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Providers for Zip Code 45177

LegalConsumer.com/obamacare

ObamacareByZipCode.com

Obamacare 2016 Marketplace Rates For Wilmington, OH

Tuesday, April 16th, 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 Wilmington, OH.

Obamacare Providers, Plans and 2016 Rates for Clinton County

Clinton County is in “Rating Area 5” of Ohio.

Currently, there are 5 providers offering 35 plans to Rating Area 5. †

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 Wilmington, OH area accept this insurance coverage as within the plan's "network".
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Coordinated Health Mutual, Inc.

Local: 1-614-212-6004 x4889 | Toll Free: 1-800-580-8502

TTY: 1-800-545-8279

Plan: (PPO) 2016 Gold 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (Coordinated Health Mutual, Inc.)

Deductible: Individual: $2,000 : Family: $4,000
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		 $328.37
$372.70
$419.66
$586.47
$891.20		 $656.74
$745.40
$839.32
$1172.94
$1782.40		 $865.25
$953.91
$1047.83
$1381.45		 $1073.76
$1162.42
$1256.34
$1589.96		 $1282.27
$1370.93
$1464.85
$1798.47		 $536.88
$581.21
$628.17
$794.98		 $745.39
$789.72
$836.68
$1003.49		 $953.90
$998.23
$1045.19
$1212.00		 $208.51

Plan: (PPO) 2016 Silver 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (Coordinated Health Mutual, Inc.)

Deductible: Individual: $2,250 : Family: $4,500
Out of Pocket Maximum per year: Individual: $6,750 : Family: $13,500

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		 $296.87
$336.95
$379.40
$530.21
$805.71		 $593.74
$673.90
$758.80
$1060.42
$1611.42		 $782.25
$862.41
$947.31
$1248.93		 $970.76
$1050.92
$1135.82
$1437.44		 $1159.27
$1239.43
$1324.33
$1625.95		 $485.38
$525.46
$567.91
$718.72		 $673.89
$713.97
$756.42
$907.23		 $862.40
$902.48
$944.93
$1095.74		 $188.51

Plan: (PPO) 2016 Bronze 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (Coordinated Health Mutual, Inc.)

Deductible: Individual: $6,300 : Family: $12,600
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		 $243.85
$276.77
$311.64
$435.52
$661.81		 $487.70
$553.54
$623.28
$871.04
$1323.62		 $642.54
$708.38
$778.12
$1025.88		 $797.38
$863.22
$932.96
$1180.72		 $952.22
$1018.06
$1087.80
$1335.56		 $398.69
$431.61
$466.48
$590.36		 $553.53
$586.45
$621.32
$745.20		 $708.37
$741.29
$776.16
$900.04		 $154.84

Plan: (PPO) 2016 Gold 2

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (Coordinated Health Mutual, Inc.)

Deductible: Individual: $1,250 : Family: $2,500
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		 $339.76
$385.63
$434.22
$606.81
$922.11		 $679.52
$771.26
$868.44
$1213.62
$1844.22		 $895.27
$987.01
$1084.19
$1429.37		 $1111.02
$1202.76
$1299.94
$1645.12		 $1326.77
$1418.51
$1515.69
$1860.87		 $555.51
$601.38
$649.97
$822.56		 $771.26
$817.13
$865.72
$1038.31		 $987.01
$1032.88
$1081.47
$1254.06		 $215.75

Plan: (PPO) 2016 Gold 3 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (Coordinated Health Mutual, Inc.)

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

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		 $322.80
$366.38
$412.54
$576.52
$876.08		 $645.60
$732.76
$825.08
$1153.04
$1752.16		 $850.58
$937.74
$1030.06
$1358.02		 $1055.56
$1142.72
$1235.04
$1563.00		 $1260.54
$1347.70
$1440.02
$1767.98		 $527.78
$571.36
$617.52
$781.50		 $732.76
$776.34
$822.50
$986.48		 $937.74
$981.32
$1027.48
$1191.46		 $204.98

Plan: (PPO) 2016 Silver 2 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (Coordinated Health Mutual, Inc.)

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

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		 $274.59
$311.65
$350.92
$490.41
$745.23		 $549.18
$623.30
$701.84
$980.82
$1490.46		 $723.54
$797.66
$876.20
$1155.18		 $897.90
$972.02
$1050.56
$1329.54		 $1072.26
$1146.38
$1224.92
$1503.90		 $448.95
$486.01
$525.28
$664.77		 $623.31
$660.37
$699.64
$839.13		 $797.67
$834.73
$874.00
$1013.49		 $174.36

Plan: (PPO) 2016 Bronze 2 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (Coordinated Health Mutual, Inc.)

Deductible: Individual: $6,250 : Family: $12,500
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
Bronze 21
30
40
50
60		 $230.02
$261.08
$293.97
$410.82
$624.29		 $460.04
$522.16
$587.94
$821.64
$1248.58		 $606.11
$668.23
$734.01
$967.71		 $752.18
$814.30
$880.08
$1113.78		 $898.25
$960.37
$1026.15
$1259.85		 $376.09
$407.15
$440.04
$556.89		 $522.16
$553.22
$586.11
$702.96		 $668.23
$699.29
$732.18
$849.03		 $146.07

Plan: (PPO) 2016 Catastrophic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (Coordinated Health Mutual, 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		 $174.12
$197.63
$222.53
$310.98
$472.56		 $348.24
$395.26
$445.06
$621.96
$945.12		 $458.81
$505.83
$555.63
$732.53		 $569.38
$616.40
$666.20
$843.10		 $679.95
$726.97
$776.77
$953.67		 $284.69
$308.20
$333.10
$421.55		 $395.26
$418.77
$443.67
$532.12		 $505.83
$529.34
$554.24
$642.69		 $110.57

Plan: (PPO) 2016 Silver 3 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8502 - Provider Directory for This Plan: (Coordinated Health Mutual, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
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		 $297.16
$337.28
$379.78
$530.74
$806.50		 $594.32
$674.56
$759.56
$1061.48
$1613.00		 $783.02
$863.26
$948.26
$1250.18		 $971.72
$1051.96
$1136.96
$1438.88		 $1160.42
$1240.66
$1325.66
$1627.58		 $485.86
$525.98
$568.48
$719.44		 $674.56
$714.68
$757.18
$908.14		 $863.26
$903.38
$945.88
$1096.84		 $188.70
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Community Insurance Company(Anthem BCBS)

Local: 1-855-748-1808 | Toll Free: 1-855-748-1808

Plan: (PPO) Anthem Catastrophic Pathway X PPO 6850 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

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		 $193.64
$219.78
$247.47
$345.84
$525.54		 $387.28
$439.56
$494.94
$691.68
$1051.08		 $510.24
$562.52
$617.90
$814.64		 $633.20
$685.48
$740.86
$937.60		 $756.16
$808.44
$863.82
$1060.56		 $316.60
$342.74
$370.43
$468.80		 $439.56
$465.70
$493.39
$591.76		 $562.52
$588.66
$616.35
$714.72		 $122.96

Plan: (PPO) Anthem Bronze Pathway X PPO 0 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

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		 $240.94
$273.47
$307.92
$430.32
$653.91		 $481.88
$546.94
$615.84
$860.64
$1307.82		 $634.88
$699.94
$768.84
$1013.64		 $787.88
$852.94
$921.84
$1166.64		 $940.88
$1005.94
$1074.84
$1319.64		 $393.94
$426.47
$460.92
$583.32		 $546.94
$579.47
$613.92
$736.32		 $699.94
$732.47
$766.92
$889.32		 $153.00

Plan: (PPO) Anthem Bronze Pathway X PPO 5000 25

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

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		 $232.29
$263.65
$296.87
$414.87
$630.44		 $464.58
$527.30
$593.74
$829.74
$1260.88		 $612.08
$674.80
$741.24
$977.24		 $759.58
$822.30
$888.74
$1124.74		 $907.08
$969.80
$1036.24
$1272.24		 $379.79
$411.15
$444.37
$562.37		 $527.29
$558.65
$591.87
$709.87		 $674.79
$706.15
$739.37
$857.37		 $147.50

Plan: (PPO) Anthem Bronze Pathway X PPO 5000 30

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

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		 $230.23
$261.31
$294.23
$411.19
$624.84		 $460.46
$522.62
$588.46
$822.38
$1249.68		 $606.66
$668.82
$734.66
$968.58		 $752.86
$815.02
$880.86
$1114.78		 $899.06
$961.22
$1027.06
$1260.98		 $376.43
$407.51
$440.43
$557.39		 $522.63
$553.71
$586.63
$703.59		 $668.83
$699.91
$732.83
$849.79		 $146.20

Plan: (PPO) Anthem Bronze Pathway X PPO 6500 20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

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		 $238.67
$270.89
$305.02
$426.26
$647.75		 $477.34
$541.78
$610.04
$852.52
$1295.50		 $628.90
$693.34
$761.60
$1004.08		 $780.46
$844.90
$913.16
$1155.64		 $932.02
$996.46
$1064.72
$1307.20		 $390.23
$422.45
$456.58
$577.82		 $541.79
$574.01
$608.14
$729.38		 $693.35
$725.57
$759.70
$880.94		 $151.56

Plan: (PPO) Anthem Bronze Pathway X PPO 5550 20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

Deductible: Individual: $5,550 : Family: $11,100
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		 $239.97
$272.37
$306.68
$428.59
$651.28		 $479.94
$544.74
$613.36
$857.18
$1302.56		 $632.32
$697.12
$765.74
$1009.56		 $784.70
$849.50
$918.12
$1161.94		 $937.08
$1001.88
$1070.50
$1314.32		 $392.35
$424.75
$459.06
$580.97		 $544.73
$577.13
$611.44
$733.35		 $697.11
$729.51
$763.82
$885.73		 $152.38

Plan: (PPO) Anthem Silver Pathway X PPO 3000 10

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

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		 $276.85
$314.22
$353.81
$494.45
$751.37		 $553.70
$628.44
$707.62
$988.90
$1502.74		 $729.50
$804.24
$883.42
$1164.70		 $905.30
$980.04
$1059.22
$1340.50		 $1081.10
$1155.84
$1235.02
$1516.30		 $452.65
$490.02
$529.61
$670.25		 $628.45
$665.82
$705.41
$846.05		 $804.25
$841.62
$881.21
$1021.85		 $175.80

Plan: (PPO) Anthem Silver Pathway X PPO 10 for HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

Deductible: Individual: $2,600 : Family: $5,200
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		 $290.44
$329.65
$371.18
$518.73
$788.25		 $580.88
$659.30
$742.36
$1037.46
$1576.50		 $765.31
$843.73
$926.79
$1221.89		 $949.74
$1028.16
$1111.22
$1406.32		 $1134.17
$1212.59
$1295.65
$1590.75		 $474.87
$514.08
$555.61
$703.16		 $659.30
$698.51
$740.04
$887.59		 $843.73
$882.94
$924.47
$1072.02		 $184.43

Plan: (PPO) Anthem Silver Pathway X PPO 3750 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

Deductible: Individual: $3,750 : Family: $7,500
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		 $294.09
$333.79
$375.85
$525.24
$798.16		 $588.18
$667.58
$751.70
$1050.48
$1596.32		 $774.93
$854.33
$938.45
$1237.23		 $961.68
$1041.08
$1125.20
$1423.98		 $1148.43
$1227.83
$1311.95
$1610.73		 $480.84
$520.54
$562.60
$711.99		 $667.59
$707.29
$749.35
$898.74		 $854.34
$894.04
$936.10
$1085.49		 $186.75

Plan: (PPO) Anthem Silver Pathway X PPO 2000 20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

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		 $288.36
$327.29
$368.52
$515.01
$782.61		 $576.72
$654.58
$737.04
$1030.02
$1565.22		 $759.83
$837.69
$920.15
$1213.13		 $942.94
$1020.80
$1103.26
$1396.24		 $1126.05
$1203.91
$1286.37
$1579.35		 $471.47
$510.40
$551.63
$698.12		 $654.58
$693.51
$734.74
$881.23		 $837.69
$876.62
$917.85
$1064.34		 $183.11

Plan: (PPO) Anthem Silver Pathway X PPO 2500 10

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

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		 $289.78
$328.90
$370.34
$517.55
$786.46		 $579.56
$657.80
$740.68
$1035.10
$1572.92		 $763.57
$841.81
$924.69
$1219.11		 $947.58
$1025.82
$1108.70
$1403.12		 $1131.59
$1209.83
$1292.71
$1587.13		 $473.79
$512.91
$554.35
$701.56		 $657.80
$696.92
$738.36
$885.57		 $841.81
$880.93
$922.37
$1069.58		 $184.01

Plan: (PPO) Anthem Gold Pathway X PPO 1250 10

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

Deductible: Individual: $1,250 : Family: $2,500
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
Gold 21
30
40
50
60		 $342.26
$388.47
$437.41
$611.28
$928.89		 $684.52
$776.94
$874.82
$1222.56
$1857.78		 $901.86
$994.28
$1092.16
$1439.90		 $1119.20
$1211.62
$1309.50
$1657.24		 $1336.54
$1428.96
$1526.84
$1874.58		 $559.60
$605.81
$654.75
$828.62		 $776.94
$823.15
$872.09
$1045.96		 $994.28
$1040.49
$1089.43
$1263.30		 $217.34

Plan: (PPO) Anthem Silver Pathway X PPO 3500 25

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

Deductible: Individual: $3,500 : Family: $7,000
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
Silver 21
30
40
50
60		 $277.32
$314.76
$354.41
$495.29
$752.65		 $554.64
$629.52
$708.82
$990.58
$1505.30		 $730.74
$805.62
$884.92
$1166.68		 $906.84
$981.72
$1061.02
$1342.78		 $1082.94
$1157.82
$1237.12
$1518.88		 $453.42
$490.86
$530.51
$671.39		 $629.52
$666.96
$706.61
$847.49		 $805.62
$843.06
$882.71
$1023.59		 $176.10

Plan: (PPO) Anthem Silver Pathway X PPO 2200 15

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

Deductible: Individual: $2,200 : Family: $4,400
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
Silver 21
30
40
50
60		 $291.52
$330.88
$372.56
$520.65
$791.19		 $583.04
$661.76
$745.12
$1041.30
$1582.38		 $768.16
$846.88
$930.24
$1226.42		 $953.28
$1032.00
$1115.36
$1411.54		 $1138.40
$1217.12
$1300.48
$1596.66		 $476.64
$516.00
$557.68
$705.77		 $661.76
$701.12
$742.80
$890.89		 $846.88
$886.24
$927.92
$1076.01		 $185.12

Plan: (PPO) Anthem Bronze Pathway X PPO 5850 35

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

Deductible: Individual: $5,850 : Family: $11,700
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		 $223.92
$254.15
$286.17
$399.92
$607.72		 $447.84
$508.30
$572.34
$799.84
$1215.44		 $590.03
$650.49
$714.53
$942.03		 $732.22
$792.68
$856.72
$1084.22		 $874.41
$934.87
$998.91
$1226.41		 $366.11
$396.34
$428.36
$542.11		 $508.30
$538.53
$570.55
$684.30		 $650.49
$680.72
$712.74
$826.49		 $142.19

Plan: (HMO) Anthem Bronze Pathway X HMO 5000 40

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

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		 $202.32
$229.63
$258.56
$361.34
$549.10		 $404.64
$459.26
$517.12
$722.68
$1098.20		 $533.11
$587.73
$645.59
$851.15		 $661.58
$716.20
$774.06
$979.62		 $790.05
$844.67
$902.53
$1108.09		 $330.79
$358.10
$387.03
$489.81		 $459.26
$486.57
$515.50
$618.28		 $587.73
$615.04
$643.97
$746.75		 $128.47

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

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		 $209.32
$237.58
$267.51
$373.85
$568.09		 $418.64
$475.16
$535.02
$747.70
$1136.18		 $551.56
$608.08
$667.94
$880.62		 $684.48
$741.00
$800.86
$1013.54		 $817.40
$873.92
$933.78
$1146.46		 $342.24
$370.50
$400.43
$506.77		 $475.16
$503.42
$533.35
$639.69		 $608.08
$636.34
$666.27
$772.61		 $132.92

Plan: (HMO) Anthem Bronze Pathway X HMO 6850 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

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		 $209.48
$237.76
$267.72
$374.13
$568.53		 $418.96
$475.52
$535.44
$748.26
$1137.06		 $551.98
$608.54
$668.46
$881.28		 $685.00
$741.56
$801.48
$1014.30		 $818.02
$874.58
$934.50
$1147.32		 $342.50
$370.78
$400.74
$507.15		 $475.52
$503.80
$533.76
$640.17		 $608.54
$636.82
$666.78
$773.19		 $133.02

Plan: (HMO) Anthem Silver Pathway X HMO 4250 30

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

Deductible: Individual: $4,250 : Family: $8,500
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		 $240.89
$273.41
$307.86
$430.23
$653.78		 $481.78
$546.82
$615.72
$860.46
$1307.56		 $634.75
$699.79
$768.69
$1013.43		 $787.72
$852.76
$921.66
$1166.40		 $940.69
$1005.73
$1074.63
$1319.37		 $393.86
$426.38
$460.83
$583.20		 $546.83
$579.35
$613.80
$736.17		 $699.80
$732.32
$766.77
$889.14		 $152.97

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

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		 $253.64
$287.88
$324.15
$453.00
$688.38		 $507.28
$575.76
$648.30
$906.00
$1376.76		 $668.34
$736.82
$809.36
$1067.06		 $829.40
$897.88
$970.42
$1228.12		 $990.46
$1058.94
$1131.48
$1389.18		 $414.70
$448.94
$485.21
$614.06		 $575.76
$610.00
$646.27
$775.12		 $736.82
$771.06
$807.33
$936.18		 $161.06

Plan: (HMO) Anthem Silver Pathway X HMO 2850 15

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

Deductible: Individual: $2,850 : Family: $5,700
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
Silver 21
30
40
50
60		 $249.44
$283.11
$318.78
$445.50
$676.98		 $498.88
$566.22
$637.56
$891.00
$1353.96		 $657.27
$724.61
$795.95
$1049.39		 $815.66
$883.00
$954.34
$1207.78		 $974.05
$1041.39
$1112.73
$1366.17		 $407.83
$441.50
$477.17
$603.89		 $566.22
$599.89
$635.56
$762.28		 $724.61
$758.28
$793.95
$920.67		 $158.39

Plan: (HMO) Anthem Gold Pathway X HMO 1450 20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

Deductible: Individual: $1,450 : Family: $2,900
Out of Pocket Maximum per year: Individual: $3,100 : Family: $6,200

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		 $301.16
$341.82
$384.88
$537.87
$817.35		 $602.32
$683.64
$769.76
$1075.74
$1634.70		 $793.56
$874.88
$961.00
$1266.98		 $984.80
$1066.12
$1152.24
$1458.22		 $1176.04
$1257.36
$1343.48
$1649.46		 $492.40
$533.06
$576.12
$729.11		 $683.64
$724.30
$767.36
$920.35		 $874.88
$915.54
$958.60
$1111.59		 $191.24

Plan: (HMO) Anthem Gold Pathway HMO X 1150 10

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS))

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		 $312.88
$355.12
$399.86
$558.80
$849.16		 $625.76
$710.24
$799.72
$1117.60
$1698.32		 $824.44
$908.92
$998.40
$1316.28		 $1023.12
$1107.60
$1197.08
$1514.96		 $1221.80
$1306.28
$1395.76
$1713.64		 $511.56
$553.80
$598.54
$757.48		 $710.24
$752.48
$797.22
$956.16		 $908.92
$951.16
$995.90
$1154.84		 $198.68
ADVERTISEMENT

UnitedHealthcare of Ohio, Inc.

Local: 1-877-760-3310 | Toll Free: 1-877-760-3310

Plan: (HMO) Gold Compass 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-760-3310 - Provider Directory for This Plan: (UnitedHealthcare of Ohio, Inc.)

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		 $292.62
$332.13
$373.97
$522.62
$794.18		 $585.24
$664.26
$747.94
$1045.24
$1588.36		 $771.06
$850.08
$933.76
$1231.06		 $956.88
$1035.90
$1119.58
$1416.88		 $1142.70
$1221.72
$1305.40
$1602.70		 $478.44
$517.95
$559.79
$708.44		 $664.26
$703.77
$745.61
$894.26		 $850.08
$889.59
$931.43
$1080.08		 $185.82

Plan: (HMO) Silver Compass HSA 3000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-760-3310 - Provider Directory for This Plan: (UnitedHealthcare of Ohio, Inc.)

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		 $242.99
$275.79
$310.54
$433.97
$659.46		 $485.98
$551.58
$621.08
$867.94
$1318.92		 $640.28
$705.88
$775.38
$1022.24		 $794.58
$860.18
$929.68
$1176.54		 $948.88
$1014.48
$1083.98
$1330.84		 $397.29
$430.09
$464.84
$588.27		 $551.59
$584.39
$619.14
$742.57		 $705.89
$738.69
$773.44
$896.87		 $154.30

Plan: (HMO) Silver Compass 2000 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-760-3310 - Provider Directory for This Plan: (UnitedHealthcare of Ohio, 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		 $252.86
$287.00
$323.16
$451.61
$686.27		 $505.72
$574.00
$646.32
$903.22
$1372.54		 $666.29
$734.57
$806.89
$1063.79		 $826.86
$895.14
$967.46
$1224.36		 $987.43
$1055.71
$1128.03
$1384.93		 $413.43
$447.57
$483.73
$612.18		 $574.00
$608.14
$644.30
$772.75		 $734.57
$768.71
$804.87
$933.32		 $160.57

Plan: (HMO) Silver Compass 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-760-3310 - Provider Directory for This Plan: (UnitedHealthcare of Ohio, Inc.)

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		 $254.94
$289.36
$325.81
$455.32
$691.91		 $509.88
$578.72
$651.62
$910.64
$1383.82		 $671.77
$740.61
$813.51
$1072.53		 $833.66
$902.50
$975.40
$1234.42		 $995.55
$1064.39
$1137.29
$1396.31		 $416.83
$451.25
$487.70
$617.21		 $578.72
$613.14
$649.59
$779.10		 $740.61
$775.03
$811.48
$940.99		 $161.89

Plan: (HMO) Silver Compass 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-760-3310 - Provider Directory for This Plan: (UnitedHealthcare of Ohio, Inc.)

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		 $256.76
$291.42
$328.14
$458.57
$696.85		 $513.52
$582.84
$656.28
$917.14
$1393.70		 $676.56
$745.88
$819.32
$1080.18		 $839.60
$908.92
$982.36
$1243.22		 $1002.64
$1071.96
$1145.40
$1406.26		 $419.80
$454.46
$491.18
$621.61		 $582.84
$617.50
$654.22
$784.65		 $745.88
$780.54
$817.26
$947.69		 $163.04

Plan: (HMO) Silver Compass 4500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-760-3310 - Provider Directory for This Plan: (UnitedHealthcare of Ohio, Inc.)

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		 $262.48
$297.91
$335.45
$468.78
$712.36		 $524.96
$595.82
$670.90
$937.56
$1424.72		 $691.63
$762.49
$837.57
$1104.23		 $858.30
$929.16
$1004.24
$1270.90		 $1024.97
$1095.83
$1170.91
$1437.57		 $429.15
$464.58
$502.12
$635.45		 $595.82
$631.25
$668.79
$802.12		 $762.49
$797.92
$835.46
$968.79		 $166.67

Plan: (HMO) Bronze Compass HSA 5500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-760-3310 - Provider Directory for This Plan: (UnitedHealthcare of Ohio, 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		 $212.06
$240.69
$271.01
$378.74
$575.53		 $424.12
$481.38
$542.02
$757.48
$1151.06		 $558.78
$616.04
$676.68
$892.14		 $693.44
$750.70
$811.34
$1026.80		 $828.10
$885.36
$946.00
$1161.46		 $346.72
$375.35
$405.67
$513.40		 $481.38
$510.01
$540.33
$648.06		 $616.04
$644.67
$674.99
$782.72		 $134.66

Plan: (HMO) Bronze Compass 6500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-760-3310 - Provider Directory for This Plan: (UnitedHealthcare of Ohio, Inc.)

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		 $223.50
$253.67
$285.63
$399.16
$606.57		 $447.00
$507.34
$571.26
$798.32
$1213.14		 $588.92
$649.26
$713.18
$940.24		 $730.84
$791.18
$855.10
$1082.16		 $872.76
$933.10
$997.02
$1224.08		 $365.42
$395.59
$427.55
$541.08		 $507.34
$537.51
$569.47
$683.00		 $649.26
$679.43
$711.39
$824.92		 $141.92

Plan: (HMO) Gold Compass 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-760-3310 - Provider Directory for This Plan: (UnitedHealthcare of Ohio, Inc.)

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		 $288.21
$327.11
$368.33
$514.73
$782.19		 $576.42
$654.22
$736.66
$1029.46
$1564.38		 $759.43
$837.23
$919.67
$1212.47		 $942.44
$1020.24
$1102.68
$1395.48		 $1125.45
$1203.25
$1285.69
$1578.49		 $471.22
$510.12
$551.34
$697.74		 $654.23
$693.13
$734.35
$880.75		 $837.24
$876.14
$917.36
$1063.76		 $183.01
ADVERTISEMENT

CareSource

Local: 1-800-479-9502 | Toll Free: 1-800-479-9502

TTY: 1-800-750-0750

Plan: (HMO) CareSource Just4Me Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource)

Deductible: Individual: $1,000 : Family: $2,000
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
Gold 21
30
40
50
60		 $285.78
$324.36
$365.22
$510.40
$775.60		 $571.56
$648.72
$730.44
$1020.80
$1551.20		 $753.03
$830.19
$911.91
$1202.27		 $934.50
$1011.66
$1093.38
$1383.74		 $1115.97
$1193.13
$1274.85
$1565.21		 $467.25
$505.83
$546.69
$691.87		 $648.72
$687.30
$728.16
$873.34		 $830.19
$868.77
$909.63
$1054.81		 $181.47

Plan: (HMO) CareSource Just4Me Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource)

Deductible: Individual: $3,500 : Family: $7,000
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		 $228.16
$258.96
$291.58
$407.49
$619.22		 $456.32
$517.92
$583.16
$814.98
$1238.44		 $601.20
$662.80
$728.04
$959.86		 $746.08
$807.68
$872.92
$1104.74		 $890.96
$952.56
$1017.80
$1249.62		 $373.04
$403.84
$436.46
$552.37		 $517.92
$548.72
$581.34
$697.25		 $662.80
$693.60
$726.22
$842.13		 $144.88

Plan: (HMO) CareSource Just4Me Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource)

Deductible: Individual: $6,650 : Family: $13,300
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		 $189.63
$215.23
$242.34
$338.67
$514.65		 $379.26
$430.46
$484.68
$677.34
$1029.30		 $499.67
$550.87
$605.09
$797.75		 $620.08
$671.28
$725.50
$918.16		 $740.49
$791.69
$845.91
$1038.57		 $310.04
$335.64
$362.75
$459.08		 $430.45
$456.05
$483.16
$579.49		 $550.86
$576.46
$603.57
$699.90		 $120.41

Plan: (HMO) CareSource Just4Me Gold with Dental and Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource)

Deductible: Individual: $1,000 : Family: $2,000
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
Gold 21
30
40
50
60		 $304.68
$345.81
$389.38
$544.15
$826.90		 $609.36
$691.62
$778.76
$1088.30
$1653.80		 $802.83
$885.09
$972.23
$1281.77		 $996.30
$1078.56
$1165.70
$1475.24		 $1189.77
$1272.03
$1359.17
$1668.71		 $498.15
$539.28
$582.85
$737.62		 $691.62
$732.75
$776.32
$931.09		 $885.09
$926.22
$969.79
$1124.56		 $193.47

Plan: (HMO) CareSource Just4Me Silver with Dental and Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource)

Deductible: Individual: $3,500 : Family: $7,000
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		 $247.07
$280.42
$315.75
$441.26
$670.54		 $494.14
$560.84
$631.50
$882.52
$1341.08		 $651.02
$717.72
$788.38
$1039.40		 $807.90
$874.60
$945.26
$1196.28		 $964.78
$1031.48
$1102.14
$1353.16		 $403.95
$437.30
$472.63
$598.14		 $560.83
$594.18
$629.51
$755.02		 $717.71
$751.06
$786.39
$911.90		 $156.88

Plan: (HMO) CareSource Just4Me Bronze with Dental and Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource)

Deductible: Individual: $6,650 : Family: $13,300
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		 $208.53
$236.68
$266.50
$372.43
$565.95		 $417.06
$473.36
$533.00
$744.86
$1131.90		 $549.47
$605.77
$665.41
$877.27		 $681.88
$738.18
$797.82
$1009.68		 $814.29
$870.59
$930.23
$1142.09		 $340.94
$369.09
$398.91
$504.84		 $473.35
$501.50
$531.32
$637.25		 $605.76
$633.91
$663.73
$769.66		 $132.41
ADVERTISEMENT

All Savers Insurance Company

Local: 1-920-661-1111 | Toll Free: 1-800-232-5432

Plan: (POS) Gold Navigate Plus 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - 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		 $338.10
$383.75
$432.10
$603.85
$917.61		 $676.20
$767.50
$864.20
$1207.70
$1835.22		 $890.90
$982.20
$1078.90
$1422.40		 $1105.60
$1196.90
$1293.60
$1637.10		 $1320.30
$1411.60
$1508.30
$1851.80		 $552.80
$598.45
$646.80
$818.55		 $767.50
$813.15
$861.50
$1033.25		 $982.20
$1027.85
$1076.20
$1247.95		 $214.70

Plan: (POS) Gold Navigate Plus 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - 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		 $333.23
$378.22
$425.87
$595.15
$904.39		 $666.46
$756.44
$851.74
$1190.30
$1808.78		 $878.06
$968.04
$1063.34
$1401.90		 $1089.66
$1179.64
$1274.94
$1613.50		 $1301.26
$1391.24
$1486.54
$1825.10		 $544.83
$589.82
$637.47
$806.75		 $756.43
$801.42
$849.07
$1018.35		 $968.03
$1013.02
$1060.67
$1229.95		 $211.60

Plan: (POS) Silver Navigate Plus HSA 3000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - 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		 $280.80
$318.71
$358.86
$501.50
$762.08		 $561.60
$637.42
$717.72
$1003.00
$1524.16		 $739.91
$815.73
$896.03
$1181.31		 $918.22
$994.04
$1074.34
$1359.62		 $1096.53
$1172.35
$1252.65
$1537.93		 $459.11
$497.02
$537.17
$679.81		 $637.42
$675.33
$715.48
$858.12		 $815.73
$853.64
$893.79
$1036.43		 $178.31

Plan: (POS) Silver Navigate Plus 2000 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - 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		 $292.55
$332.04
$373.87
$522.49
$793.97		 $585.10
$664.08
$747.74
$1044.98
$1587.94		 $770.87
$849.85
$933.51
$1230.75		 $956.64
$1035.62
$1119.28
$1416.52		 $1142.41
$1221.39
$1305.05
$1602.29		 $478.32
$517.81
$559.64
$708.26		 $664.09
$703.58
$745.41
$894.03		 $849.86
$889.35
$931.18
$1079.80		 $185.77

Plan: (POS) Silver Navigate Plus 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - 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		 $293.69
$333.34
$375.34
$524.53
$797.08		 $587.38
$666.68
$750.68
$1049.06
$1594.16		 $773.87
$853.17
$937.17
$1235.55		 $960.36
$1039.66
$1123.66
$1422.04		 $1146.85
$1226.15
$1310.15
$1608.53		 $480.18
$519.83
$561.83
$711.02		 $666.67
$706.32
$748.32
$897.51		 $853.16
$892.81
$934.81
$1084.00		 $186.49

Plan: (POS) Silver Navigate Plus 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - 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		 $295.98
$335.94
$378.27
$528.63
$803.30		 $591.96
$671.88
$756.54
$1057.26
$1606.60		 $779.91
$859.83
$944.49
$1245.21		 $967.86
$1047.78
$1132.44
$1433.16		 $1155.81
$1235.73
$1320.39
$1621.11		 $483.93
$523.89
$566.22
$716.58		 $671.88
$711.84
$754.17
$904.53		 $859.83
$899.79
$942.12
$1092.48		 $187.95

Plan: (POS) Silver Navigate Plus 4500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - 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		 $302.86
$343.75
$387.06
$540.91
$821.96		 $605.72
$687.50
$774.12
$1081.82
$1643.92		 $798.04
$879.82
$966.44
$1274.14		 $990.36
$1072.14
$1158.76
$1466.46		 $1182.68
$1264.46
$1351.08
$1658.78		 $495.18
$536.07
$579.38
$733.23		 $687.50
$728.39
$771.70
$925.55		 $879.82
$920.71
$964.02
$1117.87		 $192.32

Plan: (POS) Bronze Navigate Plus HSA 5500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - 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		 $244.41
$277.40
$312.35
$436.51
$663.32		 $488.82
$554.80
$624.70
$873.02
$1326.64		 $644.02
$710.00
$779.90
$1028.22		 $799.22
$865.20
$935.10
$1183.42		 $954.42
$1020.40
$1090.30
$1338.62		 $399.61
$432.60
$467.55
$591.71		 $554.81
$587.80
$622.75
$746.91		 $710.01
$743.00
$777.95
$902.11		 $155.20

Plan: (POS) Bronze Navigate Plus 6500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - 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		 $255.58
$290.09
$326.63
$456.47
$693.65		 $511.16
$580.18
$653.26
$912.94
$1387.30		 $673.46
$742.48
$815.56
$1075.24		 $835.76
$904.78
$977.86
$1237.54		 $998.06
$1067.08
$1140.16
$1399.84		 $417.88
$452.39
$488.93
$618.77		 $580.18
$614.69
$651.23
$781.07		 $742.48
$776.99
$813.53
$943.37		 $162.30
ADVERTISEMENT

HealthSpan

Local: 1-513-551-1400 | Toll Free: 1-855-329-1882

Plan: (HMO) Select Gold 250-70

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-329-1882 - Provider Directory for This Plan: (HealthSpan)

Deductible: Individual: $250 : Family: $500
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		 $323.43
$367.09
$413.34
$577.64
$877.77		 $646.86
$734.18
$826.68
$1155.28
$1755.54		 $852.24
$939.56
$1032.06
$1360.66		 $1057.62
$1144.94
$1237.44
$1566.04		 $1263.00
$1350.32
$1442.82
$1771.42		 $528.81
$572.47
$618.72
$783.02		 $734.19
$777.85
$824.10
$988.40		 $939.57
$983.23
$1029.48
$1193.78		 $205.38

Plan: (HMO) Select Gold 1000-80

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-329-1882 - Provider Directory for This Plan: (HealthSpan)

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		 $322.05
$365.53
$411.58
$575.18
$874.05		 $644.10
$731.06
$823.16
$1150.36
$1748.10		 $848.61
$935.57
$1027.67
$1354.87		 $1053.12
$1140.08
$1232.18
$1559.38		 $1257.63
$1344.59
$1436.69
$1763.89		 $526.56
$570.04
$616.09
$779.69		 $731.07
$774.55
$820.60
$984.20		 $935.58
$979.06
$1025.11
$1188.71		 $204.51

Plan: (HMO) Select Gold 2000-100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-329-1882 - Provider Directory for This Plan: (HealthSpan)

Deductible: Individual: $2,000 : Family: $4,000
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
Gold 21
30
40
50
60		 $323.71
$367.41
$413.71
$578.15
$878.55		 $647.42
$734.82
$827.42
$1156.30
$1757.10		 $852.98
$940.38
$1032.98
$1361.86		 $1058.54
$1145.94
$1238.54
$1567.42		 $1264.10
$1351.50
$1444.10
$1772.98		 $529.27
$572.97
$619.27
$783.71		 $734.83
$778.53
$824.83
$989.27		 $940.39
$984.09
$1030.39
$1194.83		 $205.56

Plan: (HMO) Select Silver 1500-70 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-329-1882 - Provider Directory for This Plan: (HealthSpan)

Deductible: Individual: $1,500 : Family: $3,000
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
Silver 21
30
40
50
60		 $268.65
$304.92
$343.33
$479.81
$729.11		 $537.30
$609.84
$686.66
$959.62
$1458.22		 $707.89
$780.43
$857.25
$1130.21		 $878.48
$951.02
$1027.84
$1300.80		 $1049.07
$1121.61
$1198.43
$1471.39		 $439.24
$475.51
$513.92
$650.40		 $609.83
$646.10
$684.51
$820.99		 $780.42
$816.69
$855.10
$991.58		 $170.59

Plan: (HMO) Select Silver 2500-70

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-329-1882 - Provider Directory for This Plan: (HealthSpan)

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		 $271.08
$307.67
$346.43
$484.14
$735.69		 $542.16
$615.34
$692.86
$968.28
$1471.38		 $714.30
$787.48
$865.00
$1140.42		 $886.44
$959.62
$1037.14
$1312.56		 $1058.58
$1131.76
$1209.28
$1484.70		 $443.22
$479.81
$518.57
$656.28		 $615.36
$651.95
$690.71
$828.42		 $787.50
$824.09
$862.85
$1000.56		 $172.14

Plan: (HMO) Select Silver 3500 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-329-1882 - Provider Directory for This Plan: (HealthSpan)

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
Silver 21
30
40
50
60		 $270.69
$307.24
$345.94
$483.45
$734.65		 $541.38
$614.48
$691.88
$966.90
$1469.30		 $713.27
$786.37
$863.77
$1138.79		 $885.16
$958.26
$1035.66
$1310.68		 $1057.05
$1130.15
$1207.55
$1482.57		 $442.58
$479.13
$517.83
$655.34		 $614.47
$651.02
$689.72
$827.23		 $786.36
$822.91
$861.61
$999.12		 $171.89

Plan: (HMO) Select Bronze 4500-70 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-329-1882 - Provider Directory for This Plan: (HealthSpan)

Deductible: Individual: $4,500 : Family: $9,000
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		 $224.22
$254.49
$286.55
$400.45
$608.52		 $448.44
$508.98
$573.10
$800.90
$1217.04		 $590.82
$651.36
$715.48
$943.28		 $733.20
$793.74
$857.86
$1085.66		 $875.58
$936.12
$1000.24
$1228.04		 $366.60
$396.87
$428.93
$542.83		 $508.98
$539.25
$571.31
$685.21		 $651.36
$681.63
$713.69
$827.59		 $142.38

Plan: (HMO) Select Bronze 5500-80

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-329-1882 - Provider Directory for This Plan: (HealthSpan)

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		 $232.26
$263.62
$296.83
$414.81
$630.35		 $464.52
$527.24
$593.66
$829.62
$1260.70		 $612.01
$674.73
$741.15
$977.11		 $759.50
$822.22
$888.64
$1124.60		 $906.99
$969.71
$1036.13
$1272.09		 $379.75
$411.11
$444.32
$562.30		 $527.24
$558.60
$591.81
$709.79		 $674.73
$706.09
$739.30
$857.28		 $147.49

Plan: (HMO) Select Bronze 6000 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-329-1882 - Provider Directory for This Plan: (HealthSpan)

Deductible: Individual: $6,000 : Family: $12,000
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
Bronze 21
30
40
50
60		 $224.38
$254.67
$286.75
$400.73
$608.95		 $448.76
$509.34
$573.50
$801.46
$1217.90		 $591.24
$651.82
$715.98
$943.94		 $733.72
$794.30
$858.46
$1086.42		 $876.20
$936.78
$1000.94
$1228.90		 $366.86
$397.15
$429.23
$543.21		 $509.34
$539.63
$571.71
$685.69		 $651.82
$682.11
$714.19
$828.17		 $142.48
ADVERTISEMENT

Medical Health Insuring Corp. of Ohio

Local: 1-888-308-0357 | Toll Free: 1-888-308-0357

Plan: (PPO) Market 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)

Deductible: Individual: $1,000 : Family: $2,000
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
Gold 21
30
40
50
60		 $405.94
$460.74
$518.79
$725.00
$1101.71		 $811.88
$921.48
$1037.58
$1450.00
$2203.42		 $1069.65
$1179.25
$1295.35
$1707.77		 $1327.42
$1437.02
$1553.12
$1965.54		 $1585.19
$1694.79
$1810.89
$2223.31		 $663.71
$718.51
$776.56
$982.77		 $921.48
$976.28
$1034.33
$1240.54		 $1179.25
$1234.05
$1292.10
$1498.31		 ++

Plan: (PPO) Market Child Only 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)

Deductible: Individual: $1,000 : Family: See Plan Brochure
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
Gold 21
30
40
50
60

























$257.77

Plan: (PPO) Market 6000 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)

Deductible: Individual: $6,000 : Family: $12,000
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
Bronze 21
30
40
50
60		 $257.98
$292.81
$329.70
$460.76
$700.17		 $515.96
$585.62
$659.40
$921.52
$1400.34		 $679.78
$749.44
$823.22
$1085.34		 $843.60
$913.26
$987.04
$1249.16		 $1007.42
$1077.08
$1150.86
$1412.98		 $421.80
$456.63
$493.52
$624.58		 $585.62
$620.45
$657.34
$788.40		 $749.44
$784.27
$821.16
$952.22		 ++

Plan: (PPO) Market Child Only 6000 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)

Deductible: Individual: $6,000 : Family: See Plan Brochure
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
Bronze 21
30
40
50
60

























$163.82

Plan: (PPO) Market Young Adult Essentials

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)

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		 $184.94
$209.91
$236.35
$330.30
$501.93		 $369.88
$419.82
$472.70
$660.60
$1003.86		 $487.32
$537.26
$590.14
$778.04		 $604.76
$654.70
$707.58
$895.48		 $722.20
$772.14
$825.02
$1012.92		 $302.38
$327.35
$353.79
$447.74		 $419.82
$444.79
$471.23
$565.18		 $537.26
$562.23
$588.67
$682.62		 $117.44

Plan: (PPO) Market 2400

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)

Deductible: Individual: $2,400 : Family: $4,800
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		 $326.99
$371.13
$417.89
$584.00
$887.44		 $653.98
$742.26
$835.78
$1168.00
$1774.88		 $861.62
$949.90
$1043.42
$1375.64		 $1069.26
$1157.54
$1251.06
$1583.28		 $1276.90
$1365.18
$1458.70
$1790.92		 $534.63
$578.77
$625.53
$791.64		 $742.27
$786.41
$833.17
$999.28		 $949.91
$994.05
$1040.81
$1206.92		 ++

Plan: (PPO) Market Child Only 2400

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)

Deductible: Individual: $2,400 : Family: See Plan Brochure
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

























$207.64

Plan: (PPO) Market 5000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)

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		 $272.59
$309.39
$348.37
$486.85
$739.82		 $545.18
$618.78
$696.74
$973.70
$1479.64		 $718.28
$791.88
$869.84
$1146.80		 $891.38
$964.98
$1042.94
$1319.90		 $1064.48
$1138.08
$1216.04
$1493.00		 $445.69
$482.49
$521.47
$659.95		 $618.79
$655.59
$694.57
$833.05		 $791.89
$828.69
$867.67
$1006.15		 ++

Plan: (PPO) Market Child Only 5000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-308-0357 - Provider Directory for This Plan: (Medical Health Insuring Corp. of Ohio)

Deductible: Individual: $5,000 : Family: See Plan Brochure
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

























$173.10

†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 Clinton County here.

 

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