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Providers for Zip Code 44615

Obamacare 2016 Marketplace Rates For Carroll County, Ohio

Sunday, May 20th, 2018


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 Carroll County, Ohio.

Obamacare Providers, Plans and 2016 Rates for Carroll County

Carroll County is in “Rating Area 15” of Ohio.

Currently, there are 7 providers offering 116 plans to Rating Area 15.

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 Carrollton, OH area accept this insurance coverage as within the plan's "network".

Coordinated Health Mutual, Inc.

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

TTY: 1-800-545-8279

Plan: (PPO) 2016 Gold 1

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$355.26
$403.22
$454.02
$634.49
$964.17
$710.52
$806.44
$908.04
$1268.98
$1928.34
$936.11
$1032.03
$1133.63
$1494.57
$1161.70
$1257.62
$1359.22
$1720.16
$1387.29
$1483.21
$1584.81
$1945.75
$580.85
$628.81
$679.61
$860.08
$806.44
$854.40
$905.20
$1085.67
$1032.03
$1079.99
$1130.79
$1311.26
$225.59

Plan: (PPO) 2016 Silver 1

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$321.18
$364.54
$410.47
$573.63
$871.68
$642.36
$729.08
$820.94
$1147.26
$1743.36
$846.31
$933.03
$1024.89
$1351.21
$1050.26
$1136.98
$1228.84
$1555.16
$1254.21
$1340.93
$1432.79
$1759.11
$525.13
$568.49
$614.42
$777.58
$729.08
$772.44
$818.37
$981.53
$933.03
$976.39
$1022.32
$1185.48
$203.95

Plan: (PPO) 2016 Bronze 1

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

Deductible: Individual: $6,300 : Family: $12,600
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$263.82
$299.43
$337.16
$471.18
$716.00
$527.64
$598.86
$674.32
$942.36
$1432.00
$695.16
$766.38
$841.84
$1109.88
$862.68
$933.90
$1009.36
$1277.40
$1030.20
$1101.42
$1176.88
$1444.92
$431.34
$466.95
$504.68
$638.70
$598.86
$634.47
$672.20
$806.22
$766.38
$801.99
$839.72
$973.74
$167.52

Plan: (PPO) 2016 Gold 2

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

Deductible: Individual: $1,250 : Family: $2,500
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$367.58
$417.21
$469.77
$656.50
$997.62
$735.16
$834.42
$939.54
$1313.00
$1995.24
$968.57
$1067.83
$1172.95
$1546.41
$1201.98
$1301.24
$1406.36
$1779.82
$1435.39
$1534.65
$1639.77
$2013.23
$600.99
$650.62
$703.18
$889.91
$834.40
$884.03
$936.59
$1123.32
$1067.81
$1117.44
$1170.00
$1356.73
$233.41

Plan: (PPO) 2016 Gold 3 HSA

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$349.23
$396.38
$446.32
$623.73
$947.82
$698.46
$792.76
$892.64
$1247.46
$1895.64
$920.22
$1014.52
$1114.40
$1469.22
$1141.98
$1236.28
$1336.16
$1690.98
$1363.74
$1458.04
$1557.92
$1912.74
$570.99
$618.14
$668.08
$845.49
$792.75
$839.90
$889.84
$1067.25
$1014.51
$1061.66
$1111.60
$1289.01
$221.76

Plan: (PPO) 2016 Silver 2 HSA

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$297.07
$337.17
$379.66
$530.57
$806.25
$594.14
$674.34
$759.32
$1061.14
$1612.50
$782.78
$862.98
$947.96
$1249.78
$971.42
$1051.62
$1136.60
$1438.42
$1160.06
$1240.26
$1325.24
$1627.06
$485.71
$525.81
$568.30
$719.21
$674.35
$714.45
$756.94
$907.85
$862.99
$903.09
$945.58
$1096.49
$188.64

Plan: (PPO) 2016 Bronze 2 HSA

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$248.86
$282.46
$318.04
$444.46
$675.41
$497.72
$564.92
$636.08
$888.92
$1350.82
$655.75
$722.95
$794.11
$1046.95
$813.78
$880.98
$952.14
$1204.98
$971.81
$1039.01
$1110.17
$1363.01
$406.89
$440.49
$476.07
$602.49
$564.92
$598.52
$634.10
$760.52
$722.95
$756.55
$792.13
$918.55
$158.03

Plan: (PPO) 2016 Catastrophic

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$188.38
$213.81
$240.75
$336.44
$511.26
$376.76
$427.62
$481.50
$672.88
$1022.52
$496.38
$547.24
$601.12
$792.50
$616.00
$666.86
$720.74
$912.12
$735.62
$786.48
$840.36
$1031.74
$308.00
$333.43
$360.37
$456.06
$427.62
$453.05
$479.99
$575.68
$547.24
$572.67
$599.61
$695.30
$119.62

Plan: (PPO) 2016 Silver 3 HSA

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

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$321.50
$364.90
$410.87
$574.19
$872.54
$643.00
$729.80
$821.74
$1148.38
$1745.08
$847.15
$933.95
$1025.89
$1352.53
$1051.30
$1138.10
$1230.04
$1556.68
$1255.45
$1342.25
$1434.19
$1760.83
$525.65
$569.05
$615.02
$778.34
$729.80
$773.20
$819.17
$982.49
$933.95
$977.35
$1023.32
$1186.64
$204.15

AultCare Insurance Company

Local: 1-330-363-6360 | Toll Free: 1-800-344-8858

TTY: 1-330-363-2393

Plan: (PPO) AultCare Bronze 6000 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $6,000 : Family: $12,000
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
Bronze 21
30
40
50
60
$210.92
$239.40
$269.56
$376.70
$572.44
$421.84
$478.80
$539.12
$753.40
$1144.88
$555.77
$612.73
$673.05
$887.33
$689.70
$746.66
$806.98
$1021.26
$823.63
$880.59
$940.91
$1155.19
$344.85
$373.33
$403.49
$510.63
$478.78
$507.26
$537.42
$644.56
$612.71
$641.19
$671.35
$778.49
$133.93

Plan: (PPO) AultCare Bronze 5000 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$222.01
$251.98
$283.73
$396.51
$602.53
$444.02
$503.96
$567.46
$793.02
$1205.06
$584.99
$644.93
$708.43
$933.99
$725.96
$785.90
$849.40
$1074.96
$866.93
$926.87
$990.37
$1215.93
$362.98
$392.95
$424.70
$537.48
$503.95
$533.92
$565.67
$678.45
$644.92
$674.89
$706.64
$819.42
$140.97

Plan: (PPO) AultCare Bronze 4000 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$231.52
$262.78
$295.88
$413.50
$628.35
$463.04
$525.56
$591.76
$827.00
$1256.70
$610.06
$672.58
$738.78
$974.02
$757.08
$819.60
$885.80
$1121.04
$904.10
$966.62
$1032.82
$1268.06
$378.54
$409.80
$442.90
$560.52
$525.56
$556.82
$589.92
$707.54
$672.58
$703.84
$736.94
$854.56
$147.02

Plan: (PPO) AultCare Silver 5000 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $5,000 : Family: $10,000
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
$259.14
$294.12
$331.18
$462.82
$703.31
$518.28
$588.24
$662.36
$925.64
$1406.62
$682.83
$752.79
$826.91
$1090.19
$847.38
$917.34
$991.46
$1254.74
$1011.93
$1081.89
$1156.01
$1419.29
$423.69
$458.67
$495.73
$627.37
$588.24
$623.22
$660.28
$791.92
$752.79
$787.77
$824.83
$956.47
$164.55

Plan: (PPO) AultCare Silver 3000 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$281.28
$319.25
$359.47
$502.36
$763.38
$562.56
$638.50
$718.94
$1004.72
$1526.76
$741.17
$817.11
$897.55
$1183.33
$919.78
$995.72
$1076.16
$1361.94
$1098.39
$1174.33
$1254.77
$1540.55
$459.89
$497.86
$538.08
$680.97
$638.50
$676.47
$716.69
$859.58
$817.11
$855.08
$895.30
$1038.19
$178.61

Plan: (PPO) AultCare Silver 1500 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$303.83
$344.85
$388.30
$542.65
$824.61
$607.66
$689.70
$776.60
$1085.30
$1649.22
$800.59
$882.63
$969.53
$1278.23
$993.52
$1075.56
$1162.46
$1471.16
$1186.45
$1268.49
$1355.39
$1664.09
$496.76
$537.78
$581.23
$735.58
$689.69
$730.71
$774.16
$928.51
$882.62
$923.64
$967.09
$1121.44
$192.93

Plan: (PPO) AultCare Silver 2500 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$300.70
$341.30
$384.30
$537.05
$816.10
$601.40
$682.60
$768.60
$1074.10
$1632.20
$792.34
$873.54
$959.54
$1265.04
$983.28
$1064.48
$1150.48
$1455.98
$1174.22
$1255.42
$1341.42
$1646.92
$491.64
$532.24
$575.24
$727.99
$682.58
$723.18
$766.18
$918.93
$873.52
$914.12
$957.12
$1109.87
$190.94

Plan: (PPO) AultCare Silver 1400 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $1,400 : Family: $2,800
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
$290.39
$329.59
$371.11
$518.63
$788.11
$580.78
$659.18
$742.22
$1037.26
$1576.22
$765.18
$843.58
$926.62
$1221.66
$949.58
$1027.98
$1111.02
$1406.06
$1133.98
$1212.38
$1295.42
$1590.46
$474.79
$513.99
$555.51
$703.03
$659.19
$698.39
$739.91
$887.43
$843.59
$882.79
$924.31
$1071.83
$184.40

Plan: (PPO) AultCare Gold 1200 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $1,200 : Family: $2,400
Out of Pocket Maximum per year: Individual: $5,700 : Family: $11,400

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
Gold 21
30
40
50
60
$354.28
$402.11
$452.77
$632.74
$961.52
$708.56
$804.22
$905.54
$1265.48
$1923.04
$933.53
$1029.19
$1130.51
$1490.45
$1158.50
$1254.16
$1355.48
$1715.42
$1383.47
$1479.13
$1580.45
$1940.39
$579.25
$627.08
$677.74
$857.71
$804.22
$852.05
$902.71
$1082.68
$1029.19
$1077.02
$1127.68
$1307.65
$224.97

Plan: (PPO) AultCare Gold 750 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$356.16
$404.25
$455.18
$636.11
$966.63
$712.32
$808.50
$910.36
$1272.22
$1933.26
$938.48
$1034.66
$1136.52
$1498.38
$1164.64
$1260.82
$1362.68
$1724.54
$1390.80
$1486.98
$1588.84
$1950.70
$582.32
$630.41
$681.34
$862.27
$808.48
$856.57
$907.50
$1088.43
$1034.64
$1082.73
$1133.66
$1314.59
$226.16

Plan: (PPO) AultCare Gold 350 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $350 : Family: $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
Gold 21
30
40
50
60
$364.87
$414.13
$466.31
$651.66
$990.26
$729.74
$828.26
$932.62
$1303.32
$1980.52
$961.43
$1059.95
$1164.31
$1535.01
$1193.12
$1291.64
$1396.00
$1766.70
$1424.81
$1523.33
$1627.69
$1998.39
$596.56
$645.82
$698.00
$883.35
$828.25
$877.51
$929.69
$1115.04
$1059.94
$1109.20
$1161.38
$1346.73
$231.69

Plan: (PPO) AultCare Catastrophic Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$131.52
$149.28
$168.08
$234.89
$356.94
$263.04
$298.56
$336.16
$469.78
$713.88
$346.56
$382.08
$419.68
$553.30
$430.08
$465.60
$503.20
$636.82
$513.60
$549.12
$586.72
$720.34
$215.04
$232.80
$251.60
$318.41
$298.56
$316.32
$335.12
$401.93
$382.08
$399.84
$418.64
$485.45
$83.52

Plan: (PPO) AultCare Bronze 6000 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $6,000 : Family: $12,000
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
Bronze 21
30
40
50
60
$180.82
$205.24
$231.09
$322.95
$490.76
$361.64
$410.48
$462.18
$645.90
$981.52
$476.46
$525.30
$577.00
$760.72
$591.28
$640.12
$691.82
$875.54
$706.10
$754.94
$806.64
$990.36
$295.64
$320.06
$345.91
$437.77
$410.46
$434.88
$460.73
$552.59
$525.28
$549.70
$575.55
$667.41
$114.82

Plan: (PPO) AultCare Bronze 5000 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$190.32
$216.01
$243.23
$339.91
$516.53
$380.64
$432.02
$486.46
$679.82
$1033.06
$501.49
$552.87
$607.31
$800.67
$622.34
$673.72
$728.16
$921.52
$743.19
$794.57
$849.01
$1042.37
$311.17
$336.86
$364.08
$460.76
$432.02
$457.71
$484.93
$581.61
$552.87
$578.56
$605.78
$702.46
$120.85

Plan: (PPO) AultCare Bronze 4000 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$198.47
$225.26
$253.64
$354.46
$538.64
$396.94
$450.52
$507.28
$708.92
$1077.28
$522.97
$576.55
$633.31
$834.95
$649.00
$702.58
$759.34
$960.98
$775.03
$828.61
$885.37
$1087.01
$324.50
$351.29
$379.67
$480.49
$450.53
$477.32
$505.70
$606.52
$576.56
$603.35
$631.73
$732.55
$126.03

Plan: (PPO) AultCare Silver 5000 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $5,000 : Family: $10,000
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
$221.98
$251.95
$283.70
$396.46
$602.47
$443.96
$503.90
$567.40
$792.92
$1204.94
$584.92
$644.86
$708.36
$933.88
$725.88
$785.82
$849.32
$1074.84
$866.84
$926.78
$990.28
$1215.80
$362.94
$392.91
$424.66
$537.42
$503.90
$533.87
$565.62
$678.38
$644.86
$674.83
$706.58
$819.34
$140.96

Plan: (PPO) AultCare Silver 3000 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$240.97
$273.51
$307.96
$430.38
$654.00
$481.94
$547.02
$615.92
$860.76
$1308.00
$634.96
$700.04
$768.94
$1013.78
$787.98
$853.06
$921.96
$1166.80
$941.00
$1006.08
$1074.98
$1319.82
$393.99
$426.53
$460.98
$583.40
$547.01
$579.55
$614.00
$736.42
$700.03
$732.57
$767.02
$889.44
$153.02

Plan: (PPO) AultCare Silver 1500 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$260.32
$295.46
$332.69
$464.93
$706.51
$520.64
$590.92
$665.38
$929.86
$1413.02
$685.94
$756.22
$830.68
$1095.16
$851.24
$921.52
$995.98
$1260.46
$1016.54
$1086.82
$1161.28
$1425.76
$425.62
$460.76
$497.99
$630.23
$590.92
$626.06
$663.29
$795.53
$756.22
$791.36
$828.59
$960.83
$165.30

Plan: (PPO) AultCare Silver 2500 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$257.45
$292.20
$329.02
$459.80
$698.72
$514.90
$584.40
$658.04
$919.60
$1397.44
$678.38
$747.88
$821.52
$1083.08
$841.86
$911.36
$985.00
$1246.56
$1005.34
$1074.84
$1148.48
$1410.04
$420.93
$455.68
$492.50
$623.28
$584.41
$619.16
$655.98
$786.76
$747.89
$782.64
$819.46
$950.24
$163.48

Plan: (PPO) AultCare Silver 1400 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $1,400 : Family: $2,800
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
$248.87
$282.46
$318.05
$444.47
$675.42
$497.74
$564.92
$636.10
$888.94
$1350.84
$655.77
$722.95
$794.13
$1046.97
$813.80
$880.98
$952.16
$1205.00
$971.83
$1039.01
$1110.19
$1363.03
$406.90
$440.49
$476.08
$602.50
$564.93
$598.52
$634.11
$760.53
$722.96
$756.55
$792.14
$918.56
$158.03

Plan: (PPO) AultCare Gold 1200 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $1,200 : Family: $2,400
Out of Pocket Maximum per year: Individual: $5,700 : Family: $11,400

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
Gold 21
30
40
50
60
$303.24
$344.18
$387.54
$541.59
$822.99
$606.48
$688.36
$775.08
$1083.18
$1645.98
$799.04
$880.92
$967.64
$1275.74
$991.60
$1073.48
$1160.20
$1468.30
$1184.16
$1266.04
$1352.76
$1660.86
$495.80
$536.74
$580.10
$734.15
$688.36
$729.30
$772.66
$926.71
$880.92
$921.86
$965.22
$1119.27
$192.56

Plan: (PPO) AultCare Gold 750 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$304.93
$346.09
$389.69
$544.60
$827.57
$609.86
$692.18
$779.38
$1089.20
$1655.14
$803.49
$885.81
$973.01
$1282.83
$997.12
$1079.44
$1166.64
$1476.46
$1190.75
$1273.07
$1360.27
$1670.09
$498.56
$539.72
$583.32
$738.23
$692.19
$733.35
$776.95
$931.86
$885.82
$926.98
$970.58
$1125.49
$193.63

Plan: (PPO) AultCare Gold 350 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $350 : Family: $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
Gold 21
30
40
50
60
$312.40
$354.58
$399.25
$557.95
$847.86
$624.80
$709.16
$798.50
$1115.90
$1695.72
$823.18
$907.54
$996.88
$1314.28
$1021.56
$1105.92
$1195.26
$1512.66
$1219.94
$1304.30
$1393.64
$1711.04
$510.78
$552.96
$597.63
$756.33
$709.16
$751.34
$796.01
$954.71
$907.54
$949.72
$994.39
$1153.09
$198.38

Plan: (PPO) AultCare Catastrophic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$154.73
$175.62
$197.74
$276.35
$419.94
$309.46
$351.24
$395.48
$552.70
$839.88
$407.71
$449.49
$493.73
$650.95
$505.96
$547.74
$591.98
$749.20
$604.21
$645.99
$690.23
$847.45
$252.98
$273.87
$295.99
$374.60
$351.23
$372.12
$394.24
$472.85
$449.48
$470.37
$492.49
$571.10
$98.25

Plan: (PPO) AultCare Bronze 6000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $6,000 : Family: $12,000
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
Bronze 21
30
40
50
60
$212.73
$241.45
$271.87
$379.94
$577.36
$425.46
$482.90
$543.74
$759.88
$1154.72
$560.55
$617.99
$678.83
$894.97
$695.64
$753.08
$813.92
$1030.06
$830.73
$888.17
$949.01
$1165.15
$347.82
$376.54
$406.96
$515.03
$482.91
$511.63
$542.05
$650.12
$618.00
$646.72
$677.14
$785.21
$135.09

Plan: (PPO) AultCare Bronze 5000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$223.91
$254.14
$286.15
$399.90
$607.69
$447.82
$508.28
$572.30
$799.80
$1215.38
$590.00
$650.46
$714.48
$941.98
$732.18
$792.64
$856.66
$1084.16
$874.36
$934.82
$998.84
$1226.34
$366.09
$396.32
$428.33
$542.08
$508.27
$538.50
$570.51
$684.26
$650.45
$680.68
$712.69
$826.44
$142.18

Plan: (PPO) AultCare Bronze 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$233.49
$265.01
$298.40
$417.02
$633.69
$466.98
$530.02
$596.80
$834.04
$1267.38
$615.25
$678.29
$745.07
$982.31
$763.52
$826.56
$893.34
$1130.58
$911.79
$974.83
$1041.61
$1278.85
$381.76
$413.28
$446.67
$565.29
$530.03
$561.55
$594.94
$713.56
$678.30
$709.82
$743.21
$861.83
$148.27

Plan: (PPO) AultCare Silver 5000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $5,000 : Family: $10,000
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
$261.16
$296.41
$333.76
$466.43
$708.78
$522.32
$592.82
$667.52
$932.86
$1417.56
$688.16
$758.66
$833.36
$1098.70
$854.00
$924.50
$999.20
$1264.54
$1019.84
$1090.34
$1165.04
$1430.38
$427.00
$462.25
$499.60
$632.27
$592.84
$628.09
$665.44
$798.11
$758.68
$793.93
$831.28
$963.95
$165.84

Plan: (PPO) AultCare Silver 3000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$283.50
$321.77
$362.31
$506.33
$769.42
$567.00
$643.54
$724.62
$1012.66
$1538.84
$747.02
$823.56
$904.64
$1192.68
$927.04
$1003.58
$1084.66
$1372.70
$1107.06
$1183.60
$1264.68
$1552.72
$463.52
$501.79
$542.33
$686.35
$643.54
$681.81
$722.35
$866.37
$823.56
$861.83
$902.37
$1046.39
$180.02

Plan: (PPO) AultCare Silver 1500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$306.26
$347.61
$391.40
$546.98
$831.19
$612.52
$695.22
$782.80
$1093.96
$1662.38
$807.00
$889.70
$977.28
$1288.44
$1001.48
$1084.18
$1171.76
$1482.92
$1195.96
$1278.66
$1366.24
$1677.40
$500.74
$542.09
$585.88
$741.46
$695.22
$736.57
$780.36
$935.94
$889.70
$931.05
$974.84
$1130.42
$194.48

Plan: (PPO) AultCare Silver 2500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$302.88
$343.77
$387.08
$540.95
$822.02
$605.76
$687.54
$774.16
$1081.90
$1644.04
$798.09
$879.87
$966.49
$1274.23
$990.42
$1072.20
$1158.82
$1466.56
$1182.75
$1264.53
$1351.15
$1658.89
$495.21
$536.10
$579.41
$733.28
$687.54
$728.43
$771.74
$925.61
$879.87
$920.76
$964.07
$1117.94
$192.33

Plan: (PPO) AultCare Silver 1400

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $1,400 : Family: $2,800
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
$292.78
$332.31
$374.18
$522.91
$794.61
$585.56
$664.62
$748.36
$1045.82
$1589.22
$771.48
$850.54
$934.28
$1231.74
$957.40
$1036.46
$1120.20
$1417.66
$1143.32
$1222.38
$1306.12
$1603.58
$478.70
$518.23
$560.10
$708.83
$664.62
$704.15
$746.02
$894.75
$850.54
$890.07
$931.94
$1080.67
$185.92

Plan: (PPO) AultCare Gold 1200

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $1,200 : Family: $2,400
Out of Pocket Maximum per year: Individual: $5,700 : Family: $11,400

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
Gold 21
30
40
50
60
$356.75
$404.91
$455.93
$637.16
$968.23
$713.50
$809.82
$911.86
$1274.32
$1936.46
$940.04
$1036.36
$1138.40
$1500.86
$1166.58
$1262.90
$1364.94
$1727.40
$1393.12
$1489.44
$1591.48
$1953.94
$583.29
$631.45
$682.47
$863.70
$809.83
$857.99
$909.01
$1090.24
$1036.37
$1084.53
$1135.55
$1316.78
$226.54

Plan: (PPO) AultCare Gold 750

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$358.74
$407.17
$458.46
$640.70
$973.61
$717.48
$814.34
$916.92
$1281.40
$1947.22
$945.28
$1042.14
$1144.72
$1509.20
$1173.08
$1269.94
$1372.52
$1737.00
$1400.88
$1497.74
$1600.32
$1964.80
$586.54
$634.97
$686.26
$868.50
$814.34
$862.77
$914.06
$1096.30
$1042.14
$1090.57
$1141.86
$1324.10
$227.80

Plan: (PPO) AultCare Gold 350

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $350 : Family: $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
Gold 21
30
40
50
60
$367.53
$417.15
$469.71
$656.42
$997.49
$735.06
$834.30
$939.42
$1312.84
$1994.98
$968.44
$1067.68
$1172.80
$1546.22
$1201.82
$1301.06
$1406.18
$1779.60
$1435.20
$1534.44
$1639.56
$2012.98
$600.91
$650.53
$703.09
$889.80
$834.29
$883.91
$936.47
$1123.18
$1067.67
$1117.29
$1169.85
$1356.56
$233.38

Plan: (PPO) AultCare Catastrophic No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$153.45
$174.17
$196.11
$274.06
$416.47
$306.90
$348.34
$392.22
$548.12
$832.94
$404.34
$445.78
$489.66
$645.56
$501.78
$543.22
$587.10
$743.00
$599.22
$640.66
$684.54
$840.44
$250.89
$271.61
$293.55
$371.50
$348.33
$369.05
$390.99
$468.94
$445.77
$466.49
$488.43
$566.38
$97.44

Plan: (PPO) AultCare Gold 350 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $350 : Family: $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
Gold 21
30
40
50
60
$310.14
$352.01
$396.36
$553.91
$841.72
$620.28
$704.02
$792.72
$1107.82
$1683.44
$817.22
$900.96
$989.66
$1304.76
$1014.16
$1097.90
$1186.60
$1501.70
$1211.10
$1294.84
$1383.54
$1698.64
$507.08
$548.95
$593.30
$750.85
$704.02
$745.89
$790.24
$947.79
$900.96
$942.83
$987.18
$1144.73
$196.94

Plan: (PPO) AultCare Gold 750 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$302.74
$343.61
$386.90
$540.69
$821.63
$605.48
$687.22
$773.80
$1081.38
$1643.26
$797.72
$879.46
$966.04
$1273.62
$989.96
$1071.70
$1158.28
$1465.86
$1182.20
$1263.94
$1350.52
$1658.10
$494.98
$535.85
$579.14
$732.93
$687.22
$728.09
$771.38
$925.17
$879.46
$920.33
$963.62
$1117.41
$192.24

Plan: (PPO) AultCare Gold 1200 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $1,200 : Family: $2,400
Out of Pocket Maximum per year: Individual: $5,700 : Family: $11,400

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
Gold 21
30
40
50
60
$301.14
$341.79
$384.85
$537.83
$817.29
$602.28
$683.58
$769.70
$1075.66
$1634.58
$793.50
$874.80
$960.92
$1266.88
$984.72
$1066.02
$1152.14
$1458.10
$1175.94
$1257.24
$1343.36
$1649.32
$492.36
$533.01
$576.07
$729.05
$683.58
$724.23
$767.29
$920.27
$874.80
$915.45
$958.51
$1111.49
$191.22

Plan: (PPO) AultCare Silver 1400 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $1,400 : Family: $2,800
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
$246.83
$280.15
$315.45
$440.84
$669.89
$493.66
$560.30
$630.90
$881.68
$1339.78
$650.40
$717.04
$787.64
$1038.42
$807.14
$873.78
$944.38
$1195.16
$963.88
$1030.52
$1101.12
$1351.90
$403.57
$436.89
$472.19
$597.58
$560.31
$593.63
$628.93
$754.32
$717.05
$750.37
$785.67
$911.06
$156.74

Plan: (PPO) AultCare Silver 2500 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$255.60
$290.10
$326.65
$456.49
$693.69
$511.20
$580.20
$653.30
$912.98
$1387.38
$673.50
$742.50
$815.60
$1075.28
$835.80
$904.80
$977.90
$1237.58
$998.10
$1067.10
$1140.20
$1399.88
$417.90
$452.40
$488.95
$618.79
$580.20
$614.70
$651.25
$781.09
$742.50
$777.00
$813.55
$943.39
$162.30

Plan: (PPO) AultCare Silver 1500 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$258.26
$293.12
$330.06
$461.25
$700.92
$516.52
$586.24
$660.12
$922.50
$1401.84
$680.51
$750.23
$824.11
$1086.49
$844.50
$914.22
$988.10
$1250.48
$1008.49
$1078.21
$1152.09
$1414.47
$422.25
$457.11
$494.05
$625.24
$586.24
$621.10
$658.04
$789.23
$750.23
$785.09
$822.03
$953.22
$163.99

Plan: (PPO) AultCare Silver 3000 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$239.08
$271.36
$305.55
$427.01
$648.88
$478.16
$542.72
$611.10
$854.02
$1297.76
$629.98
$694.54
$762.92
$1005.84
$781.80
$846.36
$914.74
$1157.66
$933.62
$998.18
$1066.56
$1309.48
$390.90
$423.18
$457.37
$578.83
$542.72
$575.00
$609.19
$730.65
$694.54
$726.82
$761.01
$882.47
$151.82

Plan: (PPO) AultCare Silver 5000 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $5,000 : Family: $10,000
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
$220.27
$250.01
$281.50
$393.40
$597.81
$440.54
$500.02
$563.00
$786.80
$1195.62
$580.41
$639.89
$702.87
$926.67
$720.28
$779.76
$842.74
$1066.54
$860.15
$919.63
$982.61
$1206.41
$360.14
$389.88
$421.37
$533.27
$500.01
$529.75
$561.24
$673.14
$639.88
$669.62
$701.11
$813.01
$139.87

Plan: (PPO) AultCare Bronze 4000 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$196.79
$223.36
$251.50
$351.47
$534.09
$393.58
$446.72
$503.00
$702.94
$1068.18
$518.54
$571.68
$627.96
$827.90
$643.50
$696.64
$752.92
$952.86
$768.46
$821.60
$877.88
$1077.82
$321.75
$348.32
$376.46
$476.43
$446.71
$473.28
$501.42
$601.39
$571.67
$598.24
$626.38
$726.35
$124.96

Plan: (PPO) AultCare Bronze 5000 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$188.71
$214.18
$241.17
$337.03
$512.15
$377.42
$428.36
$482.34
$674.06
$1024.30
$497.25
$548.19
$602.17
$793.89
$617.08
$668.02
$722.00
$913.72
$736.91
$787.85
$841.83
$1033.55
$308.54
$334.01
$361.00
$456.86
$428.37
$453.84
$480.83
$576.69
$548.20
$573.67
$600.66
$696.52
$119.83

Plan: (PPO) AultCare Bronze 6000 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $6,000 : Family: $12,000
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
Bronze 21
30
40
50
60
$179.28
$203.49
$229.12
$320.20
$486.57
$358.56
$406.98
$458.24
$640.40
$973.14
$472.40
$520.82
$572.08
$754.24
$586.24
$634.66
$685.92
$868.08
$700.08
$748.50
$799.76
$981.92
$293.12
$317.33
$342.96
$434.04
$406.96
$431.17
$456.80
$547.88
$520.80
$545.01
$570.64
$661.72
$113.84

Plan: (PPO) AultCare Catastrophic Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$130.43
$148.04
$166.69
$232.95
$354.00
$260.86
$296.08
$333.38
$465.90
$708.00
$343.69
$378.91
$416.21
$548.73
$426.52
$461.74
$499.04
$631.56
$509.35
$544.57
$581.87
$714.39
$213.26
$230.87
$249.52
$315.78
$296.09
$313.70
$332.35
$398.61
$378.92
$396.53
$415.18
$481.44
$82.83

Plan: (PPO) AultCare Silver 4750

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $4,750 : Family: $9,500
Out of Pocket Maximum per year: Individual: $4,750 : Family: $9,500

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
$266.31
$302.26
$340.34
$475.62
$722.75
$532.62
$604.52
$680.68
$951.24
$1445.50
$701.72
$773.62
$849.78
$1120.34
$870.82
$942.72
$1018.88
$1289.44
$1039.92
$1111.82
$1187.98
$1458.54
$435.41
$471.36
$509.44
$644.72
$604.51
$640.46
$678.54
$813.82
$773.61
$809.56
$847.64
$982.92
$169.10

Plan: (PPO) AultCare Silver 6850

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare 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
Silver 21
30
40
50
60
$232.07
$263.39
$296.58
$414.47
$629.83
$464.14
$526.78
$593.16
$828.94
$1259.66
$611.50
$674.14
$740.52
$976.30
$758.86
$821.50
$887.88
$1123.66
$906.22
$968.86
$1035.24
$1271.02
$379.43
$410.75
$443.94
$561.83
$526.79
$558.11
$591.30
$709.19
$674.15
$705.47
$738.66
$856.55
$147.36

Plan: (PPO) AultCare Silver 4750 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $4,750 : Family: $9,500
Out of Pocket Maximum per year: Individual: $4,750 : Family: $9,500

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
$226.36
$256.92
$289.29
$404.28
$614.34
$452.72
$513.84
$578.58
$808.56
$1228.68
$596.46
$657.58
$722.32
$952.30
$740.20
$801.32
$866.06
$1096.04
$883.94
$945.06
$1009.80
$1239.78
$370.10
$400.66
$433.03
$548.02
$513.84
$544.40
$576.77
$691.76
$657.58
$688.14
$720.51
$835.50
$143.74

Plan: (PPO) AultCare Silver 6850 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare 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
Silver 21
30
40
50
60
$197.26
$223.89
$252.09
$352.30
$535.35
$394.52
$447.78
$504.18
$704.60
$1070.70
$519.78
$573.04
$629.44
$829.86
$645.04
$698.30
$754.70
$955.12
$770.30
$823.56
$879.96
$1080.38
$322.52
$349.15
$377.35
$477.56
$447.78
$474.41
$502.61
$602.82
$573.04
$599.67
$627.87
$728.08
$125.26

Plan: (PPO) AultCare Silver 4750 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $4,750 : Family: $9,500
Out of Pocket Maximum per year: Individual: $4,750 : Family: $9,500

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
$264.21
$299.88
$337.66
$471.88
$717.06
$528.42
$599.76
$675.32
$943.76
$1434.12
$696.19
$767.53
$843.09
$1111.53
$863.96
$935.30
$1010.86
$1279.30
$1031.73
$1103.07
$1178.63
$1447.07
$431.98
$467.65
$505.43
$639.65
$599.75
$635.42
$673.20
$807.42
$767.52
$803.19
$840.97
$975.19
$167.77

Plan: (PPO) AultCare Silver 6850 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare 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
Silver 21
30
40
50
60
$230.36
$261.45
$294.40
$411.42
$625.19
$460.72
$522.90
$588.80
$822.84
$1250.38
$607.00
$669.18
$735.08
$969.12
$753.28
$815.46
$881.36
$1115.40
$899.56
$961.74
$1027.64
$1261.68
$376.64
$407.73
$440.68
$557.70
$522.92
$554.01
$586.96
$703.98
$669.20
$700.29
$733.24
$850.26
$146.28

Plan: (PPO) AultCare Silver 4750 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $4,750 : Family: $9,500
Out of Pocket Maximum per year: Individual: $4,750 : Family: $9,500

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
$224.58
$254.90
$287.01
$401.10
$609.50
$449.16
$509.80
$574.02
$802.20
$1219.00
$591.77
$652.41
$716.63
$944.81
$734.38
$795.02
$859.24
$1087.42
$876.99
$937.63
$1001.85
$1230.03
$367.19
$397.51
$429.62
$543.71
$509.80
$540.12
$572.23
$686.32
$652.41
$682.73
$714.84
$828.93
$142.61

Plan: (PPO) AultCare Silver 6850 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare 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
Silver 21
30
40
50
60
$195.80
$222.24
$250.24
$349.70
$531.41
$391.60
$444.48
$500.48
$699.40
$1062.82
$515.93
$568.81
$624.81
$823.73
$640.26
$693.14
$749.14
$948.06
$764.59
$817.47
$873.47
$1072.39
$320.13
$346.57
$374.57
$474.03
$444.46
$470.90
$498.90
$598.36
$568.79
$595.23
$623.23
$722.69
$124.33

Plan: (PPO) AultCare Bronze 6600

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$206.36
$234.22
$263.73
$368.57
$560.07
$412.72
$468.44
$527.46
$737.14
$1120.14
$543.76
$599.48
$658.50
$868.18
$674.80
$730.52
$789.54
$999.22
$805.84
$861.56
$920.58
$1130.26
$337.40
$365.26
$394.77
$499.61
$468.44
$496.30
$525.81
$630.65
$599.48
$627.34
$656.85
$761.69
$131.04

Plan: (PPO) AultCare Bronze 6600 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$175.41
$199.09
$224.17
$313.28
$476.06
$350.82
$398.18
$448.34
$626.56
$952.12
$462.20
$509.56
$559.72
$737.94
$573.58
$620.94
$671.10
$849.32
$684.96
$732.32
$782.48
$960.70
$286.79
$310.47
$335.55
$424.66
$398.17
$421.85
$446.93
$536.04
$509.55
$533.23
$558.31
$647.42
$111.38

Plan: (PPO) AultCare Bronze 6600 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$204.62
$232.25
$261.51
$365.46
$555.35
$409.24
$464.50
$523.02
$730.92
$1110.70
$539.18
$594.44
$652.96
$860.86
$669.12
$724.38
$782.90
$990.80
$799.06
$854.32
$912.84
$1120.74
$334.56
$362.19
$391.45
$495.40
$464.50
$492.13
$521.39
$625.34
$594.44
$622.07
$651.33
$755.28
$129.94

Plan: (PPO) AultCare Bronze 6600 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$173.93
$197.41
$222.28
$310.64
$472.04
$347.86
$394.82
$444.56
$621.28
$944.08
$458.31
$505.27
$555.01
$731.73
$568.76
$615.72
$665.46
$842.18
$679.21
$726.17
$775.91
$952.63
$284.38
$307.86
$332.73
$421.09
$394.83
$418.31
$443.18
$531.54
$505.28
$528.76
$553.63
$641.99
$110.45

Community Insurance Company(Anthem BCBS)

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

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

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$166.57
$189.06
$212.88
$297.49
$452.07
$333.14
$378.12
$425.76
$594.98
$904.14
$438.91
$483.89
$531.53
$700.75
$544.68
$589.66
$637.30
$806.52
$650.45
$695.43
$743.07
$912.29
$272.34
$294.83
$318.65
$403.26
$378.11
$400.60
$424.42
$509.03
$483.88
$506.37
$530.19
$614.80
$105.77

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

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$207.26
$235.24
$264.88
$370.17
$562.50
$414.52
$470.48
$529.76
$740.34
$1125.00
$546.13
$602.09
$661.37
$871.95
$677.74
$733.70
$792.98
$1003.56
$809.35
$865.31
$924.59
$1135.17
$338.87
$366.85
$396.49
$501.78
$470.48
$498.46
$528.10
$633.39
$602.09
$630.07
$659.71
$765.00
$131.61

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

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$199.81
$226.78
$255.36
$356.86
$542.28
$399.62
$453.56
$510.72
$713.72
$1084.56
$526.50
$580.44
$637.60
$840.60
$653.38
$707.32
$764.48
$967.48
$780.26
$834.20
$891.36
$1094.36
$326.69
$353.66
$382.24
$483.74
$453.57
$480.54
$509.12
$610.62
$580.45
$607.42
$636.00
$737.50
$126.88

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

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$198.04
$224.78
$253.10
$353.70
$537.48
$396.08
$449.56
$506.20
$707.40
$1074.96
$521.84
$575.32
$631.96
$833.16
$647.60
$701.08
$757.72
$958.92
$773.36
$826.84
$883.48
$1084.68
$323.80
$350.54
$378.86
$479.46
$449.56
$476.30
$504.62
$605.22
$575.32
$602.06
$630.38
$730.98
$125.76

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

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$205.31
$233.03
$262.39
$366.68
$557.21
$410.62
$466.06
$524.78
$733.36
$1114.42
$540.99
$596.43
$655.15
$863.73
$671.36
$726.80
$785.52
$994.10
$801.73
$857.17
$915.89
$1124.47
$335.68
$363.40
$392.76
$497.05
$466.05
$493.77
$523.13
$627.42
$596.42
$624.14
$653.50
$757.79
$130.37

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

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

Deductible: Individual: $5,550 : Family: $11,100
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$206.42
$234.29
$263.80
$368.67
$560.22
$412.84
$468.58
$527.60
$737.34
$1120.44
$543.92
$599.66
$658.68
$868.42
$675.00
$730.74
$789.76
$999.50
$806.08
$861.82
$920.84
$1130.58
$337.50
$365.37
$394.88
$499.75
$468.58
$496.45
$525.96
$630.83
$599.66
$627.53
$657.04
$761.91
$131.08

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

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$238.14
$270.29
$304.34
$425.32
$646.31
$476.28
$540.58
$608.68
$850.64
$1292.62
$627.50
$691.80
$759.90
$1001.86
$778.72
$843.02
$911.12
$1153.08
$929.94
$994.24
$1062.34
$1304.30
$389.36
$421.51
$455.56
$576.54
$540.58
$572.73
$606.78
$727.76
$691.80
$723.95
$758.00
$878.98
$151.22

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

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

Deductible: Individual: $2,600 : Family: $5,200
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$249.84
$283.57
$319.30
$446.21
$678.07
$499.68
$567.14
$638.60
$892.42
$1356.14
$658.33
$725.79
$797.25
$1051.07
$816.98
$884.44
$955.90
$1209.72
$975.63
$1043.09
$1114.55
$1368.37
$408.49
$442.22
$477.95
$604.86
$567.14
$600.87
$636.60
$763.51
$725.79
$759.52
$795.25
$922.16
$158.65

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

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

Deductible: Individual: $3,750 : Family: $7,500
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$252.97
$287.12
$323.30
$451.80
$686.56
$505.94
$574.24
$646.60
$903.60
$1373.12
$666.58
$734.88
$807.24
$1064.24
$827.22
$895.52
$967.88
$1224.88
$987.86
$1056.16
$1128.52
$1385.52
$413.61
$447.76
$483.94
$612.44
$574.25
$608.40
$644.58
$773.08
$734.89
$769.04
$805.22
$933.72
$160.64

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

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

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$248.04
$281.53
$317.00
$443.00
$673.18
$496.08
$563.06
$634.00
$886.00
$1346.36
$653.59
$720.57
$791.51
$1043.51
$811.10
$878.08
$949.02
$1201.02
$968.61
$1035.59
$1106.53
$1358.53
$405.55
$439.04
$474.51
$600.51
$563.06
$596.55
$632.02
$758.02
$720.57
$754.06
$789.53
$915.53
$157.51

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

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$249.27
$282.92
$318.57
$445.20
$676.52
$498.54
$565.84
$637.14
$890.40
$1353.04
$656.83
$724.13
$795.43
$1048.69
$815.12
$882.42
$953.72
$1206.98
$973.41
$1040.71
$1112.01
$1365.27
$407.56
$441.21
$476.86
$603.49
$565.85
$599.50
$635.15
$761.78
$724.14
$757.79
$793.44
$920.07
$158.29

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

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

Deductible: Individual: $1,250 : Family: $2,500
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$294.42
$334.17
$376.27
$525.83
$799.06
$588.84
$668.34
$752.54
$1051.66
$1598.12
$775.80
$855.30
$939.50
$1238.62
$962.76
$1042.26
$1126.46
$1425.58
$1149.72
$1229.22
$1313.42
$1612.54
$481.38
$521.13
$563.23
$712.79
$668.34
$708.09
$750.19
$899.75
$855.30
$895.05
$937.15
$1086.71
$186.96

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

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

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$238.55
$270.75
$304.87
$426.05
$647.42
$477.10
$541.50
$609.74
$852.10
$1294.84
$628.58
$692.98
$761.22
$1003.58
$780.06
$844.46
$912.70
$1155.06
$931.54
$995.94
$1064.18
$1306.54
$390.03
$422.23
$456.35
$577.53
$541.51
$573.71
$607.83
$729.01
$692.99
$725.19
$759.31
$880.49
$151.48

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

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

Deductible: Individual: $2,200 : Family: $4,400
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$250.77
$284.62
$320.48
$447.88
$680.59
$501.54
$569.24
$640.96
$895.76
$1361.18
$660.78
$728.48
$800.20
$1055.00
$820.02
$887.72
$959.44
$1214.24
$979.26
$1046.96
$1118.68
$1373.48
$410.01
$443.86
$479.72
$607.12
$569.25
$603.10
$638.96
$766.36
$728.49
$762.34
$798.20
$925.60
$159.24

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

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$192.61
$218.61
$246.16
$344.00
$522.74
$385.22
$437.22
$492.32
$688.00
$1045.48
$507.53
$559.53
$614.63
$810.31
$629.84
$681.84
$736.94
$932.62
$752.15
$804.15
$859.25
$1054.93
$314.92
$340.92
$368.47
$466.31
$437.23
$463.23
$490.78
$588.62
$559.54
$585.54
$613.09
$710.93
$122.31
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UnitedHealthcare of Ohio, Inc.

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

Plan: (HMO) Gold Compass 1000

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

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$340.19
$386.11
$434.76
$607.57
$923.27
$680.38
$772.22
$869.52
$1215.14
$1846.54
$896.40
$988.24
$1085.54
$1431.16
$1112.42
$1204.26
$1301.56
$1647.18
$1328.44
$1420.28
$1517.58
$1863.20
$556.21
$602.13
$650.78
$823.59
$772.23
$818.15
$866.80
$1039.61
$988.25
$1034.17
$1082.82
$1255.63
$216.02

Plan: (HMO) Silver Compass HSA 3000

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$282.48
$320.62
$361.01
$504.51
$766.65
$564.96
$641.24
$722.02
$1009.02
$1533.30
$744.34
$820.62
$901.40
$1188.40
$923.72
$1000.00
$1080.78
$1367.78
$1103.10
$1179.38
$1260.16
$1547.16
$461.86
$500.00
$540.39
$683.89
$641.24
$679.38
$719.77
$863.27
$820.62
$858.76
$899.15
$1042.65
$179.38

Plan: (HMO) Silver Compass 2000 1

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$293.96
$333.65
$375.68
$525.02
$797.81
$587.92
$667.30
$751.36
$1050.04
$1595.62
$774.59
$853.97
$938.03
$1236.71
$961.26
$1040.64
$1124.70
$1423.38
$1147.93
$1227.31
$1311.37
$1610.05
$480.63
$520.32
$562.35
$711.69
$667.30
$706.99
$749.02
$898.36
$853.97
$893.66
$935.69
$1085.03
$186.67

Plan: (HMO) Silver Compass 2000

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

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$296.38
$336.39
$378.77
$529.33
$804.37
$592.76
$672.78
$757.54
$1058.66
$1608.74
$780.96
$860.98
$945.74
$1246.86
$969.16
$1049.18
$1133.94
$1435.06
$1157.36
$1237.38
$1322.14
$1623.26
$484.58
$524.59
$566.97
$717.53
$672.78
$712.79
$755.17
$905.73
$860.98
$900.99
$943.37
$1093.93
$188.20

Plan: (HMO) Silver Compass 3500

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

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$298.49
$338.79
$381.48
$533.11
$810.11
$596.98
$677.58
$762.96
$1066.22
$1620.22
$786.52
$867.12
$952.50
$1255.76
$976.06
$1056.66
$1142.04
$1445.30
$1165.60
$1246.20
$1331.58
$1634.84
$488.03
$528.33
$571.02
$722.65
$677.57
$717.87
$760.56
$912.19
$867.11
$907.41
$950.10
$1101.73
$189.54

Plan: (HMO) Silver Compass 4500

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$305.14
$346.33
$389.97
$544.98
$828.15
$610.28
$692.66
$779.94
$1089.96
$1656.30
$804.04
$886.42
$973.70
$1283.72
$997.80
$1080.18
$1167.46
$1477.48
$1191.56
$1273.94
$1361.22
$1671.24
$498.90
$540.09
$583.73
$738.74
$692.66
$733.85
$777.49
$932.50
$886.42
$927.61
$971.25
$1126.26
$193.76

Plan: (HMO) Bronze Compass HSA 5500

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$246.53
$279.81
$315.06
$440.30
$669.08
$493.06
$559.62
$630.12
$880.60
$1338.16
$649.61
$716.17
$786.67
$1037.15
$806.16
$872.72
$943.22
$1193.70
$962.71
$1029.27
$1099.77
$1350.25
$403.08
$436.36
$471.61
$596.85
$559.63
$592.91
$628.16
$753.40
$716.18
$749.46
$784.71
$909.95
$156.55

Plan: (HMO) Bronze Compass 6500

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$259.82
$294.90
$332.05
$464.04
$705.16
$519.64
$589.80
$664.10
$928.08
$1410.32
$684.63
$754.79
$829.09
$1093.07
$849.62
$919.78
$994.08
$1258.06
$1014.61
$1084.77
$1159.07
$1423.05
$424.81
$459.89
$497.04
$629.03
$589.80
$624.88
$662.03
$794.02
$754.79
$789.87
$827.02
$959.01
$164.99

Plan: (HMO) Gold Compass 0

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

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$335.05
$380.28
$428.19
$598.40
$909.33
$670.10
$760.56
$856.38
$1196.80
$1818.66
$882.86
$973.32
$1069.14
$1409.56
$1095.62
$1186.08
$1281.90
$1622.32
$1308.38
$1398.84
$1494.66
$1835.08
$547.81
$593.04
$640.95
$811.16
$760.57
$805.80
$853.71
$1023.92
$973.33
$1018.56
$1066.47
$1236.68
$212.76

Summa Insurance Company, Inc.

Local: 1-330-996-8675 x68675 | Toll Free: 1-888-996-8675

TTY: 1-800-750-0750

Plan: (PPO) SummaCare Silver 3000 with SCSelect Network and 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (Summa Insurance Company, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$245.89
$279.07
$314.24
$439.14
$667.32
$491.78
$558.14
$628.48
$878.28
$1334.64
$647.91
$714.27
$784.61
$1034.41
$804.04
$870.40
$940.74
$1190.54
$960.17
$1026.53
$1096.87
$1346.67
$402.02
$435.20
$470.37
$595.27
$558.15
$591.33
$626.50
$751.40
$714.28
$747.46
$782.63
$907.53
$156.13

Plan: (PPO) SummaCare Silver 5000 with SCSelect Network and 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (Summa Insurance Company, 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
Silver 21
30
40
50
60
$269.16
$305.49
$343.97
$480.70
$730.47
$538.32
$610.98
$687.94
$961.40
$1460.94
$709.23
$781.89
$858.85
$1132.31
$880.14
$952.80
$1029.76
$1303.22
$1051.05
$1123.71
$1200.67
$1474.13
$440.07
$476.40
$514.88
$651.61
$610.98
$647.31
$685.79
$822.52
$781.89
$818.22
$856.70
$993.43
$170.91

Plan: (PPO) SummaCare Gold 750 with SCSelect Network and 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (Summa Insurance Company, Inc.)

Deductible: Individual: $750 : Family: $1,500
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
$313.85
$356.21
$401.08
$560.51
$851.75
$627.70
$712.42
$802.16
$1121.02
$1703.50
$826.99
$911.71
$1001.45
$1320.31
$1026.28
$1111.00
$1200.74
$1519.60
$1225.57
$1310.29
$1400.03
$1718.89
$513.14
$555.50
$600.37
$759.80
$712.43
$754.79
$799.66
$959.09
$911.72
$954.08
$998.95
$1158.38
$199.29

Plan: (PPO) SummaCare Bronze 6850 with SCSelect Network and 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (Summa Insurance Company, 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
Bronze 21
30
40
50
60
$205.94
$233.73
$263.18
$367.79
$558.89
$411.88
$467.46
$526.36
$735.58
$1117.78
$542.65
$598.23
$657.13
$866.35
$673.42
$729.00
$787.90
$997.12
$804.19
$859.77
$918.67
$1127.89
$336.71
$364.50
$393.95
$498.56
$467.48
$495.27
$524.72
$629.33
$598.25
$626.04
$655.49
$760.10
$130.77

Plan: (PPO) SummaCare Value with SCSelect Network and 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (Summa Insurance Company, 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
$183.70
$208.49
$234.76
$328.07
$498.53
$367.40
$416.98
$469.52
$656.14
$997.06
$484.04
$533.62
$586.16
$772.78
$600.68
$650.26
$702.80
$889.42
$717.32
$766.90
$819.44
$1006.06
$300.34
$325.13
$351.40
$444.71
$416.98
$441.77
$468.04
$561.35
$533.62
$558.41
$584.68
$677.99
$116.64
ADVERTISEMENT - LegalConsumer.com does not review or endorse advertisers or their products.

All Savers Insurance Company

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

Plan: (POS) Gold Navigate Plus 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$370.52
$420.54
$473.53
$661.76
$1005.60
$741.04
$841.08
$947.06
$1323.52
$2011.20
$976.32
$1076.36
$1182.34
$1558.80
$1211.60
$1311.64
$1417.62
$1794.08
$1446.88
$1546.92
$1652.90
$2029.36
$605.80
$655.82
$708.81
$897.04
$841.08
$891.10
$944.09
$1132.32
$1076.36
$1126.38
$1179.37
$1367.60
$235.28

Plan: (POS) Gold Navigate Plus 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$365.19
$414.49
$466.71
$652.22
$991.11
$730.38
$828.98
$933.42
$1304.44
$1982.22
$962.27
$1060.87
$1165.31
$1536.33
$1194.16
$1292.76
$1397.20
$1768.22
$1426.05
$1524.65
$1629.09
$2000.11
$597.08
$646.38
$698.60
$884.11
$828.97
$878.27
$930.49
$1116.00
$1060.86
$1110.16
$1162.38
$1347.89
$231.89

Plan: (POS) Silver Navigate Plus HSA 3000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - Provider Directory for This Plan: (All Savers Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$307.72
$349.27
$393.27
$549.59
$835.16
$615.44
$698.54
$786.54
$1099.18
$1670.32
$810.84
$893.94
$981.94
$1294.58
$1006.24
$1089.34
$1177.34
$1489.98
$1201.64
$1284.74
$1372.74
$1685.38
$503.12
$544.67
$588.67
$744.99
$698.52
$740.07
$784.07
$940.39
$893.92
$935.47
$979.47
$1135.79
$195.40

Plan: (POS) Silver Navigate Plus 2000 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - Provider Directory for This Plan: (All Savers Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$320.60
$363.88
$409.72
$572.59
$870.10
$641.20
$727.76
$819.44
$1145.18
$1740.20
$844.78
$931.34
$1023.02
$1348.76
$1048.36
$1134.92
$1226.60
$1552.34
$1251.94
$1338.50
$1430.18
$1755.92
$524.18
$567.46
$613.30
$776.17
$727.76
$771.04
$816.88
$979.75
$931.34
$974.62
$1020.46
$1183.33
$203.58

Plan: (POS) Silver Navigate Plus 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$321.85
$365.30
$411.33
$574.83
$873.51
$643.70
$730.60
$822.66
$1149.66
$1747.02
$848.08
$934.98
$1027.04
$1354.04
$1052.46
$1139.36
$1231.42
$1558.42
$1256.84
$1343.74
$1435.80
$1762.80
$526.23
$569.68
$615.71
$779.21
$730.61
$774.06
$820.09
$983.59
$934.99
$978.44
$1024.47
$1187.97
$204.38

Plan: (POS) Silver Navigate Plus 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$324.37
$368.15
$414.54
$579.32
$880.33
$648.74
$736.30
$829.08
$1158.64
$1760.66
$854.71
$942.27
$1035.05
$1364.61
$1060.68
$1148.24
$1241.02
$1570.58
$1266.65
$1354.21
$1446.99
$1776.55
$530.34
$574.12
$620.51
$785.29
$736.31
$780.09
$826.48
$991.26
$942.28
$986.06
$1032.45
$1197.23
$205.97

Plan: (POS) Silver Navigate Plus 4500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - Provider Directory for This Plan: (All Savers Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$331.90
$376.71
$424.17
$592.78
$900.78
$663.80
$753.42
$848.34
$1185.56
$1801.56
$874.56
$964.18
$1059.10
$1396.32
$1085.32
$1174.94
$1269.86
$1607.08
$1296.08
$1385.70
$1480.62
$1817.84
$542.66
$587.47
$634.93
$803.54
$753.42
$798.23
$845.69
$1014.30
$964.18
$1008.99
$1056.45
$1225.06
$210.76

Plan: (POS) Bronze Navigate Plus HSA 5500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - Provider Directory for This Plan: (All Savers Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$267.84
$304.00
$342.31
$478.37
$726.93
$535.68
$608.00
$684.62
$956.74
$1453.86
$705.76
$778.08
$854.70
$1126.82
$875.84
$948.16
$1024.78
$1296.90
$1045.92
$1118.24
$1194.86
$1466.98
$437.92
$474.08
$512.39
$648.45
$608.00
$644.16
$682.47
$818.53
$778.08
$814.24
$852.55
$988.61
$170.08

Plan: (POS) Bronze Navigate Plus 6500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-5432 - Provider Directory for This Plan: (All Savers Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$280.09
$317.90
$357.96
$500.24
$760.17
$560.18
$635.80
$715.92
$1000.48
$1520.34
$738.04
$813.66
$893.78
$1178.34
$915.90
$991.52
$1071.64
$1356.20
$1093.76
$1169.38
$1249.50
$1534.06
$457.95
$495.76
$535.82
$678.10
$635.81
$673.62
$713.68
$855.96
$813.67
$851.48
$891.54
$1033.82
$177.86
ADVERTISEMENT - LegalConsumer.com does not review or endorse advertisers or their products.

Medical Health Insuring Corp. of Ohio

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

Plan: (PPO) Market 1000

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

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$323.59
$367.28
$413.55
$577.94
$878.23
$647.18
$734.56
$827.10
$1155.88
$1756.46
$852.66
$940.04
$1032.58
$1361.36
$1058.14
$1145.52
$1238.06
$1566.84
$1263.62
$1351.00
$1443.54
$1772.32
$529.07
$572.76
$619.03
$783.42
$734.55
$778.24
$824.51
$988.90
$940.03
$983.72
$1029.99
$1194.38
++

Plan: (PPO) Market Child Only 1000

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

Deductible: Individual: $1,000 : Family: See Plan Brochure
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60


























$205.48

Plan: (PPO) Market 6000 HSA

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$205.65
$233.42
$262.82
$367.29
$558.14
$411.30
$466.84
$525.64
$734.58
$1116.28
$541.89
$597.43
$656.23
$865.17
$672.48
$728.02
$786.82
$995.76
$803.07
$858.61
$917.41
$1126.35
$336.24
$364.01
$393.41
$497.88
$466.83
$494.60
$524.00
$628.47
$597.42
$625.19
$654.59
$759.06
++

Plan: (PPO) Market Child Only 6000 HSA

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

Deductible: Individual: $6,000 : Family: See Plan Brochure
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60


























$130.59

Plan: (PPO) Market Young Adult Essentials

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$147.43
$167.33
$188.41
$263.30
$400.11
$294.86
$334.66
$376.82
$526.60
$800.22
$388.48
$428.28
$470.44
$620.22
$482.10
$521.90
$564.06
$713.84
$575.72
$615.52
$657.68
$807.46
$241.05
$260.95
$282.03
$356.92
$334.67
$354.57
$375.65
$450.54
$428.29
$448.19
$469.27
$544.16
$93.62

Plan: (PPO) Market 2400

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

Deductible: Individual: $2,400 : Family: $4,800
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$260.66
$295.85
$333.12
$465.53
$707.43
$521.32
$591.70
$666.24
$931.06
$1414.86
$686.84
$757.22
$831.76
$1096.58
$852.36
$922.74
$997.28
$1262.10
$1017.88
$1088.26
$1162.80
$1427.62
$426.18
$461.37
$498.64
$631.05
$591.70
$626.89
$664.16
$796.57
$757.22
$792.41
$829.68
$962.09
++

Plan: (PPO) Market Child Only 2400

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

Deductible: Individual: $2,400 : Family: See Plan Brochure
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60


























$165.52

Plan: (PPO) Market 4000 HSA

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

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$260.16
$295.28
$332.49
$464.65
$706.08
$520.32
$590.56
$664.98
$929.30
$1412.16
$685.52
$755.76
$830.18
$1094.50
$850.72
$920.96
$995.38
$1259.70
$1015.92
$1086.16
$1160.58
$1424.90
$425.36
$460.48
$497.69
$629.85
$590.56
$625.68
$662.89
$795.05
$755.76
$790.88
$828.09
$960.25
++

Plan: (PPO) Market Child Only 4000 HSA

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

Deductible: Individual: $4,000 : Family: See Plan Brochure
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


























$165.20

Plan: (PPO) Market 5000

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$217.30
$246.63
$277.71
$388.09
$589.75
$434.60
$493.26
$555.42
$776.18
$1179.50
$572.58
$631.24
$693.40
$914.16
$710.56
$769.22
$831.38
$1052.14
$848.54
$907.20
$969.36
$1190.12
$355.28
$384.61
$415.69
$526.07
$493.26
$522.59
$553.67
$664.05
$631.24
$660.57
$691.65
$802.03
++

Plan: (PPO) Market Child Only 5000

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60


























$137.98

Plan: (PPO) Market 1750

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

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$266.11
$302.03
$340.09
$475.27
$722.22
$532.22
$604.06
$680.18
$950.54
$1444.44
$701.20
$773.04
$849.16
$1119.52
$870.18
$942.02
$1018.14
$1288.50
$1039.16
$1111.00
$1187.12
$1457.48
$435.09
$471.01
$509.07
$644.25
$604.07
$639.99
$678.05
$813.23
$773.05
$808.97
$847.03
$982.21
++

Plan: (PPO) Market Child Only 1750

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

Deductible: Individual: $1,750 : Family: See Plan Brochure
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60


























$168.98

†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 Carroll County here.