30
$736.06		 $572.12
$619.36
$669.40
$847.16		 $683.22
$730.46
$780.50
$958.26		 $286.06
$309.68
$334.70
$423.58		 $397.16
$420.78
$445.80
$534.68		 $508.26
$531.88
$556.90
$645.78		 $111.10

Plan: (HMO) Health Choice Essential Basic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-452-4242 - Provider Directory for This Plan: (Health Choice Insurance Co.)

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		 $116.48
$132.20
$148.86
$208.03
$316.13		 $232.96
$264.40
$297.72
$416.06
$632.26		 $306.92
$338.36
$371.68
$490.02		 $380.88
$412.32
$445.64
$563.98		 $454.84
$486.28
$519.60
$637.94		 $190.44
$206.16
$222.82
$281.99		 $264.40
$280.12
$296.78
$355.95		 $338.36
$354.08
$370.74
$429.91		 $73.96

Plan: (HMO) Health Choice Value Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-452-4242 - Provider Directory for This Plan: (Health Choice Insurance Co.)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

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		 $196.37
$222.88
$250.96
$350.72
$532.95		 $392.74
$445.76
$501.92
$701.44
$1065.90		 $517.43
$570.45
$626.61
$826.13		 $642.12
$695.14
$751.30
$950.82		 $766.81
$819.83
$875.99
$1075.51		 $321.06
$347.57
$375.65
$475.41		 $445.75
$472.26
$500.34
$600.10		 $570.44
$596.95
$625.03
$724.79		 $124.69

Plan: (HMO) Health Choice Value Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-452-4242 - Provider Directory for This Plan: (Health Choice Insurance Co.)

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		 $164.60
$186.82
$210.36
$293.98
$446.72		 $329.20
$373.64
$420.72
$587.96
$893.44		 $433.72
$478.16
$525.24
$692.48		 $538.24
$582.68
$629.76
$797.00		 $642.76
$687.20
$734.28
$901.52		 $269.12
$291.34
$314.88
$398.50		 $373.64
$395.86
$419.40
$503.02		 $478.16
$500.38
$523.92
$607.54		 $104.52

Plan: (HMO) Health Choice Value Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-452-4242 - Provider Directory for This Plan: (Health Choice Insurance Co.)

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		 $137.81
$156.41
$176.12
$246.13
$374.02		 $275.62
$312.82
$352.24
$492.26
$748.04		 $363.13
$400.33
$439.75
$579.77		 $450.64
$487.84
$527.26
$667.28		 $538.15
$575.35
$614.77
$754.79		 $225.32
$243.92
$263.63
$333.64		 $312.83
$331.43
$351.14
$421.15		 $400.34
$418.94
$438.65
$508.66		 $87.51

Plan: (HMO) Health Choice Value Basic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-452-4242 - Provider Directory for This Plan: (Health Choice Insurance Co.)

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		 $95.72
$108.64
$122.33
$170.96
$259.78		 $191.44
$217.28
$244.66
$341.92
$519.56		 $252.22
$278.06
$305.44
$402.70		 $313.00
$338.84
$366.22
$463.48		 $373.78
$399.62
$427.00
$524.26		 $156.50
$169.42
$183.11
$231.74		 $217.28
$230.20
$243.89
$292.52		 $278.06
$290.98
$304.67
$353.30		 $60.78

Plan: (HMO) Health Choice Total Wellness Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-452-4242 - Provider Directory for This Plan: (Health Choice Insurance Co.)

Deductible: Individual: $3,100 : Family: $6,200
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		 $161.90
$183.76
$206.91
$289.15
$439.40		 $323.80
$367.52
$413.82
$578.30
$878.80		 $426.61
$470.33
$516.63
$681.11		 $529.42
$573.14
$619.44
$783.92		 $632.23
$675.95
$722.25
$886.73		 $264.71
$286.57
$309.72
$391.96		 $367.52
$389.38
$412.53
$494.77		 $470.33
$492.19
$515.34
$597.58		 $102.81
ADVERTISEMENT

Aetna Health Inc. (a PA corp.)

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

Plan: (HMO) Aetna Leap Everyday ‚Ä́ Banner

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

Deductible: Individual: $5,250 : Family: $10,500
Out of Pocket Maximum per year: Individual: $5,250 : Family: $10,500

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		 $216.75
$246.01
$277.00
$387.11
$588.25		 $433.50
$492.02
$554.00
$774.22
$1176.50		 $571.14
$629.66
$691.64
$911.86		 $708.78
$767.30
$829.28
$1049.50		 $846.42
$904.94
$966.92
$1187.14		 $354.39
$383.65
$414.64
$524.75		 $492.03
$521.29
$552.28
$662.39		 $629.67
$658.93
$689.92
$800.03		 $137.64

Plan: (HMO) Aetna Leap Everyday Plus ‚Ä́ Banner

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

Deductible: Individual: $4,510 : Family: $9,020
Out of Pocket Maximum per year: Individual: $4,510 : Family: $9,020

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		 $232.81
$264.24
$297.53
$415.80
$631.85		 $465.62
$528.48
$595.06
$831.60
$1263.70		 $613.46
$676.32
$742.90
$979.44		 $761.30
$824.16
$890.74
$1127.28		 $909.14
$972.00
$1038.58
$1275.12		 $380.65
$412.08
$445.37
$563.64		 $528.49
$559.92
$593.21
$711.48		 $676.33
$707.76
$741.05
$859.32		 $147.84

Plan: (HMO) Aetna Leap Basic Plus ‚Ä́ Banner

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-336-3915 - Provider Directory for This Plan: (Aetna Health Inc. (a PA 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		 $157.42
$178.67
$201.19
$281.16
$427.25		 $314.84
$357.34
$402.38
$562.32
$854.50		 $414.80
$457.30
$502.34
$662.28		 $514.76
$557.26
$602.30
$762.24		 $614.72
$657.22
$702.26
$862.20		 $257.38
$278.63
$301.15
$381.12		 $357.34
$378.59
$401.11
$481.08		 $457.30
$478.55
$501.07
$581.04		 $99.96

Plan: (HMO) Aetna Leap Basic ‚Ä́ Banner

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-336-3915 - Provider Directory for This Plan: (Aetna Health Inc. (a PA 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		 $152.58
$173.18
$195.00
$272.51
$414.10		 $305.16
$346.36
$390.00
$545.02
$828.20		 $402.05
$443.25
$486.89
$641.91		 $498.94
$540.14
$583.78
$738.80		 $595.83
$637.03
$680.67
$835.69		 $249.47
$270.07
$291.89
$369.40		 $346.36
$366.96
$388.78
$466.29		 $443.25
$463.85
$485.67
$563.18		 $96.89

Plan: (HMO) Aetna Leap Basic HSA ‚Ä́ Banner

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-336-3915 - Provider Directory for This Plan: (Aetna Health Inc. (a PA 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		 $157.00
$178.20
$200.65
$280.41
$426.11		 $314.00
$356.40
$401.30
$560.82
$852.22		 $413.70
$456.10
$501.00
$660.52		 $513.40
$555.80
$600.70
$760.22		 $613.10
$655.50
$700.40
$859.92		 $256.70
$277.90
$300.35
$380.11		 $356.40
$377.60
$400.05
$479.81		 $456.10
$477.30
$499.75
$579.51		 $99.70

Plan: (HMO) Aetna Leap Specialty ‚Ä́ Banner

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

Deductible: Individual: $3,500 : Family: $7,000
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		 $279.82
$317.59
$357.61
$499.76
$759.43		 $559.64
$635.18
$715.22
$999.52
$1518.86		 $737.32
$812.86
$892.90
$1177.20		 $915.00
$990.54
$1070.58
$1354.88		 $1092.68
$1168.22
$1248.26
$1532.56		 $457.50
$495.27
$535.29
$677.44		 $635.18
$672.95
$712.97
$855.12		 $812.86
$850.63
$890.65
$1032.80		 $177.68

Plan: (HMO) Aetna Leap Diabetes ‚Ä́ Banner

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

Deductible: Individual: $3,500 : Family: $7,000
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		 $291.85
$331.25
$372.99
$521.25
$792.08		 $583.70
$662.50
$745.98
$1042.50
$1584.16		 $769.03
$847.83
$931.31
$1227.83		 $954.36
$1033.16
$1116.64
$1413.16		 $1139.69
$1218.49
$1301.97
$1598.49		 $477.18
$516.58
$558.32
$706.58		 $662.51
$701.91
$743.65
$891.91		 $847.84
$887.24
$928.98
$1077.24		 $185.33
ADVERTISEMENT

Health Net of Arizona, Inc.

Local: 1-877-288-9085 | Toll Free: 1-877-288-9085

TTY: 1-888-926-5180

Plan: (HMO) CommunityCare HMO Gold $30/$60/$6000/$375 with Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net of Arizona, Inc.)

Deductible: Individual: $500 : Family: $1,000
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		 $254.53
$288.90
$325.29
$454.60
$690.80		 $509.06
$577.80
$650.58
$909.20
$1381.60		 $670.69
$739.43
$812.21
$1070.83		 $832.32
$901.06
$973.84
$1232.46		 $993.95
$1062.69
$1135.47
$1394.09		 $416.16
$450.53
$486.92
$616.23		 $577.79
$612.16
$648.55
$777.86		 $739.42
$773.79
$810.18
$939.49		 $161.63

Plan: (HMO) CommunityCare HMO Silver $30/$50/$4500 with Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net of Arizona, Inc.)

Deductible: Individual: $4,500 : Family: $9,000
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
Silver 21
30
40
50
60		 $219.77
$249.43
$280.86
$392.50
$596.44		 $439.54
$498.86
$561.72
$785.00
$1192.88		 $579.09
$638.41
$701.27
$924.55		 $718.64
$777.96
$840.82
$1064.10		 $858.19
$917.51
$980.37
$1203.65		 $359.32
$388.98
$420.41
$532.05		 $498.87
$528.53
$559.96
$671.60		 $638.42
$668.08
$699.51
$811.15		 $139.55

Plan: (HMO) CommunityCare HMO Gold $30/$60/$6000/$375 without Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net of Arizona, Inc.)

Deductible: Individual: $500 : Family: $1,000
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		 $250.56
$284.38
$320.21
$447.50
$680.01		 $501.12
$568.76
$640.42
$895.00
$1360.02		 $660.22
$727.86
$799.52
$1054.10		 $819.32
$886.96
$958.62
$1213.20		 $978.42
$1046.06
$1117.72
$1372.30		 $409.66
$443.48
$479.31
$606.60		 $568.76
$602.58
$638.41
$765.70		 $727.86
$761.68
$797.51
$924.80		 $159.10

Plan: (HMO) CommunityCare HMO Silver $30/$50/$4500 without Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net of Arizona, Inc.)

Deductible: Individual: $4,500 : Family: $9,000
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
Silver 21
30
40
50
60		 $216.33
$245.54
$276.47
$386.37
$587.13		 $432.66
$491.08
$552.94
$772.74
$1174.26		 $570.03
$628.45
$690.31
$910.11		 $707.40
$765.82
$827.68
$1047.48		 $844.77
$903.19
$965.05
$1184.85		 $353.70
$382.91
$413.84
$523.74		 $491.07
$520.28
$551.21
$661.11		 $628.44
$657.65
$688.58
$798.48		 $137.37

Plan: (HMO) CommunityCare HMO Bronze 40%/40%/$5750 with Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net of Arizona, Inc.)

Deductible: Individual: $5,750 : Family: $11,500
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
Bronze 21
30
40
50
60		 $198.25
$225.02
$253.37
$354.08
$538.06		 $396.50
$450.04
$506.74
$708.16
$1076.12		 $522.39
$575.93
$632.63
$834.05		 $648.28
$701.82
$758.52
$959.94		 $774.17
$827.71
$884.41
$1085.83		 $324.14
$350.91
$379.26
$479.97		 $450.03
$476.80
$505.15
$605.86		 $575.92
$602.69
$631.04
$731.75		 $125.89

Plan: (HMO) CommunityCare HMO Bronze 40%/40%/$5750 without Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-288-9085 - Provider Directory for This Plan: (Health Net of Arizona, Inc.)

Deductible: Individual: $5,750 : Family: $11,500
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
Bronze 21
30
40
50
60		 $195.16
$221.50
$249.41
$348.55
$529.66		 $390.32
$443.00
$498.82
$697.10
$1059.32		 $514.24
$566.92
$622.74
$821.02		 $638.16
$690.84
$746.66
$944.94		 $762.08
$814.76
$870.58
$1068.86		 $319.08
$345.42
$373.33
$472.47		 $443.00
$469.34
$497.25
$596.39		 $566.92
$593.26
$621.17
$720.31		 $123.92
ADVERTISEMENT

Cigna HealthCare of Arizona, Inc

Local: 1-877-900-1237 | Toll Free: 1-877-900-1237

Plan: (HMO) Cigna Connect HSA Bronze 6000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna HealthCare of Arizona, Inc)

Deductible: Individual: $6,000 : Family: $12,000
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
Bronze 21
30
40
50
60		 $172.06
$195.29
$219.89
$307.30
$466.97		 $344.12
$390.58
$439.78
$614.60
$933.94		 $453.38
$499.84
$549.04
$723.86		 $562.64
$609.10
$658.30
$833.12		 $671.90
$718.36
$767.56
$942.38		 $281.32
$304.55
$329.15
$416.56		 $390.58
$413.81
$438.41
$525.82		 $499.84
$523.07
$547.67
$635.08		 $109.26

Plan: (HMO) Cigna Connect Flex Bronze 6400

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna HealthCare of Arizona, Inc)

Deductible: Individual: $6,400 : Family: $12,800
Out of Pocket Maximum per year: Individual: $6,700 : Family: $13,400

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
Bronze 21
30
40
50
60		 $177.14
$201.06
$226.39
$316.38
$480.77		 $354.28
$402.12
$452.78
$632.76
$961.54		 $466.77
$514.61
$565.27
$745.25		 $579.26
$627.10
$677.76
$857.74		 $691.75
$739.59
$790.25
$970.23		 $289.63
$313.55
$338.88
$428.87		 $402.12
$426.04
$451.37
$541.36		 $514.61
$538.53
$563.86
$653.85		 $112.49

Plan: (HMO) Cigna Connect HSA Silver 2700

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna HealthCare of Arizona, Inc)

Deductible: Individual: $2,700 : Family: $5,400
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		 $202.83
$230.21
$259.21
$362.25
$550.47		 $405.66
$460.42
$518.42
$724.50
$1100.94		 $534.46
$589.22
$647.22
$853.30		 $663.26
$718.02
$776.02
$982.10		 $792.06
$846.82
$904.82
$1110.90		 $331.63
$359.01
$388.01
$491.05		 $460.43
$487.81
$516.81
$619.85		 $589.23
$616.61
$645.61
$748.65		 $128.80

Plan: (HMO) Cigna Connect Flex Silver 3000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna HealthCare of Arizona, Inc)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,700 : Family: $13,400

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		 $219.85
$249.53
$280.97
$392.66
$596.68		 $439.70
$499.06
$561.94
$785.32
$1193.36		 $579.31
$638.67
$701.55
$924.93		 $718.92
$778.28
$841.16
$1064.54		 $858.53
$917.89
$980.77
$1204.15		 $359.46
$389.14
$420.58
$532.27		 $499.07
$528.75
$560.19
$671.88		 $638.68
$668.36
$699.80
$811.49		 $139.61

Plan: (HMO) Cigna Connect Flex Silver 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna HealthCare of Arizona, Inc)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,700 : Family: $13,400

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		 $211.11
$239.61
$269.79
$377.04
$572.94		 $422.22
$479.22
$539.58
$754.08
$1145.88		 $556.27
$613.27
$673.63
$888.13		 $690.32
$747.32
$807.68
$1022.18		 $824.37
$881.37
$941.73
$1156.23		 $345.16
$373.66
$403.84
$511.09		 $479.21
$507.71
$537.89
$645.14		 $613.26
$641.76
$671.94
$779.19		 $134.05

Plan: (HMO) Cigna Connect Flex Silver 5000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna HealthCare of Arizona, Inc)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,700 : Family: $13,400

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		 $209.26
$237.51
$267.43
$373.73
$567.93		 $418.52
$475.02
$534.86
$747.46
$1135.86		 $551.40
$607.90
$667.74
$880.34		 $684.28
$740.78
$800.62
$1013.22		 $817.16
$873.66
$933.50
$1146.10		 $342.14
$370.39
$400.31
$506.61		 $475.02
$503.27
$533.19
$639.49		 $607.90
$636.15
$666.07
$772.37		 $132.88

Plan: (HMO) Cigna Connect Flex Gold 1500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna HealthCare of Arizona, Inc)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

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		 $259.41
$294.43
$331.53
$463.31
$704.04		 $518.82
$588.86
$663.06
$926.62
$1408.08		 $683.55
$753.59
$827.79
$1091.35		 $848.28
$918.32
$992.52
$1256.08		 $1013.01
$1083.05
$1157.25
$1420.81		 $424.14
$459.16
$496.26
$628.04		 $588.87
$623.89
$660.99
$792.77		 $753.60
$788.62
$825.72
$957.50		 $164.73
ADVERTISEMENT

All Savers Insurance Company

Local: 1-877-512-9939 | Toll Free: 1-877-512-9939

Plan: (PPO) Bronze Compass Plus 6500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9939 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $6,500 : Family: $13,000
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		 $177.45
$201.40
$226.78
$316.92
$481.59		 $354.90
$402.80
$453.56
$633.84
$963.18		 $467.58
$515.48
$566.24
$746.52		 $580.26
$628.16
$678.92
$859.20		 $692.94
$740.84
$791.60
$971.88		 $290.13
$314.08
$339.46
$429.60		 $402.81
$426.76
$452.14
$542.28		 $515.49
$539.44
$564.82
$654.96		 $112.68

Plan: (PPO) Bronze Compass Plus HSA 5500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9939 - Provider Directory for This Plan: (All Savers Insurance Company)

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
Bronze 21
30
40
50
60		 $168.77
$191.55
$215.69
$301.42
$458.04		 $337.54
$383.10
$431.38
$602.84
$916.08		 $444.71
$490.27
$538.55
$710.01		 $551.88
$597.44
$645.72
$817.18		 $659.05
$704.61
$752.89
$924.35		 $275.94
$298.72
$322.86
$408.59		 $383.11
$405.89
$430.03
$515.76		 $490.28
$513.06
$537.20
$622.93		 $107.17

Plan: (PPO) Catastrophic Compass Plus 6850

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9939 - Provider Directory for This Plan: (All Savers 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
Catastrophic 21
30
40
50
60		 $156.58
$177.72
$200.11
$279.66
$424.96		 $313.16
$355.44
$400.22
$559.32
$849.92		 $412.59
$454.87
$499.65
$658.75		 $512.02
$554.30
$599.08
$758.18		 $611.45
$653.73
$698.51
$857.61		 $256.01
$277.15
$299.54
$379.09		 $355.44
$376.58
$398.97
$478.52		 $454.87
$476.01
$498.40
$577.95		 $99.43

Plan: (PPO) Gold Compass Plus 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9939 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $1,000 : Family: $2,000
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		 $233.43
$264.94
$298.32
$416.90
$633.52		 $466.86
$529.88
$596.64
$833.80
$1267.04		 $615.09
$678.11
$744.87
$982.03		 $763.32
$826.34
$893.10
$1130.26		 $911.55
$974.57
$1041.33
$1278.49		 $381.66
$413.17
$446.55
$565.13		 $529.89
$561.40
$594.78
$713.36		 $678.12
$709.63
$743.01
$861.59		 $148.23

Plan: (PPO) Gold Compass Plus 500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9939 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $500 : Family: $1,000
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		 $232.81
$264.24
$297.53
$415.79
$631.84		 $465.62
$528.48
$595.06
$831.58
$1263.68		 $613.45
$676.31
$742.89
$979.41		 $761.28
$824.14
$890.72
$1127.24		 $909.11
$971.97
$1038.55
$1275.07		 $380.64
$412.07
$445.36
$563.62		 $528.47
$559.90
$593.19
$711.45		 $676.30
$707.73
$741.02
$859.28		 $147.83

Plan: (PPO) Silver Compass Plus 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9939 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $2,000 : Family: $4,000
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		 $203.27
$230.71
$259.78
$363.04
$551.67		 $406.54
$461.42
$519.56
$726.08
$1103.34		 $535.61
$590.49
$648.63
$855.15		 $664.68
$719.56
$777.70
$984.22		 $793.75
$848.63
$906.77
$1113.29		 $332.34
$359.78
$388.85
$492.11		 $461.41
$488.85
$517.92
$621.18		 $590.48
$617.92
$646.99
$750.25		 $129.07

Plan: (PPO) Silver Compass Plus HSA 3000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9939 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $3,000 : Family: $6,000
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		 $194.59
$220.86
$248.69
$347.54
$528.12		 $389.18
$441.72
$497.38
$695.08
$1056.24		 $512.75
$565.29
$620.95
$818.65		 $636.32
$688.86
$744.52
$942.22		 $759.89
$812.43
$868.09
$1065.79		 $318.16
$344.43
$372.26
$471.11		 $441.73
$468.00
$495.83
$594.68		 $565.30
$591.57
$619.40
$718.25		 $123.57

Plan: (PPO) Silver Compass Plus 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9939 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $3,500 : Family: $7,000
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		 $204.30
$231.88
$261.10
$364.88
$554.47		 $408.60
$463.76
$522.20
$729.76
$1108.94		 $538.33
$593.49
$651.93
$859.49		 $668.06
$723.22
$781.66
$989.22		 $797.79
$852.95
$911.39
$1118.95		 $334.03
$361.61
$390.83
$494.61		 $463.76
$491.34
$520.56
$624.34		 $593.49
$621.07
$650.29
$754.07		 $129.73

Plan: (PPO) Silver Compass Plus 2000-1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9939 - Provider Directory for This Plan: (All Savers Insurance Company)

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		 $202.23
$229.54
$258.46
$361.19
$548.87		 $404.46
$459.08
$516.92
$722.38
$1097.74		 $532.88
$587.50
$645.34
$850.80		 $661.30
$715.92
$773.76
$979.22		 $789.72
$844.34
$902.18
$1107.64		 $330.65
$357.96
$386.88
$489.61		 $459.07
$486.38
$515.30
$618.03		 $587.49
$614.80
$643.72
$746.45		 $128.42

Plan: (PPO) Gold Compass Plus 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9939 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $0 : Family: $0
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		 $231.77
$263.06
$296.21
$413.95
$629.04		 $463.54
$526.12
$592.42
$827.90
$1258.08		 $610.72
$673.30
$739.60
$975.08		 $757.90
$820.48
$886.78
$1122.26		 $905.08
$967.66
$1033.96
$1269.44		 $378.95
$410.24
$443.39
$561.13		 $526.13
$557.42
$590.57
$708.31		 $673.31
$704.60
$737.75
$855.49		 $147.18

Plan: (PPO) Silver Compass Plus 4500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9939 - Provider Directory for This Plan: (All Savers Insurance Company)

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		 $209.46
$237.74
$267.70
$374.10
$568.49		 $418.92
$475.48
$535.40
$748.20
$1136.98		 $551.93
$608.49
$668.41
$881.21		 $684.94
$741.50
$801.42
$1014.22		 $817.95
$874.51
$934.43
$1147.23		 $342.47
$370.75
$400.71
$507.11		 $475.48
$503.76
$533.72
$640.12		 $608.49
$636.77
$666.73
$773.13		 $133.01

†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 Maricopa County here.

 

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