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Providers for Zip Code 46725

LegalConsumer.com/obamacare

ObamacareByZipCode.com

Obamacare 2016 Marketplace Rates For Whitley County, Indiana

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 Whitley County, Indiana.

Obamacare Providers, Plans and 2016 Rates for Whitley County

Whitley County is in “Rating Area 4” of Indiana.

Currently, there are 4 providers offering 58 plans to Rating Area 4. †

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

The table below shows premiums for the following scenarios for:

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

Each scenario is covered for age

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

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

  • a summary of plan benefits and costs,
  • a plan brochure, and
  • a "Provider Directory" -- where you can find out which doctors and hospitals in the Columbia City, IN area accept this insurance coverage as within the plan's "network".
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Anthem Ins Companies Inc(Anthem BCBS)

Local: 1-855-886-6152 | Toll Free: 1-855-886-6152

Plan: (HMO) Anthem Bronze Pathway X 6250 20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $6,250 : Family: $12,500
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $247.04
$280.39
$315.72
$441.21
$670.47		 $494.08
$560.78
$631.44
$882.42
$1340.94		 $650.95
$717.65
$788.31
$1039.29		 $807.82
$874.52
$945.18
$1196.16		 $964.69
$1031.39
$1102.05
$1353.03		 $403.91
$437.26
$472.59
$598.08		 $560.78
$594.13
$629.46
$754.95		 $717.65
$751.00
$786.33
$911.82		 $156.87

Plan: (HMO) Anthem Bronze Pathway X 4850 20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $4,850 : Family: $9,700
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		 $241.17
$273.73
$308.22
$430.73
$654.54		 $482.34
$547.46
$616.44
$861.46
$1309.08		 $635.48
$700.60
$769.58
$1014.60		 $788.62
$853.74
$922.72
$1167.74		 $941.76
$1006.88
$1075.86
$1320.88		 $394.31
$426.87
$461.36
$583.87		 $547.45
$580.01
$614.50
$737.01		 $700.59
$733.15
$767.64
$890.15		 $153.14

Plan: (HMO) Anthem Bronze Pathway X 6400 30

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $6,400 : Family: $12,800
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
Bronze 21
30
40
50
60		 $245.05
$278.13
$313.17
$437.66
$665.07		 $490.10
$556.26
$626.34
$875.32
$1330.14		 $645.71
$711.87
$781.95
$1030.93		 $801.32
$867.48
$937.56
$1186.54		 $956.93
$1023.09
$1093.17
$1342.15		 $400.66
$433.74
$468.78
$593.27		 $556.27
$589.35
$624.39
$748.88		 $711.88
$744.96
$780.00
$904.49		 $155.61

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $6,300 : Family: $12,600
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
Bronze 21
30
40
50
60		 $247.01
$280.36
$315.68
$441.16
$670.39		 $494.02
$560.72
$631.36
$882.32
$1340.78		 $650.87
$717.57
$788.21
$1039.17		 $807.72
$874.42
$945.06
$1196.02		 $964.57
$1031.27
$1101.91
$1352.87		 $403.86
$437.21
$472.53
$598.01		 $560.71
$594.06
$629.38
$754.86		 $717.56
$750.91
$786.23
$911.71		 $156.85

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $6,300 : 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		 $246.52
$279.80
$315.05
$440.28
$669.06		 $493.04
$559.60
$630.10
$880.56
$1338.12		 $649.58
$716.14
$786.64
$1037.10		 $806.12
$872.68
$943.18
$1193.64		 $962.66
$1029.22
$1099.72
$1350.18		 $403.06
$436.34
$471.59
$596.82		 $559.60
$592.88
$628.13
$753.36		 $716.14
$749.42
$784.67
$909.90		 $156.54

Plan: (HMO) Anthem Silver Pathway X 3500 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $3,500 : Family: $7,000
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		 $296.43
$336.45
$378.84
$529.42
$804.51		 $592.86
$672.90
$757.68
$1058.84
$1609.02		 $781.09
$861.13
$945.91
$1247.07		 $969.32
$1049.36
$1134.14
$1435.30		 $1157.55
$1237.59
$1322.37
$1623.53		 $484.66
$524.68
$567.07
$717.65		 $672.89
$712.91
$755.30
$905.88		 $861.12
$901.14
$943.53
$1094.11		 $188.23

Plan: (HMO) Anthem Silver Pathway X 2500 10

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(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		 $286.63
$325.33
$366.31
$511.92
$777.91		 $573.26
$650.66
$732.62
$1023.84
$1555.82		 $755.27
$832.67
$914.63
$1205.85		 $937.28
$1014.68
$1096.64
$1387.86		 $1119.29
$1196.69
$1278.65
$1569.87		 $468.64
$507.34
$548.32
$693.93		 $650.65
$689.35
$730.33
$875.94		 $832.66
$871.36
$912.34
$1057.95		 $182.01

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $3,000 : Family: $6,000
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		 $283.43
$321.69
$362.22
$506.21
$769.23		 $566.86
$643.38
$724.44
$1012.42
$1538.46		 $746.84
$823.36
$904.42
$1192.40		 $926.82
$1003.34
$1084.40
$1372.38		 $1106.80
$1183.32
$1264.38
$1552.36		 $463.41
$501.67
$542.20
$686.19		 $643.39
$681.65
$722.18
$866.17		 $823.37
$861.63
$902.16
$1046.15		 $179.98

Plan: (HMO) Anthem Catastrophic Pathway X 6850 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(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		 $193.89
$220.07
$247.79
$346.29
$526.22		 $387.78
$440.14
$495.58
$692.58
$1052.44		 $510.90
$563.26
$618.70
$815.70		 $634.02
$686.38
$741.82
$938.82		 $757.14
$809.50
$864.94
$1061.94		 $317.01
$343.19
$370.91
$469.41		 $440.13
$466.31
$494.03
$592.53		 $563.25
$589.43
$617.15
$715.65		 $123.12

Plan: (HMO) Anthem Gold Pathway X 1500 25

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $3,450 : Family: $6,900

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		 $351.30
$398.73
$448.96
$627.42
$953.43		 $702.60
$797.46
$897.92
$1254.84
$1906.86		 $925.68
$1020.54
$1121.00
$1477.92		 $1148.76
$1243.62
$1344.08
$1701.00		 $1371.84
$1466.70
$1567.16
$1924.08		 $574.38
$621.81
$672.04
$850.50		 $797.46
$844.89
$895.12
$1073.58		 $1020.54
$1067.97
$1118.20
$1296.66		 $223.08

Plan: (HMO) Anthem Bronze Pathway X 5850 35

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(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		 $229.84
$260.87
$293.74
$410.49
$623.79		 $459.68
$521.74
$587.48
$820.98
$1247.58		 $605.63
$667.69
$733.43
$966.93		 $751.58
$813.64
$879.38
$1112.88		 $897.53
$959.59
$1025.33
$1258.83		 $375.79
$406.82
$439.69
$556.44		 $521.74
$552.77
$585.64
$702.39		 $667.69
$698.72
$731.59
$848.34		 $145.95

Plan: (HMO) Anthem Bronze Pathway X 4950 50

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

Deductible: Individual: $4,950 : Family: $9,900
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		 $228.61
$259.47
$292.16
$408.30
$620.45		 $457.22
$518.94
$584.32
$816.60
$1240.90		 $602.39
$664.11
$729.49
$961.77		 $747.56
$809.28
$874.66
$1106.94		 $892.73
$954.45
$1019.83
$1252.11		 $373.78
$404.64
$437.33
$553.47		 $518.95
$549.81
$582.50
$698.64		 $664.12
$694.98
$727.67
$843.81		 $145.17

Plan: (HMO) Anthem Bronze Pathway X 6850 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(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		 $239.67
$272.03
$306.30
$428.05
$650.46		 $479.34
$544.06
$612.60
$856.10
$1300.92		 $631.53
$696.25
$764.79
$1008.29		 $783.72
$848.44
$916.98
$1160.48		 $935.91
$1000.63
$1069.17
$1312.67		 $391.86
$424.22
$458.49
$580.24		 $544.05
$576.41
$610.68
$732.43		 $696.24
$728.60
$762.87
$884.62		 $152.19

Plan: (HMO) Anthem Silver Pathway X 4250 30

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(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		 $265.93
$301.83
$339.86
$474.95
$721.73		 $531.86
$603.66
$679.72
$949.90
$1443.46		 $700.73
$772.53
$848.59
$1118.77		 $869.60
$941.40
$1017.46
$1287.64		 $1038.47
$1110.27
$1186.33
$1456.51		 $434.80
$470.70
$508.73
$643.82		 $603.67
$639.57
$677.60
$812.69		 $772.54
$808.44
$846.47
$981.56		 $168.87

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(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		 $231.23
$262.45
$295.51
$412.98
$627.56		 $462.46
$524.90
$591.02
$825.96
$1255.12		 $609.29
$671.73
$737.85
$972.79		 $756.12
$818.56
$884.68
$1119.62		 $902.95
$965.39
$1031.51
$1266.45		 $378.06
$409.28
$442.34
$559.81		 $524.89
$556.11
$589.17
$706.64		 $671.72
$702.94
$736.00
$853.47		 $146.83

Plan: (HMO) Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(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		 $284.41
$322.81
$363.48
$507.96
$771.89		 $568.82
$645.62
$726.96
$1015.92
$1543.78		 $749.42
$826.22
$907.56
$1196.52		 $930.02
$1006.82
$1088.16
$1377.12		 $1110.62
$1187.42
$1268.76
$1557.72		 $465.01
$503.41
$544.08
$688.56		 $645.61
$684.01
$724.68
$869.16		 $826.21
$864.61
$905.28
$1049.76		 $180.60

Plan: (HMO) Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-886-6152 - Provider Directory for This Plan: (Anthem Ins Companies Inc(Anthem BCBS))

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $376.20
$426.99
$480.78
$671.89
$1021.01		 $752.40
$853.98
$961.56
$1343.78
$2042.02		 $991.29
$1092.87
$1200.45
$1582.67		 $1230.18
$1331.76
$1439.34
$1821.56		 $1469.07
$1570.65
$1678.23
$2060.45		 $615.09
$665.88
$719.67
$910.78		 $853.98
$904.77
$958.56
$1149.67		 $1092.87
$1143.66
$1197.45
$1388.56		 $238.89
ADVERTISEMENT

All Savers Insurance Company

Local: 1-877-512-9947 | Toll Free: 1-877-512-9947

Plan: (EPO) Gold Choice 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9947 - 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		 $339.32
$385.11
$433.63
$606.00
$920.88		 $678.64
$770.22
$867.26
$1212.00
$1841.76		 $894.10
$985.68
$1082.72
$1427.46		 $1109.56
$1201.14
$1298.18
$1642.92		 $1325.02
$1416.60
$1513.64
$1858.38		 $554.78
$600.57
$649.09
$821.46		 $770.24
$816.03
$864.55
$1036.92		 $985.70
$1031.49
$1080.01
$1252.38		 $215.46

Plan: (EPO) Silver Choice HSA 3000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9947 - 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		 $281.73
$319.76
$360.04
$503.16
$764.60		 $563.46
$639.52
$720.08
$1006.32
$1529.20		 $742.36
$818.42
$898.98
$1185.22		 $921.26
$997.32
$1077.88
$1364.12		 $1100.16
$1176.22
$1256.78
$1543.02		 $460.63
$498.66
$538.94
$682.06		 $639.53
$677.56
$717.84
$860.96		 $818.43
$856.46
$896.74
$1039.86		 $178.90

Plan: (EPO) Silver Choice 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9947 - 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		 $295.50
$335.38
$377.63
$527.74
$801.95		 $591.00
$670.76
$755.26
$1055.48
$1603.90		 $778.63
$858.39
$942.89
$1243.11		 $966.26
$1046.02
$1130.52
$1430.74		 $1153.89
$1233.65
$1318.15
$1618.37		 $483.13
$523.01
$565.26
$715.37		 $670.76
$710.64
$752.89
$903.00		 $858.39
$898.27
$940.52
$1090.63		 $187.63

Plan: (EPO) Silver Choice 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9947 - 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		 $297.74
$337.93
$380.51
$531.75
$808.05		 $595.48
$675.86
$761.02
$1063.50
$1616.10		 $784.54
$864.92
$950.08
$1252.56		 $973.60
$1053.98
$1139.14
$1441.62		 $1162.66
$1243.04
$1328.20
$1630.68		 $486.80
$526.99
$569.57
$720.81		 $675.86
$716.05
$758.63
$909.87		 $864.92
$905.11
$947.69
$1098.93		 $189.06

Plan: (EPO) Silver Choice 4500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9947 - 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		 $304.21
$345.26
$388.76
$543.29
$825.59		 $608.42
$690.52
$777.52
$1086.58
$1651.18		 $801.58
$883.68
$970.68
$1279.74		 $994.74
$1076.84
$1163.84
$1472.90		 $1187.90
$1270.00
$1357.00
$1666.06		 $497.37
$538.42
$581.92
$736.45		 $690.53
$731.58
$775.08
$929.61		 $883.69
$924.74
$968.24
$1122.77		 $193.16

Plan: (EPO) Bronze Choice HSA 5500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9947 - 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		 $245.78
$278.95
$314.10
$438.95
$667.02		 $491.56
$557.90
$628.20
$877.90
$1334.04		 $647.63
$713.97
$784.27
$1033.97		 $803.70
$870.04
$940.34
$1190.04		 $959.77
$1026.11
$1096.41
$1346.11		 $401.85
$435.02
$470.17
$595.02		 $557.92
$591.09
$626.24
$751.09		 $713.99
$747.16
$782.31
$907.16		 $156.07

Plan: (EPO) Bronze Choice 6500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9947 - 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		 $258.98
$293.93
$330.97
$462.53
$702.85		 $517.96
$587.86
$661.94
$925.06
$1405.70		 $682.41
$752.31
$826.39
$1089.51		 $846.86
$916.76
$990.84
$1253.96		 $1011.31
$1081.21
$1155.29
$1418.41		 $423.43
$458.38
$495.42
$626.98		 $587.88
$622.83
$659.87
$791.43		 $752.33
$787.28
$824.32
$955.88		 $164.45

Plan: (EPO) Gold Choice 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9947 - 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		 $333.98
$379.05
$426.81
$596.47
$906.39		 $667.96
$758.10
$853.62
$1192.94
$1812.78		 $880.03
$970.17
$1065.69
$1405.01		 $1092.10
$1182.24
$1277.76
$1617.08		 $1304.17
$1394.31
$1489.83
$1829.15		 $546.05
$591.12
$638.88
$808.54		 $758.12
$803.19
$850.95
$1020.61		 $970.19
$1015.26
$1063.02
$1232.68		 $212.07

Plan: (EPO) Silver Choice 2000 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-512-9947 - 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		 $293.25
$332.83
$374.76
$523.73
$795.86		 $586.50
$665.66
$749.52
$1047.46
$1591.72		 $772.71
$851.87
$935.73
$1233.67		 $958.92
$1038.08
$1121.94
$1419.88		 $1145.13
$1224.29
$1308.15
$1606.09		 $479.46
$519.04
$560.97
$709.94		 $665.67
$705.25
$747.18
$896.15		 $851.88
$891.46
$933.39
$1082.36		 $186.21
ADVERTISEMENT

Physicians Health Plan of Northern Indiana, Inc.

Local: 1-260-432-6690 x11 | Toll Free: 1-800-982-6257

TTY: 1-260-459-2600

Plan: (HMO) Marquee Silver 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-982-6257 - Provider Directory for This Plan: (Physicians Health Plan of Northern Indiana, 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		 $269.35
$305.71
$344.23
$481.06
$731.02		 $538.70
$611.42
$688.46
$962.12
$1462.04		 $709.74
$782.46
$859.50
$1133.16		 $880.78
$953.50
$1030.54
$1304.20		 $1051.82
$1124.54
$1201.58
$1475.24		 $440.39
$476.75
$515.27
$652.10		 $611.43
$647.79
$686.31
$823.14		 $782.47
$818.83
$857.35
$994.18		 $171.04

Plan: (HMO) Marquee Silver 2500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-982-6257 - Provider Directory for This Plan: (Physicians Health Plan of Northern Indiana, Inc.)

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		 $271.80
$308.49
$347.36
$485.43
$737.67		 $543.60
$616.98
$694.72
$970.86
$1475.34		 $716.19
$789.57
$867.31
$1143.45		 $888.78
$962.16
$1039.90
$1316.04		 $1061.37
$1134.75
$1212.49
$1488.63		 $444.39
$481.08
$519.95
$658.02		 $616.98
$653.67
$692.54
$830.61		 $789.57
$826.26
$865.13
$1003.20		 $172.59

Plan: (HMO) Marquee HSA Silver 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-982-6257 - Provider Directory for This Plan: (Physicians Health Plan of Northern Indiana, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $280.65
$318.54
$358.67
$501.24
$761.68		 $561.30
$637.08
$717.34
$1002.48
$1523.36		 $739.51
$815.29
$895.55
$1180.69		 $917.72
$993.50
$1073.76
$1358.90		 $1095.93
$1171.71
$1251.97
$1537.11		 $458.86
$496.75
$536.88
$679.45		 $637.07
$674.96
$715.09
$857.66		 $815.28
$853.17
$893.30
$1035.87		 $178.21

Plan: (HMO) Marquee HSA Bronze 3750

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-982-6257 - Provider Directory for This Plan: (Physicians Health Plan of Northern Indiana, Inc.)

Deductible: Individual: $3,750 : Family: $7,500
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		 $231.08
$262.28
$295.32
$412.71
$627.15		 $462.16
$524.56
$590.64
$825.42
$1254.30		 $608.90
$671.30
$737.38
$972.16		 $755.64
$818.04
$884.12
$1118.90		 $902.38
$964.78
$1030.86
$1265.64		 $377.82
$409.02
$442.06
$559.45		 $524.56
$555.76
$588.80
$706.19		 $671.30
$702.50
$735.54
$852.93		 $146.74

Plan: (HMO) Marquee Bronze 5000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-982-6257 - Provider Directory for This Plan: (Physicians Health Plan of Northern Indiana, Inc.)

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		 $219.55
$249.19
$280.58
$392.12
$595.86		 $439.10
$498.38
$561.16
$784.24
$1191.72		 $578.51
$637.79
$700.57
$923.65		 $717.92
$777.20
$839.98
$1063.06		 $857.33
$916.61
$979.39
$1202.47		 $358.96
$388.60
$419.99
$531.53		 $498.37
$528.01
$559.40
$670.94		 $637.78
$667.42
$698.81
$810.35		 $139.41

Plan: (HMO) Marquee HSA Bronze 6000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-982-6257 - Provider Directory for This Plan: (Physicians Health Plan of Northern Indiana, Inc.)

Deductible: Individual: $6,000 : Family: $12,000
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		 $218.44
$247.93
$279.17
$390.13
$592.85		 $436.88
$495.86
$558.34
$780.26
$1185.70		 $575.59
$634.57
$697.05
$918.97		 $714.30
$773.28
$835.76
$1057.68		 $853.01
$911.99
$974.47
$1196.39		 $357.15
$386.64
$417.88
$528.84		 $495.86
$525.35
$556.59
$667.55		 $634.57
$664.06
$695.30
$806.26		 $138.71

Plan: (HMO) Marquee Gold 1250

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-982-6257 - Provider Directory for This Plan: (Physicians Health Plan of Northern Indiana, Inc.)

Deductible: Individual: $1,250 : Family: $2,500
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $334.48
$379.63
$427.47
$597.38
$907.78		 $668.96
$759.26
$854.94
$1194.76
$1815.56		 $881.35
$971.65
$1067.33
$1407.15		 $1093.74
$1184.04
$1279.72
$1619.54		 $1306.13
$1396.43
$1492.11
$1831.93		 $546.87
$592.02
$639.86
$809.77		 $759.26
$804.41
$852.25
$1022.16		 $971.65
$1016.80
$1064.64
$1234.55		 $212.39

Plan: (HMO) Marquee Catastrophic 6850

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-982-6257 - Provider Directory for This Plan: (Physicians Health Plan of Northern Indiana, 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		 $161.06
$182.80
$205.83
$287.65
$437.12		 $322.12
$365.60
$411.66
$575.30
$874.24		 $424.39
$467.87
$513.93
$677.57		 $526.66
$570.14
$616.20
$779.84		 $628.93
$672.41
$718.47
$882.11		 $263.33
$285.07
$308.10
$389.92		 $365.60
$387.34
$410.37
$492.19		 $467.87
$489.61
$512.64
$594.46		 $102.27

Plan: (POS) Marquee Bronze 5000 POS

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-982-6257 - Provider Directory for This Plan: (Physicians Health Plan of Northern Indiana, Inc.)

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		 $223.67
$253.87
$285.85
$399.47
$607.04		 $447.34
$507.74
$571.70
$798.94
$1214.08		 $589.37
$649.77
$713.73
$940.97		 $731.40
$791.80
$855.76
$1083.00		 $873.43
$933.83
$997.79
$1225.03		 $365.70
$395.90
$427.88
$541.50		 $507.73
$537.93
$569.91
$683.53		 $649.76
$679.96
$711.94
$825.56		 $142.03
ADVERTISEMENT

MDwise Marketplace, Inc.

Local: 1-855-417-5615 | Toll Free: 1-855-417-5615

TTY: 1-800-743-3333

Plan: (HMO) MDwise Marketplace Bronze Plus

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-417-5615 - Provider Directory for This Plan: (MDwise Marketplace, Inc.)

Deductible: Individual: $4,800 : Family: $9,600
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		 $209.49
$237.77
$267.73
$374.15
$568.56		 $418.98
$475.54
$535.46
$748.30
$1137.12		 $552.00
$608.56
$668.48
$881.32		 $685.02
$741.58
$801.50
$1014.34		 $818.04
$874.60
$934.52
$1147.36		 $342.51
$370.79
$400.75
$507.17		 $475.53
$503.81
$533.77
$640.19		 $608.55
$636.83
$666.79
$773.21		 $133.02

Plan: (HMO) MDwise Marketplace Silver Plus

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-417-5615 - Provider Directory for This Plan: (MDwise Marketplace, Inc.)

Deductible: Individual: $2,500 : Family: $5,000
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		 $236.50
$268.43
$302.25
$422.39
$641.87		 $473.00
$536.86
$604.50
$844.78
$1283.74		 $623.17
$687.03
$754.67
$994.95		 $773.34
$837.20
$904.84
$1145.12		 $923.51
$987.37
$1055.01
$1295.29		 $386.67
$418.60
$452.42
$572.56		 $536.84
$568.77
$602.59
$722.73		 $687.01
$718.94
$752.76
$872.90		 $150.17

Plan: (HMO) MDwise Marketplace Gold Plus

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-417-5615 - Provider Directory for This Plan: (MDwise Marketplace, Inc.)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $283.23
$321.47
$361.97
$505.86
$768.70		 $566.46
$642.94
$723.94
$1011.72
$1537.40		 $746.31
$822.79
$903.79
$1191.57		 $926.16
$1002.64
$1083.64
$1371.42		 $1106.01
$1182.49
$1263.49
$1551.27		 $463.08
$501.32
$541.82
$685.71		 $642.93
$681.17
$721.67
$865.56		 $822.78
$861.02
$901.52
$1045.41		 $179.85

Plan: (HMO) MDwise Marketplace Bronze Basic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-417-5615 - Provider Directory for This Plan: (MDwise Marketplace, Inc.)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $204.84
$232.49
$261.78
$365.84
$555.93		 $409.68
$464.98
$523.56
$731.68
$1111.86		 $539.75
$595.05
$653.63
$861.75		 $669.82
$725.12
$783.70
$991.82		 $799.89
$855.19
$913.77
$1121.89		 $334.91
$362.56
$391.85
$495.91		 $464.98
$492.63
$521.92
$625.98		 $595.05
$622.70
$651.99
$756.05		 $130.07

Plan: (HMO) MDwise Marketplace Silver Basic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-417-5615 - Provider Directory for This Plan: (MDwise Marketplace, Inc.)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $223.21
$253.35
$285.27
$398.66
$605.81		 $446.42
$506.70
$570.54
$797.32
$1211.62		 $588.16
$648.44
$712.28
$939.06		 $729.90
$790.18
$854.02
$1080.80		 $871.64
$931.92
$995.76
$1222.54		 $364.95
$395.09
$427.01
$540.40		 $506.69
$536.83
$568.75
$682.14		 $648.43
$678.57
$710.49
$823.88		 $141.74

Plan: (HMO) MDwise Marketplace Silver Coinsurance

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-417-5615 - Provider Directory for This Plan: (MDwise Marketplace, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
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		 $232.91
$264.36
$297.67
$415.99
$632.14		 $465.82
$528.72
$595.34
$831.98
$1264.28		 $613.72
$676.62
$743.24
$979.88		 $761.62
$824.52
$891.14
$1127.78		 $909.52
$972.42
$1039.04
$1275.68		 $380.81
$412.26
$445.57
$563.89		 $528.71
$560.16
$593.47
$711.79		 $676.61
$708.06
$741.37
$859.69		 $147.90

Plan: (HMO) MDwise Marketplace Bronze Plus with Adult Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-417-5615 - Provider Directory for This Plan: (MDwise Marketplace, Inc.)

Deductible: Individual: $4,800 : Family: $9,600
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		 $213.83
$242.70
$273.27
$381.90
$580.34		 $427.66
$485.40
$546.54
$763.80
$1160.68		 $563.44
$621.18
$682.32
$899.58		 $699.22
$756.96
$818.10
$1035.36		 $835.00
$892.74
$953.88
$1171.14		 $349.61
$378.48
$409.05
$517.68		 $485.39
$514.26
$544.83
$653.46		 $621.17
$650.04
$680.61
$789.24		 $135.78

Plan: (HMO) MDwise Marketplace Silver Plus with Adult Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-417-5615 - Provider Directory for This Plan: (MDwise Marketplace, Inc.)

Deductible: Individual: $2,500 : Family: $5,000
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		 $240.84
$273.35
$307.79
$430.14
$653.64		 $481.68
$546.70
$615.58
$860.28
$1307.28		 $634.61
$699.63
$768.51
$1013.21		 $787.54
$852.56
$921.44
$1166.14		 $940.47
$1005.49
$1074.37
$1319.07		 $393.77
$426.28
$460.72
$583.07		 $546.70
$579.21
$613.65
$736.00		 $699.63
$732.14
$766.58
$888.93		 $152.93

Plan: (HMO) MDwise Marketplace Gold Plus with Adult Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-417-5615 - Provider Directory for This Plan: (MDwise Marketplace, Inc.)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $287.57
$326.39
$367.52
$513.61
$780.48		 $575.14
$652.78
$735.04
$1027.22
$1560.96		 $757.75
$835.39
$917.65
$1209.83		 $940.36
$1018.00
$1100.26
$1392.44		 $1122.97
$1200.61
$1282.87
$1575.05		 $470.18
$509.00
$550.13
$696.22		 $652.79
$691.61
$732.74
$878.83		 $835.40
$874.22
$915.35
$1061.44		 $182.61
ADVERTISEMENT

Celtic Insurance Company

Local: 1-877-687-1182 | Toll Free: 1-877-941-9232

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-941-9232 - 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		 $311.49
$353.53
$398.07
$556.30
$845.36		 $622.98
$707.06
$796.14
$1112.60
$1690.72		 $820.77
$904.85
$993.93
$1310.39		 $1018.56
$1102.64
$1191.72
$1508.18		 $1216.35
$1300.43
$1389.51
$1705.97		 $509.28
$551.32
$595.86
$754.09		 $707.07
$749.11
$793.65
$951.88		 $904.86
$946.90
$991.44
$1149.67		 $197.79

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-941-9232 - 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		 $244.14
$277.09
$312.00
$436.02
$662.58		 $488.28
$554.18
$624.00
$872.04
$1325.16		 $643.30
$709.20
$779.02
$1027.06		 $798.32
$864.22
$934.04
$1182.08		 $953.34
$1019.24
$1089.06
$1337.10		 $399.16
$432.11
$467.02
$591.04		 $554.18
$587.13
$622.04
$746.06		 $709.20
$742.15
$777.06
$901.08		 $155.02

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-941-9232 - 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		 $240.54
$273.00
$307.39
$429.58
$652.78		 $481.08
$546.00
$614.78
$859.16
$1305.56		 $633.81
$698.73
$767.51
$1011.89		 $786.54
$851.46
$920.24
$1164.62		 $939.27
$1004.19
$1072.97
$1317.35		 $393.27
$425.73
$460.12
$582.31		 $546.00
$578.46
$612.85
$735.04		 $698.73
$731.19
$765.58
$887.77		 $152.73

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-941-9232 - 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		 $252.56
$286.65
$322.76
$451.06
$685.42		 $505.12
$573.30
$645.52
$902.12
$1370.84		 $665.49
$733.67
$805.89
$1062.49		 $825.86
$894.04
$966.26
$1222.86		 $986.23
$1054.41
$1126.63
$1383.23		 $412.93
$447.02
$483.13
$611.43		 $573.30
$607.39
$643.50
$771.80		 $733.67
$767.76
$803.87
$932.17		 $160.37

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-941-9232 - 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		 $217.69
$247.06
$278.19
$388.77
$590.77		 $435.38
$494.12
$556.38
$777.54
$1181.54		 $573.60
$632.34
$694.60
$915.76		 $711.82
$770.56
$832.82
$1053.98		 $850.04
$908.78
$971.04
$1192.20		 $355.91
$385.28
$416.41
$526.99		 $494.13
$523.50
$554.63
$665.21		 $632.35
$661.72
$692.85
$803.43		 $138.22

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-941-9232 - 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		 $224.90
$255.25
$287.41
$401.66
$610.35		 $449.80
$510.50
$574.82
$803.32
$1220.70		 $592.61
$653.31
$717.63
$946.13		 $735.42
$796.12
$860.44
$1088.94		 $878.23
$938.93
$1003.25
$1231.75		 $367.71
$398.06
$430.22
$544.47		 $510.52
$540.87
$573.03
$687.28		 $653.33
$683.68
$715.84
$830.09		 $142.81

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-941-9232 - 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		 $249.01
$282.62
$318.23
$444.72
$675.80		 $498.02
$565.24
$636.46
$889.44
$1351.60		 $656.14
$723.36
$794.58
$1047.56		 $814.26
$881.48
$952.70
$1205.68		 $972.38
$1039.60
$1110.82
$1363.80		 $407.13
$440.74
$476.35
$602.84		 $565.25
$598.86
$634.47
$760.96		 $723.37
$756.98
$792.59
$919.08		 $158.12

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-941-9232 - 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		 $245.33
$278.44
$313.53
$438.15
$665.81		 $490.66
$556.88
$627.06
$876.30
$1331.62		 $646.44
$712.66
$782.84
$1032.08		 $802.22
$868.44
$938.62
$1187.86		 $958.00
$1024.22
$1094.40
$1343.64		 $401.11
$434.22
$469.31
$593.93		 $556.89
$590.00
$625.09
$749.71		 $712.67
$745.78
$780.87
$905.49		 $155.78

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-941-9232 - 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		 $257.60
$292.37
$329.20
$460.06
$699.10		 $515.20
$584.74
$658.40
$920.12
$1398.20		 $678.77
$748.31
$821.97
$1083.69		 $842.34
$911.88
$985.54
$1247.26		 $1005.91
$1075.45
$1149.11
$1410.83		 $421.17
$455.94
$492.77
$623.63		 $584.74
$619.51
$656.34
$787.20		 $748.31
$783.08
$819.91
$950.77		 $163.57

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-941-9232 - 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		 $222.03
$251.99
$283.74
$396.53
$602.56		 $444.06
$503.98
$567.48
$793.06
$1205.12		 $585.04
$644.96
$708.46
$934.04		 $726.02
$785.94
$849.44
$1075.02		 $867.00
$926.92
$990.42
$1216.00		 $363.01
$392.97
$424.72
$537.51		 $503.99
$533.95
$565.70
$678.49		 $644.97
$674.93
$706.68
$819.47		 $140.98

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-941-9232 - 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		 $229.39
$260.34
$293.15
$409.67
$622.53		 $458.78
$520.68
$586.30
$819.34
$1245.06		 $604.44
$666.34
$731.96
$965.00		 $750.10
$812.00
$877.62
$1110.66		 $895.76
$957.66
$1023.28
$1256.32		 $375.05
$406.00
$438.81
$555.33		 $520.71
$551.66
$584.47
$700.99		 $666.37
$697.32
$730.13
$846.65		 $145.66

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-941-9232 - 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		 $265.87
$301.75
$339.76
$474.82
$721.53		 $531.74
$603.50
$679.52
$949.64
$1443.06		 $700.56
$772.32
$848.34
$1118.46		 $869.38
$941.14
$1017.16
$1287.28		 $1038.20
$1109.96
$1185.98
$1456.10		 $434.69
$470.57
$508.58
$643.64		 $603.51
$639.39
$677.40
$812.46		 $772.33
$808.21
$846.22
$981.28		 $168.82

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-941-9232 - 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		 $261.94
$297.29
$334.74
$467.80
$710.87		 $523.88
$594.58
$669.48
$935.60
$1421.74		 $690.20
$760.90
$835.80
$1101.92		 $856.52
$927.22
$1002.12
$1268.24		 $1022.84
$1093.54
$1168.44
$1434.56		 $428.26
$463.61
$501.06
$634.12		 $594.58
$629.93
$667.38
$800.44		 $760.90
$796.25
$833.70
$966.76		 $166.32

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-941-9232 - 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		 $275.03
$312.15
$351.48
$491.19
$746.41		 $550.06
$624.30
$702.96
$982.38
$1492.82		 $724.70
$798.94
$877.60
$1157.02		 $899.34
$973.58
$1052.24
$1331.66		 $1073.98
$1148.22
$1226.88
$1506.30		 $449.67
$486.79
$526.12
$665.83		 $624.31
$661.43
$700.76
$840.47		 $798.95
$836.07
$875.40
$1015.11		 $174.64

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-941-9232 - 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		 $237.05
$269.04
$302.94
$423.36
$643.34		 $474.10
$538.08
$605.88
$846.72
$1286.68		 $624.62
$688.60
$756.40
$997.24		 $775.14
$839.12
$906.92
$1147.76		 $925.66
$989.64
$1057.44
$1298.28		 $387.57
$419.56
$453.46
$573.88		 $538.09
$570.08
$603.98
$724.40		 $688.61
$720.60
$754.50
$874.92		 $150.52

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-941-9232 - 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		 $244.91
$277.96
$312.98
$437.39
$664.66		 $489.82
$555.92
$625.96
$874.78
$1329.32		 $645.33
$711.43
$781.47
$1030.29		 $800.84
$866.94
$936.98
$1185.80		 $956.35
$1022.45
$1092.49
$1341.31		 $400.42
$433.47
$468.49
$592.90		 $555.93
$588.98
$624.00
$748.41		 $711.44
$744.49
$779.51
$903.92		 $155.51

†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 Whitley County here.

 

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