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Providers for Zip Code 60629

LegalConsumer.com/obamacare

ObamacareByZipCode.com

Obamacare 2016 Marketplace Rates For Cook County, Illinois

Thursday, April 18th, 2024


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

2016 Rates and Providers

(click here for 2014)

(click here for 2015)

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

Obamacare Providers, Plans and 2016 Rates for Cook County

Cook County is in “Rating Area 1” of Illinois.

Currently, there are 7 providers offering 80 plans to Rating Area 1. †

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 Chicago, IL area accept this insurance coverage as within the plan's "network".
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UnitedHealthcare of the Midwest, Inc.

Local: 1-877-512-9940 | Toll Free: 1-877-512-9940

Plan: (HMO) Bronze Compass 6500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9940 - Provider Directory for This Plan: (UnitedHealthcare of the Midwest, 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		 $210.21
$238.59
$268.65
$375.44
$570.51		 $420.42
$477.18
$537.30
$750.88
$1141.02		 $553.90
$610.66
$670.78
$884.36		 $687.38
$744.14
$804.26
$1017.84		 $820.86
$877.62
$937.74
$1151.32		 $343.69
$372.07
$402.13
$508.92		 $477.17
$505.55
$535.61
$642.40		 $610.65
$639.03
$669.09
$775.88		 $133.48

Plan: (HMO) Bronze Compass HSA 5500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9940 - Provider Directory for This Plan: (UnitedHealthcare of the Midwest, 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		 $199.43
$226.35
$254.87
$356.18
$541.25		 $398.86
$452.70
$509.74
$712.36
$1082.50		 $525.50
$579.34
$636.38
$839.00		 $652.14
$705.98
$763.02
$965.64		 $778.78
$832.62
$889.66
$1092.28		 $326.07
$352.99
$381.51
$482.82		 $452.71
$479.63
$508.15
$609.46		 $579.35
$606.27
$634.79
$736.10		 $126.64

Plan: (HMO) Gold Compass 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9940 - Provider Directory for This Plan: (UnitedHealthcare of the Midwest, 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		 $275.36
$312.53
$351.91
$491.79
$747.33		 $550.72
$625.06
$703.82
$983.58
$1494.66		 $725.57
$799.91
$878.67
$1158.43		 $900.42
$974.76
$1053.52
$1333.28		 $1075.27
$1149.61
$1228.37
$1508.13		 $450.21
$487.38
$526.76
$666.64		 $625.06
$662.23
$701.61
$841.49		 $799.91
$837.08
$876.46
$1016.34		 $174.85

Plan: (HMO) Gold Compass 500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9940 - Provider Directory for This Plan: (UnitedHealthcare of the Midwest, Inc.)

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		 $274.19
$311.20
$350.41
$489.70
$744.15		 $548.38
$622.40
$700.82
$979.40
$1488.30		 $722.49
$796.51
$874.93
$1153.51		 $896.60
$970.62
$1049.04
$1327.62		 $1070.71
$1144.73
$1223.15
$1501.73		 $448.30
$485.31
$524.52
$663.81		 $622.41
$659.42
$698.63
$837.92		 $796.52
$833.53
$872.74
$1012.03		 $174.11

Plan: (HMO) Silver Compass 4500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9940 - Provider Directory for This Plan: (UnitedHealthcare of the Midwest, 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		 $247.00
$280.35
$315.67
$441.15
$670.37		 $494.00
$560.70
$631.34
$882.30
$1340.74		 $650.85
$717.55
$788.19
$1039.15		 $807.70
$874.40
$945.04
$1196.00		 $964.55
$1031.25
$1101.89
$1352.85		 $403.85
$437.20
$472.52
$598.00		 $560.70
$594.05
$629.37
$754.85		 $717.55
$750.90
$786.22
$911.70		 $156.85

Plan: (HMO) Silver Compass 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9940 - Provider Directory for This Plan: (UnitedHealthcare of the Midwest, 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		 $239.97
$272.37
$306.69
$428.59
$651.29		 $479.94
$544.74
$613.38
$857.18
$1302.58		 $632.32
$697.12
$765.76
$1009.56		 $784.70
$849.50
$918.14
$1161.94		 $937.08
$1001.88
$1070.52
$1314.32		 $392.35
$424.75
$459.07
$580.97		 $544.73
$577.13
$611.45
$733.35		 $697.11
$729.51
$763.83
$885.73		 $152.38

Plan: (HMO) Silver Compass HSA 3000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9940 - Provider Directory for This Plan: (UnitedHealthcare of the Midwest, 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		 $228.72
$259.60
$292.31
$408.50
$620.76		 $457.44
$519.20
$584.62
$817.00
$1241.52		 $602.68
$664.44
$729.86
$962.24		 $747.92
$809.68
$875.10
$1107.48		 $893.16
$954.92
$1020.34
$1252.72		 $373.96
$404.84
$437.55
$553.74		 $519.20
$550.08
$582.79
$698.98		 $664.44
$695.32
$728.03
$844.22		 $145.24

Plan: (HMO) Gold Compass 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9940 - Provider Directory for This Plan: (UnitedHealthcare of the Midwest, 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		 $271.14
$307.75
$346.52
$484.26
$735.88		 $542.28
$615.50
$693.04
$968.52
$1471.76		 $714.45
$787.67
$865.21
$1140.69		 $886.62
$959.84
$1037.38
$1312.86		 $1058.79
$1132.01
$1209.55
$1485.03		 $443.31
$479.92
$518.69
$656.43		 $615.48
$652.09
$690.86
$828.60		 $787.65
$824.26
$863.03
$1000.77		 $172.17

Plan: (HMO) Silver Compass 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9940 - Provider Directory for This Plan: (UnitedHealthcare of the Midwest, 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		 $241.61
$274.23
$308.78
$431.52
$655.74		 $483.22
$548.46
$617.56
$863.04
$1311.48		 $636.64
$701.88
$770.98
$1016.46		 $790.06
$855.30
$924.40
$1169.88		 $943.48
$1008.72
$1077.82
$1323.30		 $395.03
$427.65
$462.20
$584.94		 $548.45
$581.07
$615.62
$738.36		 $701.87
$734.49
$769.04
$891.78		 $153.42

Plan: (HMO) Silver Compass 2000 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9940 - Provider Directory for This Plan: (UnitedHealthcare of the Midwest, 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		 $238.10
$270.24
$304.29
$425.24
$646.20		 $476.20
$540.48
$608.58
$850.48
$1292.40		 $627.39
$691.67
$759.77
$1001.67		 $778.58
$842.86
$910.96
$1152.86		 $929.77
$994.05
$1062.15
$1304.05		 $389.29
$421.43
$455.48
$576.43		 $540.48
$572.62
$606.67
$727.62		 $691.67
$723.81
$757.86
$878.81		 $151.19
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Celtic Insurance Company

Local: 1-855-745-5507 | Toll Free: 1-866-565-8576

Plan: (HMO) Ambetter Secure Care 1 (2016) with 3 Free PCP Visits: Sinai / IlliniCare Health Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-565-8576 - Provider Directory for This Plan: (Celtic Insurance Company)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $203.32
$230.76
$259.84
$363.12
$551.80		 $406.64
$461.52
$519.68
$726.24
$1103.60		 $535.74
$590.62
$648.78
$855.34		 $664.84
$719.72
$777.88
$984.44		 $793.94
$848.82
$906.98
$1113.54		 $332.42
$359.86
$388.94
$492.22		 $461.52
$488.96
$518.04
$621.32		 $590.62
$618.06
$647.14
$750.42		 $129.10

Plan: (HMO) Ambetter Balanced Care 1 (2016): Sinai / IlliniCare Health Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-565-8576 - Provider Directory for This Plan: (Celtic 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
Silver 21
30
40
50
60		 $154.55
$175.41
$197.51
$276.02
$419.43		 $309.10
$350.82
$395.02
$552.04
$838.86		 $407.24
$448.96
$493.16
$650.18		 $505.38
$547.10
$591.30
$748.32		 $603.52
$645.24
$689.44
$846.46		 $252.69
$273.55
$295.65
$374.16		 $350.83
$371.69
$393.79
$472.30		 $448.97
$469.83
$491.93
$570.44		 $98.14

Plan: (HMO) Ambetter Balanced Care 2 (2016): Sinai / IlliniCare Health Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-565-8576 - Provider Directory for This Plan: (Celtic Insurance Company)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $152.42
$172.99
$194.78
$272.20
$413.64		 $304.84
$345.98
$389.56
$544.40
$827.28		 $401.62
$442.76
$486.34
$641.18		 $498.40
$539.54
$583.12
$737.96		 $595.18
$636.32
$679.90
$834.74		 $249.20
$269.77
$291.56
$368.98		 $345.98
$366.55
$388.34
$465.76		 $442.76
$463.33
$485.12
$562.54		 $96.78

Plan: (HMO) Ambetter Balanced Care 10 (2016): Sinai / IlliniCare Health Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-565-8576 - Provider Directory for This Plan: (Celtic Insurance Company)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $161.26
$183.02
$206.08
$287.99
$437.63		 $322.52
$366.04
$412.16
$575.98
$875.26		 $424.91
$468.43
$514.55
$678.37		 $527.30
$570.82
$616.94
$780.76		 $629.69
$673.21
$719.33
$883.15		 $263.65
$285.41
$308.47
$390.38		 $366.04
$387.80
$410.86
$492.77		 $468.43
$490.19
$513.25
$595.16		 $102.39

Plan: (HMO) Ambetter Essential Care 1 (2016): Sinai / IlliniCare Health Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-565-8576 - Provider Directory for This Plan: (Celtic Insurance Company)

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		 $128.03
$145.31
$163.62
$228.65
$347.46		 $256.06
$290.62
$327.24
$457.30
$694.92		 $337.36
$371.92
$408.54
$538.60		 $418.66
$453.22
$489.84
$619.90		 $499.96
$534.52
$571.14
$701.20		 $209.33
$226.61
$244.92
$309.95		 $290.63
$307.91
$326.22
$391.25		 $371.93
$389.21
$407.52
$472.55		 $81.30

Plan: (HMO) Ambetter Balanced Care 1 (2016) + Vision + Adult Dental: Sinai / IlliniCare Health Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-565-8576 - Provider Directory for This Plan: (Celtic 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
Silver 21
30
40
50
60		 $167.03
$189.56
$213.45
$298.29
$453.28		 $334.06
$379.12
$426.90
$596.58
$906.56		 $440.12
$485.18
$532.96
$702.64		 $546.18
$591.24
$639.02
$808.70		 $652.24
$697.30
$745.08
$914.76		 $273.09
$295.62
$319.51
$404.35		 $379.15
$401.68
$425.57
$510.41		 $485.21
$507.74
$531.63
$616.47		 $106.06

Plan: (HMO) Ambetter Balanced Care 2 (2016) + Vision + Adult Dental: Sinai / IlliniCare Health Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-565-8576 - Provider Directory for This Plan: (Celtic Insurance Company)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $164.72
$186.95
$210.50
$294.17
$447.02		 $329.44
$373.90
$421.00
$588.34
$894.04		 $434.03
$478.49
$525.59
$692.93		 $538.62
$583.08
$630.18
$797.52		 $643.21
$687.67
$734.77
$902.11		 $269.31
$291.54
$315.09
$398.76		 $373.90
$396.13
$419.68
$503.35		 $478.49
$500.72
$524.27
$607.94		 $104.59

Plan: (HMO) Ambetter Balanced Care 10 (2016) + Vision + Adult Dental: Sinai / IlliniCare Health Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-565-8576 - Provider Directory for This Plan: (Celtic Insurance Company)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $174.27
$197.79
$222.71
$311.23
$472.95		 $348.54
$395.58
$445.42
$622.46
$945.90		 $459.20
$506.24
$556.08
$733.12		 $569.86
$616.90
$666.74
$843.78		 $680.52
$727.56
$777.40
$954.44		 $284.93
$308.45
$333.37
$421.89		 $395.59
$419.11
$444.03
$532.55		 $506.25
$529.77
$554.69
$643.21		 $110.66
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Blue Cross Blue Shield of Illinois

Local: 1-800-538-8833 | Toll Free: 1-800-538-8833

TTY: 1-800-526-0844

Plan: (HMO) Blue Precision Gold HMO? 101

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $1,750 : Family: $5,250
Out of Pocket Maximum per year: Individual: $3,500 : 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
Gold 21
30
40
50
60		 $246.42
$279.68
$314.92
$440.10
$668.77		 $492.84
$559.36
$629.84
$880.20
$1337.54		 $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) Blue Precision Silver HMO? 102

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $2,000 : 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		 $216.34
$245.54
$276.48
$386.38
$587.14		 $432.68
$491.08
$552.96
$772.76
$1174.28		 $570.05
$628.45
$690.33
$910.13		 $707.42
$765.82
$827.70
$1047.50		 $844.79
$903.19
$965.07
$1184.87		 $353.71
$382.91
$413.85
$523.75		 $491.08
$520.28
$551.22
$661.12		 $628.45
$657.65
$688.59
$798.49		 $137.37

Plan: (HMO) Blue Precision Bronze HMO? 103

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $6,000 : 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		 $186.49
$211.66
$238.33
$333.06
$506.12		 $372.98
$423.32
$476.66
$666.12
$1012.24		 $491.40
$541.74
$595.08
$784.54		 $609.82
$660.16
$713.50
$902.96		 $728.24
$778.58
$831.92
$1021.38		 $304.91
$330.08
$356.75
$451.48		 $423.33
$448.50
$475.17
$569.90		 $541.75
$566.92
$593.59
$688.32		 $118.42

Plan: (HMO) BlueCare Direct Gold? 101 with Advocate

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $1,750 : Family: $5,250
Out of Pocket Maximum per year: Individual: $3,500 : 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
Gold 21
30
40
50
60		 $221.78
$251.71
$283.43
$396.09
$601.90		 $443.56
$503.42
$566.86
$792.18
$1203.80		 $584.39
$644.25
$707.69
$933.01		 $725.22
$785.08
$848.52
$1073.84		 $866.05
$925.91
$989.35
$1214.67		 $362.61
$392.54
$424.26
$536.92		 $503.44
$533.37
$565.09
$677.75		 $644.27
$674.20
$705.92
$818.58		 $140.83

Plan: (HMO) BlueCare Direct Silver? 102 with Advocate

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $2,000 : 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		 $194.70
$220.99
$248.83
$347.74
$528.43		 $389.40
$441.98
$497.66
$695.48
$1056.86		 $513.04
$565.62
$621.30
$819.12		 $636.68
$689.26
$744.94
$942.76		 $760.32
$812.90
$868.58
$1066.40		 $318.34
$344.63
$372.47
$471.38		 $441.98
$468.27
$496.11
$595.02		 $565.62
$591.91
$619.75
$718.66		 $123.64

Plan: (HMO) BlueCare Direct Bronze? 103 with Advocate

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $6,000 : 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		 $167.84
$190.50
$214.50
$299.76
$455.51		 $335.68
$381.00
$429.00
$599.52
$911.02		 $442.26
$487.58
$535.58
$706.10		 $548.84
$594.16
$642.16
$812.68		 $655.42
$700.74
$748.74
$919.26		 $274.42
$297.08
$321.08
$406.34		 $381.00
$403.66
$427.66
$512.92		 $487.58
$510.24
$534.24
$619.50		 $106.58

Plan: (PPO) Blue Cross Blue Shield Premier? 101, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $1,750 : Family: $5,250
Out of Pocket Maximum per year: Individual: $3,300 : Family: $9,900

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
Gold 21
30
40
50
60		 $290.65
$329.88
$371.45
$519.09
$788.81		 $581.30
$659.76
$742.90
$1038.18
$1577.62		 $765.86
$844.32
$927.46
$1222.74		 $950.42
$1028.88
$1112.02
$1407.30		 $1134.98
$1213.44
$1296.58
$1591.86		 $475.21
$514.44
$556.01
$703.65		 $659.77
$699.00
$740.57
$888.21		 $844.33
$883.56
$925.13
$1072.77		 $184.56

Plan: (PPO) Blue Cross Blue Shield Solution? 102, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $3,750 : Family: $11,250
Out of Pocket Maximum per year: Individual: $6,500 : 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		 $232.71
$264.12
$297.40
$415.62
$631.57		 $465.42
$528.24
$594.80
$831.24
$1263.14		 $613.19
$676.01
$742.57
$979.01		 $760.96
$823.78
$890.34
$1126.78		 $908.73
$971.55
$1038.11
$1274.55		 $380.48
$411.89
$445.17
$563.39		 $528.25
$559.66
$592.94
$711.16		 $676.02
$707.43
$740.71
$858.93		 $147.77

Plan: (PPO) Blue Cross Blue Shield Basic? 103, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $6,250 : 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		 $179.35
$203.56
$229.21
$320.32
$486.76		 $358.70
$407.12
$458.42
$640.64
$973.52		 $472.59
$521.01
$572.31
$754.53		 $586.48
$634.90
$686.20
$868.42		 $700.37
$748.79
$800.09
$982.31		 $293.24
$317.45
$343.10
$434.21		 $407.13
$431.34
$456.99
$548.10		 $521.02
$545.23
$570.88
$661.99		 $113.89

Plan: (PPO) Blue Choice Preferred Gold PPO? 101

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $500 : Family: $1,500
Out of Pocket Maximum per year: Individual: $5,250 : 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		 $297.80
$338.00
$380.59
$531.87
$808.23		 $595.60
$676.00
$761.18
$1063.74
$1616.46		 $784.70
$865.10
$950.28
$1252.84		 $973.80
$1054.20
$1139.38
$1441.94		 $1162.90
$1243.30
$1328.48
$1631.04		 $486.90
$527.10
$569.69
$720.97		 $676.00
$716.20
$758.79
$910.07		 $865.10
$905.30
$947.89
$1099.17		 $189.10

Plan: (PPO) Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $3,250 : Family: $9,750
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		 $238.97
$271.23
$305.40
$426.80
$648.56		 $477.94
$542.46
$610.80
$853.60
$1297.12		 $629.69
$694.21
$762.55
$1005.35		 $781.44
$845.96
$914.30
$1157.10		 $933.19
$997.71
$1066.05
$1308.85		 $390.72
$422.98
$457.15
$578.55		 $542.47
$574.73
$608.90
$730.30		 $694.22
$726.48
$760.65
$882.05		 $151.75

Plan: (PPO) Blue Choice Preferred Silver PPO? 104

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $3,500 : Family: $10,500
Out of Pocket Maximum per year: Individual: $3,500 : 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		 $244.37
$277.36
$312.31
$436.45
$663.23		 $488.74
$554.72
$624.62
$872.90
$1326.46		 $643.92
$709.90
$779.80
$1028.08		 $799.10
$865.08
$934.98
$1183.26		 $954.28
$1020.26
$1090.16
$1338.44		 $399.55
$432.54
$467.49
$591.63		 $554.73
$587.72
$622.67
$746.81		 $709.91
$742.90
$777.85
$901.99		 $155.18

Plan: (PPO) Blue Choice Preferred Bronze PPO? 105

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $4,500 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,450 : 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		 $190.11
$215.78
$242.96
$339.54
$515.96		 $380.22
$431.56
$485.92
$679.08
$1031.92		 $500.94
$552.28
$606.64
$799.80		 $621.66
$673.00
$727.36
$920.52		 $742.38
$793.72
$848.08
$1041.24		 $310.83
$336.50
$363.68
$460.26		 $431.55
$457.22
$484.40
$580.98		 $552.27
$577.94
$605.12
$701.70		 $120.72

Plan: (PPO) Blue Choice Preferred Bronze PPO? 106

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $6,000 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,000 : 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		 $189.12
$214.65
$241.69
$337.77
$513.27		 $378.24
$429.30
$483.38
$675.54
$1026.54		 $498.33
$549.39
$603.47
$795.63		 $618.42
$669.48
$723.56
$915.72		 $738.51
$789.57
$843.65
$1035.81		 $309.21
$334.74
$361.78
$457.86		 $429.30
$454.83
$481.87
$577.95		 $549.39
$574.92
$601.96
$698.04		 $120.09

Plan: (PPO) Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $6,800 : 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		 $182.63
$207.28
$233.40
$326.17
$495.65		 $365.26
$414.56
$466.80
$652.34
$991.30		 $481.23
$530.53
$582.77
$768.31		 $597.20
$646.50
$698.74
$884.28		 $713.17
$762.47
$814.71
$1000.25		 $298.60
$323.25
$349.37
$442.14		 $414.57
$439.22
$465.34
$558.11		 $530.54
$555.19
$581.31
$674.08		 $115.97

Plan: (PPO) Blue Choice Preferred Security PPO? 100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

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		 $171.97
$195.19
$219.78
$307.14
$466.73		 $343.94
$390.38
$439.56
$614.28
$933.46		 $453.14
$499.58
$548.76
$723.48		 $562.34
$608.78
$657.96
$832.68		 $671.54
$717.98
$767.16
$941.88		 $281.17
$304.39
$328.98
$416.34		 $390.37
$413.59
$438.18
$525.54		 $499.57
$522.79
$547.38
$634.74		 $109.20
ADVERTISEMENT

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/Chicago 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		 $156.71
$177.87
$200.28
$279.88
$425.31		 $313.42
$355.74
$400.56
$559.76
$850.62		 $412.93
$455.25
$500.07
$659.27		 $512.44
$554.76
$599.58
$758.78		 $611.95
$654.27
$699.09
$858.29		 $256.22
$277.38
$299.79
$379.39		 $355.73
$376.89
$399.30
$478.90		 $455.24
$476.40
$498.81
$578.41		 $99.51

Plan: (HMO) Humana Bronze 6450/Chicago 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		 $210.47
$238.88
$268.98
$375.90
$571.22		 $420.94
$477.76
$537.96
$751.80
$1142.44		 $554.59
$611.41
$671.61
$885.45		 $688.24
$745.06
$805.26
$1019.10		 $821.89
$878.71
$938.91
$1152.75		 $344.12
$372.53
$402.63
$509.55		 $477.77
$506.18
$536.28
$643.20		 $611.42
$639.83
$669.93
$776.85		 $133.65

Plan: (HMO) Humana Bronze 4850/Chicago 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: $4,850 : Family: $9,700
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $229.24
$260.19
$292.97
$409.42
$622.16		 $458.48
$520.38
$585.94
$818.84
$1244.32		 $604.05
$665.95
$731.51
$964.41		 $749.62
$811.52
$877.08
$1109.98		 $895.19
$957.09
$1022.65
$1255.55		 $374.81
$405.76
$438.54
$554.99		 $520.38
$551.33
$584.11
$700.56		 $665.95
$696.90
$729.68
$846.13		 $145.57

Plan: (HMO) Humana Silver 3800/Chicago 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		 $255.67
$290.19
$326.75
$456.63
$693.89		 $511.34
$580.38
$653.50
$913.26
$1387.78		 $673.69
$742.73
$815.85
$1075.61		 $836.04
$905.08
$978.20
$1237.96		 $998.39
$1067.43
$1140.55
$1400.31		 $418.02
$452.54
$489.10
$618.98		 $580.37
$614.89
$651.45
$781.33		 $742.72
$777.24
$813.80
$943.68		 $162.35

Plan: (HMO) Humana Gold 2250/Chicago 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		 $302.21
$343.01
$386.22
$539.75
$820.20		 $604.42
$686.02
$772.44
$1079.50
$1640.40		 $796.32
$877.92
$964.34
$1271.40		 $988.22
$1069.82
$1156.24
$1463.30		 $1180.12
$1261.72
$1348.14
$1655.20		 $494.11
$534.91
$578.12
$731.65		 $686.01
$726.81
$770.02
$923.55		 $877.91
$918.71
$961.92
$1115.45		 $191.90
ADVERTISEMENT

Harken Health Insurance Company

Local: | Toll Free:

Plan: (PPO) Care Gold I

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

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $258.99
$293.95
$330.99
$462.55
$702.89		 $517.98
$587.90
$661.98
$925.10
$1405.78		 $682.44
$752.36
$826.44
$1089.56		 $846.90
$916.82
$990.90
$1254.02		 $1011.36
$1081.28
$1155.36
$1418.48		 $423.45
$458.41
$495.45
$627.01		 $587.91
$622.87
$659.91
$791.47		 $752.37
$787.33
$824.37
$955.93		 $164.46

Plan: (PPO) Care Gold II

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

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $266.64
$302.63
$340.76
$476.21
$723.65		 $533.28
$605.26
$681.52
$952.42
$1447.30		 $702.59
$774.57
$850.83
$1121.73		 $871.90
$943.88
$1020.14
$1291.04		 $1041.21
$1113.19
$1189.45
$1460.35		 $435.95
$471.94
$510.07
$645.52		 $605.26
$641.25
$679.38
$814.83		 $774.57
$810.56
$848.69
$984.14		 $169.31

Plan: (PPO) Care Silver I

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

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $218.48
$247.98
$279.22
$390.21
$592.97		 $436.96
$495.96
$558.44
$780.42
$1185.94		 $575.70
$634.70
$697.18
$919.16		 $714.44
$773.44
$835.92
$1057.90		 $853.18
$912.18
$974.66
$1196.64		 $357.22
$386.72
$417.96
$528.95		 $495.96
$525.46
$556.70
$667.69		 $634.70
$664.20
$695.44
$806.43		 $138.74

Plan: (PPO) Care Silver II

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

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $224.56
$254.88
$286.99
$401.06
$609.46		 $449.12
$509.76
$573.98
$802.12
$1218.92		 $591.72
$652.36
$716.58
$944.72		 $734.32
$794.96
$859.18
$1087.32		 $876.92
$937.56
$1001.78
$1229.92		 $367.16
$397.48
$429.59
$543.66		 $509.76
$540.08
$572.19
$686.26		 $652.36
$682.68
$714.79
$828.86		 $142.60

Plan: (PPO) Care Bronze

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

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $189.68
$215.29
$242.42
$338.77
$514.80		 $379.36
$430.58
$484.84
$677.54
$1029.60		 $499.81
$551.03
$605.29
$797.99		 $620.26
$671.48
$725.74
$918.44		 $740.71
$791.93
$846.19
$1038.89		 $310.13
$335.74
$362.87
$459.22		 $430.58
$456.19
$483.32
$579.67		 $551.03
$576.64
$603.77
$700.12		 $120.45
ADVERTISEMENT

Land of Lincoln Mutual Health Insurance Company

Local: 1-844-674-3844 | Toll Free: 1-844-674-3844

TTY: 1-888-858-9130

Plan: (PPO) Swedish Covenant LLH 3-Tier Gold PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health Insurance Company)

Deductible: Individual: $500 : Family: $1,000
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		 $269.42
$305.79
$344.31
$481.18
$731.20		 $538.84
$611.58
$688.62
$962.36
$1462.40		 $709.92
$782.66
$859.70
$1133.44		 $881.00
$953.74
$1030.78
$1304.52		 $1052.08
$1124.82
$1201.86
$1475.60		 $440.50
$476.87
$515.39
$652.26		 $611.58
$647.95
$686.47
$823.34		 $782.66
$819.03
$857.55
$994.42		 $171.08

Plan: (PPO) Swedish Covenant LLH 3-Tier Silver PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health Insurance Company)

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		 $219.06
$248.63
$279.95
$391.24
$594.52		 $438.12
$497.26
$559.90
$782.48
$1189.04		 $577.22
$636.36
$699.00
$921.58		 $716.32
$775.46
$838.10
$1060.68		 $855.42
$914.56
$977.20
$1199.78		 $358.16
$387.73
$419.05
$530.34		 $497.26
$526.83
$558.15
$669.44		 $636.36
$665.93
$697.25
$808.54		 $139.10

Plan: (PPO) Champion LLH 3-Tier Gold PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health Insurance Company)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $5,800 : Family: $11,600

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
Gold 21
30
40
50
60		 $320.71
$364.00
$409.86
$572.78
$870.40		 $641.42
$728.00
$819.72
$1145.56
$1740.80		 $845.07
$931.65
$1023.37
$1349.21		 $1048.72
$1135.30
$1227.02
$1552.86		 $1252.37
$1338.95
$1430.67
$1756.51		 $524.36
$567.65
$613.51
$776.43		 $728.01
$771.30
$817.16
$980.08		 $931.66
$974.95
$1020.81
$1183.73		 $203.65

Plan: (PPO) Champion LLH 3-Tier Silver PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health Insurance Company)

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		 $262.91
$298.40
$335.99
$469.55
$713.53		 $525.82
$596.80
$671.98
$939.10
$1427.06		 $692.76
$763.74
$838.92
$1106.04		 $859.70
$930.68
$1005.86
$1272.98		 $1026.64
$1097.62
$1172.80
$1439.92		 $429.85
$465.34
$502.93
$636.49		 $596.79
$632.28
$669.87
$803.43		 $763.73
$799.22
$836.81
$970.37		 $166.94

Plan: (PPO) Illinois Health Partners LLH 3-Tier Gold PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health Insurance Company)

Deductible: Individual: $500 : Family: $1,000
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
Gold 21
30
40
50
60		 $291.52
$330.87
$372.56
$520.65
$791.18		 $583.04
$661.74
$745.12
$1041.30
$1582.36		 $768.15
$846.85
$930.23
$1226.41		 $953.26
$1031.96
$1115.34
$1411.52		 $1138.37
$1217.07
$1300.45
$1596.63		 $476.63
$515.98
$557.67
$705.76		 $661.74
$701.09
$742.78
$890.87		 $846.85
$886.20
$927.89
$1075.98		 $185.11

Plan: (PPO) Illinois Health Partners LLH 3-Tier Silver PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health Insurance Company)

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		 $237.88
$269.99
$304.01
$424.85
$645.60		 $475.76
$539.98
$608.02
$849.70
$1291.20		 $626.81
$691.03
$759.07
$1000.75		 $777.86
$842.08
$910.12
$1151.80		 $928.91
$993.13
$1061.17
$1302.85		 $388.93
$421.04
$455.06
$575.90		 $539.98
$572.09
$606.11
$726.95		 $691.03
$723.14
$757.16
$878.00		 $151.05

Plan: (PPO) Presence Health LLH 3-Tier Gold PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health Insurance Company)

Deductible: Individual: $500 : Family: $1,000
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
Gold 21
30
40
50
60		 $260.52
$295.69
$332.94
$465.28
$707.05		 $521.04
$591.38
$665.88
$930.56
$1414.10		 $686.47
$756.81
$831.31
$1095.99		 $851.90
$922.24
$996.74
$1261.42		 $1017.33
$1087.67
$1162.17
$1426.85		 $425.95
$461.12
$498.37
$630.71		 $591.38
$626.55
$663.80
$796.14		 $756.81
$791.98
$829.23
$961.57		 $165.43

Plan: (PPO) Presence Health LLH 3-Tier Silver PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health Insurance Company)

Deductible: Individual: $3,400 : Family: $6,800
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		 $211.47
$240.01
$270.25
$377.68
$573.92		 $422.94
$480.02
$540.50
$755.36
$1147.84		 $557.22
$614.30
$674.78
$889.64		 $691.50
$748.58
$809.06
$1023.92		 $825.78
$882.86
$943.34
$1158.20		 $345.75
$374.29
$404.53
$511.96		 $480.03
$508.57
$538.81
$646.24		 $614.31
$642.85
$673.09
$780.52		 $134.28

Plan: (PPO) Adventist LLH 3-Tier Gold PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health Insurance Company)

Deductible: Individual: $500 : Family: $1,000
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		 $299.40
$339.81
$382.63
$534.72
$812.57		 $598.80
$679.62
$765.26
$1069.44
$1625.14		 $788.91
$869.73
$955.37
$1259.55		 $979.02
$1059.84
$1145.48
$1449.66		 $1169.13
$1249.95
$1335.59
$1639.77		 $489.51
$529.92
$572.74
$724.83		 $679.62
$720.03
$762.85
$914.94		 $869.73
$910.14
$952.96
$1105.05		 $190.11

Plan: (PPO) Adventist LLH 3-Tier Silver PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health Insurance Company)

Deductible: Individual: $3,400 : Family: $6,800
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		 $246.55
$279.83
$315.09
$440.33
$669.13		 $493.10
$559.66
$630.18
$880.66
$1338.26		 $649.65
$716.21
$786.73
$1037.21		 $806.20
$872.76
$943.28
$1193.76		 $962.75
$1029.31
$1099.83
$1350.31		 $403.10
$436.38
$471.64
$596.88		 $559.65
$592.93
$628.19
$753.43		 $716.20
$749.48
$784.74
$909.98		 $156.55

Plan: (PPO) Adventist LLH 3-Tier Bronze PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health Insurance Company)

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		 $194.41
$220.65
$248.45
$347.21
$527.62		 $388.82
$441.30
$496.90
$694.42
$1055.24		 $512.27
$564.75
$620.35
$817.87		 $635.72
$688.20
$743.80
$941.32		 $759.17
$811.65
$867.25
$1064.77		 $317.86
$344.10
$371.90
$470.66		 $441.31
$467.55
$495.35
$594.11		 $564.76
$591.00
$618.80
$717.56		 $123.45

Plan: (PPO) Family Health Network LLH 3-Tier Silver PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health Insurance Company)

Deductible: Individual: $2,800 : Family: $5,600
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
Silver 21
30
40
50
60		 $217.13
$246.44
$277.49
$387.79
$589.29		 $434.26
$492.88
$554.98
$775.58
$1178.58		 $572.13
$630.75
$692.85
$913.45		 $710.00
$768.62
$830.72
$1051.32		 $847.87
$906.49
$968.59
$1189.19		 $355.00
$384.31
$415.36
$525.66		 $492.87
$522.18
$553.23
$663.53		 $630.74
$660.05
$691.10
$801.40		 $137.87

Plan: (PPO) Family Health Network LLH 3-Tier Bronze PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health Insurance Company)

Deductible: Individual: $5,000 : Family: $10,000
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		 $163.27
$185.31
$208.65
$291.60
$443.11		 $326.54
$370.62
$417.30
$583.20
$886.22		 $430.21
$474.29
$520.97
$686.87		 $533.88
$577.96
$624.64
$790.54		 $637.55
$681.63
$728.31
$894.21		 $266.94
$288.98
$312.32
$395.27		 $370.61
$392.65
$415.99
$498.94		 $474.28
$496.32
$519.66
$602.61		 $103.67

Plan: (PPO) Chicago Health System LLH 3-Tier Gold PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health Insurance Company)

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $5,100 : Family: $10,200

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		 $268.90
$305.20
$343.65
$480.25
$729.79		 $537.80
$610.40
$687.30
$960.50
$1459.58		 $708.55
$781.15
$858.05
$1131.25		 $879.30
$951.90
$1028.80
$1302.00		 $1050.05
$1122.65
$1199.55
$1472.75		 $439.65
$475.95
$514.40
$651.00		 $610.40
$646.70
$685.15
$821.75		 $781.15
$817.45
$855.90
$992.50		 $170.75

Plan: (PPO) Chicago Health System LLH 3-Tier Silver PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health Insurance Company)

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		 $219.33
$248.93
$280.30
$391.72
$595.26		 $438.66
$497.86
$560.60
$783.44
$1190.52		 $577.93
$637.13
$699.87
$922.71		 $717.20
$776.40
$839.14
$1061.98		 $856.47
$915.67
$978.41
$1201.25		 $358.60
$388.20
$419.57
$530.99		 $497.87
$527.47
$558.84
$670.26		 $637.14
$666.74
$698.11
$809.53		 $139.27

Plan: (PPO) Land of Lincoln Health Traditional Gold PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health Insurance Company)

Deductible: Individual: $1,350 : Family: $2,700
Out of Pocket Maximum per year: Individual: $3,300 : Family: $6,600

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
Gold 21
30
40
50
60		 $314.01
$356.40
$401.30
$560.82
$852.22		 $628.02
$712.80
$802.60
$1121.64
$1704.44		 $827.41
$912.19
$1001.99
$1321.03		 $1026.80
$1111.58
$1201.38
$1520.42		 $1226.19
$1310.97
$1400.77
$1719.81		 $513.40
$555.79
$600.69
$760.21		 $712.79
$755.18
$800.08
$959.60		 $912.18
$954.57
$999.47
$1158.99		 $199.39

Plan: (PPO) Land of Lincoln Health Traditional Silver PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health Insurance Company)

Deductible: Individual: $1,900 : Family: $3,800
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $263.31
$298.85
$336.51
$470.27
$714.62		 $526.62
$597.70
$673.02
$940.54
$1429.24		 $693.82
$764.90
$840.22
$1107.74		 $861.02
$932.10
$1007.42
$1274.94		 $1028.22
$1099.30
$1174.62
$1442.14		 $430.51
$466.05
$503.71
$637.47		 $597.71
$633.25
$670.91
$804.67		 $764.91
$800.45
$838.11
$971.87		 $167.20

Plan: (PPO) Land of Lincoln Health Traditional Bronze PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-674-3844 - Provider Directory for This Plan: (Land of Lincoln Mutual Health 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		 $212.57
$241.26
$271.66
$379.65
$576.91		 $425.14
$482.52
$543.32
$759.30
$1153.82		 $560.12
$617.50
$678.30
$894.28		 $695.10
$752.48
$813.28
$1029.26		 $830.08
$887.46
$948.26
$1164.24		 $347.55
$376.24
$406.64
$514.63		 $482.53
$511.22
$541.62
$649.61		 $617.51
$646.20
$676.60
$784.59		 $134.98
ADVERTISEMENT

Coventry Health Care of Illinois, Inc.

Local: 1-217-366-1226 | Toll Free: 1-855-449-2889

TTY: 1-217-366-5551

Plan: (PPO) Coventry Gold $15 Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-449-2889 - Provider Directory for This Plan: (Coventry Health Care of Illinois, Inc.)

Deductible: Individual: $1,400 : Family: $2,800
Out of Pocket Maximum per year: Individual: $4,950 : Family: $9,900

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
Gold 21
30
40
50
60		 $469.65
$533.06
$600.22
$838.80
$1274.64		 $939.30
$1066.12
$1200.44
$1677.60
$2549.28		 $1237.53
$1364.35
$1498.67
$1975.83		 $1535.76
$1662.58
$1796.90
$2274.06		 $1833.99
$1960.81
$2095.13
$2572.29		 $767.88
$831.29
$898.45
$1137.03		 $1066.11
$1129.52
$1196.68
$1435.26		 $1364.34
$1427.75
$1494.91
$1733.49		 $298.23

Plan: (PPO) Coventry Silver $15 Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-449-2889 - Provider Directory for This Plan: (Coventry Health Care of Illinois, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,200 : Family: $12,400

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $375.64
$426.35
$480.06
$670.89
$1019.48		 $751.28
$852.70
$960.12
$1341.78
$2038.96		 $989.81
$1091.23
$1198.65
$1580.31		 $1228.34
$1329.76
$1437.18
$1818.84		 $1466.87
$1568.29
$1675.71
$2057.37		 $614.17
$664.88
$718.59
$909.42		 $852.70
$903.41
$957.12
$1147.95		 $1091.23
$1141.94
$1195.65
$1386.48		 $238.53

Plan: (PPO) Coventry Bronze Deductible Only HSA Eligible

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-449-2889 - Provider Directory for This Plan: (Coventry Health Care of Illinois, 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		 $304.91
$346.07
$389.67
$544.57
$827.52		 $609.82
$692.14
$779.34
$1089.14
$1655.04		 $803.44
$885.76
$972.96
$1282.76		 $997.06
$1079.38
$1166.58
$1476.38		 $1190.68
$1273.00
$1360.20
$1670.00		 $498.53
$539.69
$583.29
$738.19		 $692.15
$733.31
$776.91
$931.81		 $885.77
$926.93
$970.53
$1125.43		 $193.62
ADVERTISEMENT

Aetna Health Inc. (a PA corp.)

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

Plan: (HMO) Aetna Whole Health Chicago Gold $10 Copay

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $298.51
$338.81
$381.49
$533.13
$810.15		 $597.02
$677.62
$762.98
$1066.26
$1620.30		 $786.57
$867.17
$952.53
$1255.81		 $976.12
$1056.72
$1142.08
$1445.36		 $1165.67
$1246.27
$1331.63
$1634.91		 $488.06
$528.36
$571.04
$722.68		 $677.61
$717.91
$760.59
$912.23		 $867.16
$907.46
$950.14
$1101.78		 $189.55

Plan: (HMO) Aetna Whole Health Chicago Silver $10 Copay

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: $6,250 : Family: $12,500

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $222.44
$252.47
$284.28
$397.28
$603.71		 $444.88
$504.94
$568.56
$794.56
$1207.42		 $586.13
$646.19
$709.81
$935.81		 $727.38
$787.44
$851.06
$1077.06		 $868.63
$928.69
$992.31
$1218.31		 $363.69
$393.72
$425.53
$538.53		 $504.94
$534.97
$566.78
$679.78		 $646.19
$676.22
$708.03
$821.03		 $141.25

Plan: (HMO) Aetna Whole Health Chicago Bronze $15 Copay

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		 $174.49
$198.04
$223.00
$311.64
$473.56		 $348.98
$396.08
$446.00
$623.28
$947.12		 $459.78
$506.88
$556.80
$734.08		 $570.58
$617.68
$667.60
$844.88		 $681.38
$728.48
$778.40
$955.68		 $285.29
$308.84
$333.80
$422.44		 $396.09
$419.64
$444.60
$533.24		 $506.89
$530.44
$555.40
$644.04		 $110.80

Plan: (HMO) AetnaWholeHealth Chicago Bronze Deductible Only HSA Eligible

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		 $176.60
$200.44
$225.69
$315.40
$479.28		 $353.20
$400.88
$451.38
$630.80
$958.56		 $465.34
$513.02
$563.52
$742.94		 $577.48
$625.16
$675.66
$855.08		 $689.62
$737.30
$787.80
$967.22		 $288.74
$312.58
$337.83
$427.54		 $400.88
$424.72
$449.97
$539.68		 $513.02
$536.86
$562.11
$651.82		 $112.14

†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 Cook County here.

 

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