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Providers for Zip Code 29936

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ObamacareByZipCode.com

Obamacare 2016 Marketplace Rates For Jasper County, South Carolina

Thursday, April 18th, 2024


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

2016 Rates and Providers

(click here for 2014)

(click here for 2015)

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

Obamacare Providers, Plans and 2016 Rates for Jasper County

Jasper County is in “Rating Area 27” of South Carolina.

Currently, there are 3 providers offering 27 plans to Rating Area 27. †

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 Ridgeland, SC area accept this insurance coverage as within the plan's "network".
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Blue Cross and Blue Shield of South Carolina

Local: 1-855-404-6752 | Toll Free: 1-855-404-6752

TTY: 1-800-735-8583

Plan: (EPO) BlueEssentials Gold 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

Deductible: Individual: $1,200 : Family: $2,400
Out of Pocket Maximum per year: Individual: $4,200 : Family: $8,400

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		 $281.83
$319.88
$360.18
$503.35
$764.89		 $563.66
$639.76
$720.36
$1006.70
$1529.78		 $742.62
$818.72
$899.32
$1185.66		 $921.58
$997.68
$1078.28
$1364.62		 $1100.54
$1176.64
$1257.24
$1543.58		 $460.79
$498.84
$539.14
$682.31		 $639.75
$677.80
$718.10
$861.27		 $818.71
$856.76
$897.06
$1040.23		 $178.96

Plan: (EPO) BlueEssentials Silver 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

Deductible: Individual: $200 : Family: $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		 $240.33
$272.78
$307.14
$429.23
$652.26		 $480.66
$545.56
$614.28
$858.46
$1304.52		 $633.27
$698.17
$766.89
$1011.07		 $785.88
$850.78
$919.50
$1163.68		 $938.49
$1003.39
$1072.11
$1316.29		 $392.94
$425.39
$459.75
$581.84		 $545.55
$578.00
$612.36
$734.45		 $698.16
$730.61
$764.97
$887.06		 $152.61

Plan: (EPO) BlueEssentials Silver 2

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

Deductible: Individual: $2,000 : Family: $4,000
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		 $223.54
$253.72
$285.68
$399.24
$606.68		 $447.08
$507.44
$571.36
$798.48
$1213.36		 $589.03
$649.39
$713.31
$940.43		 $730.98
$791.34
$855.26
$1082.38		 $872.93
$933.29
$997.21
$1224.33		 $365.49
$395.67
$427.63
$541.19		 $507.44
$537.62
$569.58
$683.14		 $649.39
$679.57
$711.53
$825.09		 $141.95

Plan: (EPO) BlueEssentials Silver 3

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $5,200 : Family: $10,400

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $232.08
$263.41
$296.60
$414.50
$629.87		 $464.16
$526.82
$593.20
$829.00
$1259.74		 $611.53
$674.19
$740.57
$976.37		 $758.90
$821.56
$887.94
$1123.74		 $906.27
$968.93
$1035.31
$1271.11		 $379.45
$410.78
$443.97
$561.87		 $526.82
$558.15
$591.34
$709.24		 $674.19
$705.52
$738.71
$856.61		 $147.37

Plan: (EPO) BlueEssentials Bronze 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $202.52
$229.86
$258.82
$361.71
$549.65		 $405.04
$459.72
$517.64
$723.42
$1099.30		 $533.64
$588.32
$646.24
$852.02		 $662.24
$716.92
$774.84
$980.62		 $790.84
$845.52
$903.44
$1109.22		 $331.12
$358.46
$387.42
$490.31		 $459.72
$487.06
$516.02
$618.91		 $588.32
$615.66
$644.62
$747.51		 $128.60

Plan: (EPO) BlueEssentials HD Bronze 2

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

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		 $198.84
$225.69
$254.12
$355.13
$539.66		 $397.68
$451.38
$508.24
$710.26
$1079.32		 $523.95
$577.65
$634.51
$836.53		 $650.22
$703.92
$760.78
$962.80		 $776.49
$830.19
$887.05
$1089.07		 $325.11
$351.96
$380.39
$481.40		 $451.38
$478.23
$506.66
$607.67		 $577.65
$604.50
$632.93
$733.94		 $126.27

Plan: (EPO) BlueEssentials Gold 2

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

Deductible: Individual: $800 : Family: $1,600
Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $284.52
$322.94
$363.62
$508.16
$772.20		 $569.04
$645.88
$727.24
$1016.32
$1544.40		 $749.71
$826.55
$907.91
$1196.99		 $930.38
$1007.22
$1088.58
$1377.66		 $1111.05
$1187.89
$1269.25
$1558.33		 $465.19
$503.61
$544.29
$688.83		 $645.86
$684.28
$724.96
$869.50		 $826.53
$864.95
$905.63
$1050.17		 $180.67

Plan: (EPO) BlueEssentials HD Gold 3

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $288.36
$327.29
$368.53
$515.02
$782.62		 $576.72
$654.58
$737.06
$1030.04
$1565.24		 $759.83
$837.69
$920.17
$1213.15		 $942.94
$1020.80
$1103.28
$1396.26		 $1126.05
$1203.91
$1286.39
$1579.37		 $471.47
$510.40
$551.64
$698.13		 $654.58
$693.51
$734.75
$881.24		 $837.69
$876.62
$917.86
$1064.35		 $183.11

Plan: (EPO) BlueEssentials Silver 4

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

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		 $228.62
$259.48
$292.17
$408.31
$620.46		 $457.24
$518.96
$584.34
$816.62
$1240.92		 $602.41
$664.13
$729.51
$961.79		 $747.58
$809.30
$874.68
$1106.96		 $892.75
$954.47
$1019.85
$1252.13		 $373.79
$404.65
$437.34
$553.48		 $518.96
$549.82
$582.51
$698.65		 $664.13
$694.99
$727.68
$843.82		 $145.17

Plan: (EPO) BlueEssentials HD Silver 5

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

Deductible: Individual: $2,300 : Family: $4,600
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		 $232.61
$264.01
$297.27
$415.44
$631.29		 $465.22
$528.02
$594.54
$830.88
$1262.58		 $612.93
$675.73
$742.25
$978.59		 $760.64
$823.44
$889.96
$1126.30		 $908.35
$971.15
$1037.67
$1274.01		 $380.32
$411.72
$444.98
$563.15		 $528.03
$559.43
$592.69
$710.86		 $675.74
$707.14
$740.40
$858.57		 $147.71

Plan: (EPO) BlueEssentials HD Silver 6

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

Deductible: Individual: $3,600 : Family: $7,200
Out of Pocket Maximum per year: Individual: $3,600 : Family: $7,200

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $233.43
$264.95
$298.33
$416.91
$633.54		 $466.86
$529.90
$596.66
$833.82
$1267.08		 $615.09
$678.13
$744.89
$982.05		 $763.32
$826.36
$893.12
$1130.28		 $911.55
$974.59
$1041.35
$1278.51		 $381.66
$413.18
$446.56
$565.14		 $529.89
$561.41
$594.79
$713.37		 $678.12
$709.64
$743.02
$861.60		 $148.23

Plan: (EPO) BlueEssentials HD Bronze 3

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

Deductible: Individual: $4,750 : Family: $9,500
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
Bronze 21
30
40
50
60		 $206.63
$234.53
$264.07
$369.04
$560.79		 $413.26
$469.06
$528.14
$738.08
$1121.58		 $544.47
$600.27
$659.35
$869.29		 $675.68
$731.48
$790.56
$1000.50		 $806.89
$862.69
$921.77
$1131.71		 $337.84
$365.74
$395.28
$500.25		 $469.05
$496.95
$526.49
$631.46		 $600.26
$628.16
$657.70
$762.67		 $131.21

Plan: (EPO) BlueEssentials HD Bronze 4

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

Deductible: Individual: $5,200 : Family: $10,400
Out of Pocket Maximum per year: Individual: $6,450 : Family: $12,900

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $203.92
$231.45
$260.61
$364.20
$553.44		 $407.84
$462.90
$521.22
$728.40
$1106.88		 $537.33
$592.39
$650.71
$857.89		 $666.82
$721.88
$780.20
$987.38		 $796.31
$851.37
$909.69
$1116.87		 $333.41
$360.94
$390.10
$493.69		 $462.90
$490.43
$519.59
$623.18		 $592.39
$619.92
$649.08
$752.67		 $129.49

Plan: (EPO) BlueEssentials HD Bronze 5

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

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		 $201.29
$228.46
$257.25
$359.50
$546.29		 $402.58
$456.92
$514.50
$719.00
$1092.58		 $530.40
$584.74
$642.32
$846.82		 $658.22
$712.56
$770.14
$974.64		 $786.04
$840.38
$897.96
$1102.46		 $329.11
$356.28
$385.07
$487.32		 $456.93
$484.10
$512.89
$615.14		 $584.75
$611.92
$640.71
$742.96		 $127.82

Plan: (EPO) BlueEssentials Silver 7

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $209.49
$237.77
$267.73
$374.15
$568.56		 $418.98
$475.54
$535.46
$748.30
$1137.12		 $552.01
$608.57
$668.49
$881.33		 $685.04
$741.60
$801.52
$1014.36		 $818.07
$874.63
$934.55
$1147.39		 $342.52
$370.80
$400.76
$507.18		 $475.55
$503.83
$533.79
$640.21		 $608.58
$636.86
$666.82
$773.24		 $133.03

Plan: (EPO) BlueEssentials Silver 8

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $221.09
$250.94
$282.56
$394.87
$600.05		 $442.18
$501.88
$565.12
$789.74
$1200.10		 $582.57
$642.27
$705.51
$930.13		 $722.96
$782.66
$845.90
$1070.52		 $863.35
$923.05
$986.29
$1210.91		 $361.48
$391.33
$422.95
$535.26		 $501.87
$531.72
$563.34
$675.65		 $642.26
$672.11
$703.73
$816.04		 $140.39

Plan: (EPO) BlueEssentials Silver 9

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

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		 $217.44
$246.79
$277.89
$388.35
$590.13		 $434.88
$493.58
$555.78
$776.70
$1180.26		 $572.95
$631.65
$693.85
$914.77		 $711.02
$769.72
$831.92
$1052.84		 $849.09
$907.79
$969.99
$1190.91		 $355.51
$384.86
$415.96
$526.42		 $493.58
$522.93
$554.03
$664.49		 $631.65
$661.00
$692.10
$802.56		 $138.07

Plan: (EPO) BlueEssentials Silver 10

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $215.69
$244.81
$275.65
$385.22
$585.38		 $431.38
$489.62
$551.30
$770.44
$1170.76		 $568.34
$626.58
$688.26
$907.40		 $705.30
$763.54
$825.22
$1044.36		 $842.26
$900.50
$962.18
$1181.32		 $352.65
$381.77
$412.61
$522.18		 $489.61
$518.73
$549.57
$659.14		 $626.57
$655.69
$686.53
$796.10		 $136.96

Plan: (EPO) BlueEssentials Silver 11

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $212.01
$240.63
$270.95
$378.65
$575.39		 $424.02
$481.26
$541.90
$757.30
$1150.78		 $558.65
$615.89
$676.53
$891.93		 $693.28
$750.52
$811.16
$1026.56		 $827.91
$885.15
$945.79
$1161.19		 $346.64
$375.26
$405.58
$513.28		 $481.27
$509.89
$540.21
$647.91		 $615.90
$644.52
$674.84
$782.54		 $134.63

Plan: (EPO) BlueEssentials Silver 12

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

Deductible: Individual: $4,800 : Family: $9,600
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $213.21
$241.99
$272.48
$380.79
$578.65		 $426.42
$483.98
$544.96
$761.58
$1157.30		 $561.81
$619.37
$680.35
$896.97		 $697.20
$754.76
$815.74
$1032.36		 $832.59
$890.15
$951.13
$1167.75		 $348.60
$377.38
$407.87
$516.18		 $483.99
$512.77
$543.26
$651.57		 $619.38
$648.16
$678.65
$786.96		 $135.39

Plan: (EPO) BlueEssentials Catastrophic 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

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		 $178.56
$202.66
$228.19
$318.90
$484.60		 $357.12
$405.32
$456.38
$637.80
$969.20		 $470.50
$518.70
$569.76
$751.18		 $583.88
$632.08
$683.14
$864.56		 $697.26
$745.46
$796.52
$977.94		 $291.94
$316.04
$341.57
$432.28		 $405.32
$429.42
$454.95
$545.66		 $518.70
$542.80
$568.33
$659.04		 $113.38

Plan: (EPO) Blue Cross Blue Shield Gold 1, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $4,200 : Family: $8,400

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		 $284.12
$322.48
$363.11
$507.45
$771.11		 $568.24
$644.96
$726.22
$1014.90
$1542.22		 $748.66
$825.38
$906.64
$1195.32		 $929.08
$1005.80
$1087.06
$1375.74		 $1109.50
$1186.22
$1267.48
$1556.16		 $464.54
$502.90
$543.53
$687.87		 $644.96
$683.32
$723.95
$868.29		 $825.38
$863.74
$904.37
$1048.71		 $180.42

Plan: (EPO) Blue Cross Blue Shield Silver 1, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-404-6752 - Provider Directory for This Plan: (Blue Cross and Blue Shield of South Carolina)

Deductible: Individual: $2,500 : Family: $5,000
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		 $229.69
$260.70
$293.55
$410.23
$623.38		 $459.38
$521.40
$587.10
$820.46
$1246.76		 $605.23
$667.25
$732.95
$966.31		 $751.08
$813.10
$878.80
$1112.16		 $896.93
$958.95
$1024.65
$1258.01		 $375.54
$406.55
$439.40
$556.08		 $521.39
$552.40
$585.25
$701.93		 $667.24
$698.25
$731.10
$847.78		 $145.85
ADVERTISEMENT

BlueChoice HealthPlan of South Carolina, Inc.

Local: 1-855-433-2132 | Toll Free: 1-855-433-2132

Plan: (EPO) Blue Option Bronze 5001 HD

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $202.03
$229.30
$258.19
$360.82
$548.30		 $404.06
$458.60
$516.38
$721.64
$1096.60		 $532.35
$586.89
$644.67
$849.93		 $660.64
$715.18
$772.96
$978.22		 $788.93
$843.47
$901.25
$1106.51		 $330.32
$357.59
$386.48
$489.11		 $458.61
$485.88
$514.77
$617.40		 $586.90
$614.17
$643.06
$745.69		 $128.29

Plan: (EPO) Blue Option Bronze 6750

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $6,750 : Family: $13,500
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
Bronze 21
30
40
50
60		 $200.61
$227.69
$256.38
$358.29
$544.46		 $401.22
$455.38
$512.76
$716.58
$1088.92		 $528.61
$582.77
$640.15
$843.97		 $656.00
$710.16
$767.54
$971.36		 $783.39
$837.55
$894.93
$1098.75		 $328.00
$355.08
$383.77
$485.68		 $455.39
$482.47
$511.16
$613.07		 $582.78
$609.86
$638.55
$740.46		 $127.39

Plan: (EPO) Blue Option Catastrophic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, 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		 $177.43
$201.38
$226.75
$316.88
$481.54		 $354.86
$402.76
$453.50
$633.76
$963.08		 $467.53
$515.43
$566.17
$746.43		 $580.20
$628.10
$678.84
$859.10		 $692.87
$740.77
$791.51
$971.77		 $290.10
$314.05
$339.42
$429.55		 $402.77
$426.72
$452.09
$542.22		 $515.44
$539.39
$564.76
$654.89		 $112.67

Plan: (EPO) Blue Option Silver 400

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $400 : Family: $800
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $231.84
$263.14
$296.29
$414.07
$629.22		 $463.68
$526.28
$592.58
$828.14
$1258.44		 $610.90
$673.50
$739.80
$975.36		 $758.12
$820.72
$887.02
$1122.58		 $905.34
$967.94
$1034.24
$1269.80		 $379.06
$410.36
$443.51
$561.29		 $526.28
$557.58
$590.73
$708.51		 $673.50
$704.80
$737.95
$855.73		 $147.22

Plan: (EPO) Blue Option Silver 2501 HD

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $5,650 : Family: $11,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
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		 $231.64
$262.91
$296.03
$413.71
$628.67		 $463.28
$525.82
$592.06
$827.42
$1257.34		 $610.37
$672.91
$739.15
$974.51		 $757.46
$820.00
$886.24
$1121.60		 $904.55
$967.09
$1033.33
$1268.69		 $378.73
$410.00
$443.12
$560.80		 $525.82
$557.09
$590.21
$707.89		 $672.91
$704.18
$737.30
$854.98		 $147.09

Plan: (EPO) Blue Option Silver 2502

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $226.07
$256.59
$288.92
$403.77
$613.56		 $452.14
$513.18
$577.84
$807.54
$1227.12		 $595.70
$656.74
$721.40
$951.10		 $739.26
$800.30
$864.96
$1094.66		 $882.82
$943.86
$1008.52
$1238.22		 $369.63
$400.15
$432.48
$547.33		 $513.19
$543.71
$576.04
$690.89		 $656.75
$687.27
$719.60
$834.45		 $143.56

Plan: (EPO) Blue Option Silver 1750

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $1,750 : Family: $3,500
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $230.44
$261.55
$294.50
$411.56
$625.41		 $460.88
$523.10
$589.00
$823.12
$1250.82		 $607.21
$669.43
$735.33
$969.45		 $753.54
$815.76
$881.66
$1115.78		 $899.87
$962.09
$1027.99
$1262.11		 $376.77
$407.88
$440.83
$557.89		 $523.10
$554.21
$587.16
$704.22		 $669.43
$700.54
$733.49
$850.55		 $146.33

Plan: (EPO) Blue Option Silver 1500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $223.67
$253.87
$285.85
$399.48
$607.05		 $447.34
$507.74
$571.70
$798.96
$1214.10		 $589.37
$649.77
$713.73
$940.99		 $731.40
$791.80
$855.76
$1083.02		 $873.43
$933.83
$997.79
$1225.05		 $365.70
$395.90
$427.88
$541.51		 $507.73
$537.93
$569.91
$683.54		 $649.76
$679.96
$711.94
$825.57		 $142.03

Plan: (EPO) Blue Option Gold 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $290.23
$329.41
$370.92
$518.35
$787.69		 $580.46
$658.82
$741.84
$1036.70
$1575.38		 $764.76
$843.12
$926.14
$1221.00		 $949.06
$1027.42
$1110.44
$1405.30		 $1133.36
$1211.72
$1294.74
$1589.60		 $474.53
$513.71
$555.22
$702.65		 $658.83
$698.01
$739.52
$886.95		 $843.13
$882.31
$923.82
$1071.25		 $184.30

Plan: (EPO) Blue Option Silver 3000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $3,000 : Family: $6,000
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		 $223.30
$253.44
$285.38
$398.81
$606.03		 $446.60
$506.88
$570.76
$797.62
$1212.06		 $588.39
$648.67
$712.55
$939.41		 $730.18
$790.46
$854.34
$1081.20		 $871.97
$932.25
$996.13
$1222.99		 $365.09
$395.23
$427.17
$540.60		 $506.88
$537.02
$568.96
$682.39		 $648.67
$678.81
$710.75
$824.18		 $141.79

Plan: (EPO) Blue Option Silver 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $225.63
$256.09
$288.35
$402.97
$612.35		 $451.26
$512.18
$576.70
$805.94
$1224.70		 $594.53
$655.45
$719.97
$949.21		 $737.80
$798.72
$863.24
$1092.48		 $881.07
$941.99
$1006.51
$1235.75		 $368.90
$399.36
$431.62
$546.24		 $512.17
$542.63
$574.89
$689.51		 $655.44
$685.90
$718.16
$832.78		 $143.27

Plan: (EPO) Blue Option Silver 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $225.46
$255.90
$288.14
$402.67
$611.90		 $450.92
$511.80
$576.28
$805.34
$1223.80		 $594.09
$654.97
$719.45
$948.51		 $737.26
$798.14
$862.62
$1091.68		 $880.43
$941.31
$1005.79
$1234.85		 $368.63
$399.07
$431.31
$545.84		 $511.80
$542.24
$574.48
$689.01		 $654.97
$685.41
$717.65
$832.18		 $143.17

Plan: (EPO) Blue Option Silver 6000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $213.03
$241.79
$272.25
$380.47
$578.17		 $426.06
$483.58
$544.50
$760.94
$1156.34		 $561.33
$618.85
$679.77
$896.21		 $696.60
$754.12
$815.04
$1031.48		 $831.87
$889.39
$950.31
$1166.75		 $348.30
$377.06
$407.52
$515.74		 $483.57
$512.33
$542.79
$651.01		 $618.84
$647.60
$678.06
$786.28		 $135.27

Plan: (EPO) Blue Option Gold 1100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $1,100 : Family: $2,200
Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000

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		 $288.83
$327.82
$369.12
$515.85
$783.88		 $577.66
$655.64
$738.24
$1031.70
$1567.76		 $761.07
$839.05
$921.65
$1215.11		 $944.48
$1022.46
$1105.06
$1398.52		 $1127.89
$1205.87
$1288.47
$1581.93		 $472.24
$511.23
$552.53
$699.26		 $655.65
$694.64
$735.94
$882.67		 $839.06
$878.05
$919.35
$1066.08		 $183.41

Plan: (EPO) Blue Option Gold 800

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $800 : Family: $1,600
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		 $286.71
$325.42
$366.42
$512.07
$778.13		 $573.42
$650.84
$732.84
$1024.14
$1556.26		 $755.48
$832.90
$914.90
$1206.20		 $937.54
$1014.96
$1096.96
$1388.26		 $1119.60
$1197.02
$1279.02
$1570.32		 $468.77
$507.48
$548.48
$694.13		 $650.83
$689.54
$730.54
$876.19		 $832.89
$871.60
$912.60
$1058.25		 $182.06

Plan: (EPO) Blue Option Gold 2000 HD

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $289.75
$328.87
$370.30
$517.50
$786.39		 $579.50
$657.74
$740.60
$1035.00
$1572.78		 $763.49
$841.73
$924.59
$1218.99		 $947.48
$1025.72
$1108.58
$1402.98		 $1131.47
$1209.71
$1292.57
$1586.97		 $473.74
$512.86
$554.29
$701.49		 $657.73
$696.85
$738.28
$885.48		 $841.72
$880.84
$922.27
$1069.47		 $183.99

Plan: (EPO) Blue Option Bronze 4500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, 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
Bronze 21
30
40
50
60		 $202.46
$229.79
$258.74
$361.60
$549.48		 $404.92
$459.58
$517.48
$723.20
$1098.96		 $533.48
$588.14
$646.04
$851.76		 $662.04
$716.70
$774.60
$980.32		 $790.60
$845.26
$903.16
$1108.88		 $331.02
$358.35
$387.30
$490.16		 $459.58
$486.91
$515.86
$618.72		 $588.14
$615.47
$644.42
$747.28		 $128.56

Plan: (EPO) Blue Option Bronze 6250 HD

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, 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		 $203.83
$231.35
$260.49
$364.04
$553.19		 $407.66
$462.70
$520.98
$728.08
$1106.38		 $537.09
$592.13
$650.41
$857.51		 $666.52
$721.56
$779.84
$986.94		 $795.95
$850.99
$909.27
$1116.37		 $333.26
$360.78
$389.92
$493.47		 $462.69
$490.21
$519.35
$622.90		 $592.12
$619.64
$648.78
$752.33		 $129.43

Plan: (EPO) Blue Option Bronze 6850

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, 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		 $202.21
$229.51
$258.43
$361.15
$548.80		 $404.42
$459.02
$516.86
$722.30
$1097.60		 $532.82
$587.42
$645.26
$850.70		 $661.22
$715.82
$773.66
$979.10		 $789.62
$844.22
$902.06
$1107.50		 $330.61
$357.91
$386.83
$489.55		 $459.01
$486.31
$515.23
$617.95		 $587.41
$614.71
$643.63
$746.35		 $128.40

Plan: (EPO) Blue Option Silver 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $229.02
$259.93
$292.68
$409.02
$621.55		 $458.04
$519.86
$585.36
$818.04
$1243.10		 $603.46
$665.28
$730.78
$963.46		 $748.88
$810.70
$876.20
$1108.88		 $894.30
$956.12
$1021.62
$1254.30		 $374.44
$405.35
$438.10
$554.44		 $519.86
$550.77
$583.52
$699.86		 $665.28
$696.19
$728.94
$845.28		 $145.42

Plan: (EPO) Blue Option Silver 3400 HD

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $3,400 : Family: $6,800
Out of Pocket Maximum per year: Individual: $3,400 : Family: $6,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $236.71
$268.66
$302.51
$422.76
$642.42		 $473.42
$537.32
$605.02
$845.52
$1284.84		 $623.73
$687.63
$755.33
$995.83		 $774.04
$837.94
$905.64
$1146.14		 $924.35
$988.25
$1055.95
$1296.45		 $387.02
$418.97
$452.82
$573.07		 $537.33
$569.28
$603.13
$723.38		 $687.64
$719.59
$753.44
$873.69		 $150.31

Plan: (EPO) Blue Option Silver 3650 HD

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $3,650 : Family: $7,300
Out of Pocket Maximum per year: Individual: $3,650 : Family: $7,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
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		 $233.14
$264.61
$297.95
$416.39
$632.74		 $466.28
$529.22
$595.90
$832.78
$1265.48		 $614.32
$677.26
$743.94
$980.82		 $762.36
$825.30
$891.98
$1128.86		 $910.40
$973.34
$1040.02
$1276.90		 $381.18
$412.65
$445.99
$564.43		 $529.22
$560.69
$594.03
$712.47		 $677.26
$708.73
$742.07
$860.51		 $148.04

Plan: (EPO) Blue Option Silver 5001

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $212.80
$241.53
$271.96
$380.06
$577.54		 $425.60
$483.06
$543.92
$760.12
$1155.08		 $560.73
$618.19
$679.05
$895.25		 $695.86
$753.32
$814.18
$1030.38		 $830.99
$888.45
$949.31
$1165.51		 $347.93
$376.66
$407.09
$515.19		 $483.06
$511.79
$542.22
$650.32		 $618.19
$646.92
$677.35
$785.45		 $135.13

Plan: (EPO) Blue Option Silver 6001

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

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
Silver 21
30
40
50
60		 $215.58
$244.69
$275.51
$385.03
$585.09		 $431.16
$489.38
$551.02
$770.06
$1170.18		 $568.05
$626.27
$687.91
$906.95		 $704.94
$763.16
$824.80
$1043.84		 $841.83
$900.05
$961.69
$1180.73		 $352.47
$381.58
$412.40
$521.92		 $489.36
$518.47
$549.29
$658.81		 $626.25
$655.36
$686.18
$795.70		 $136.89

Plan: (EPO) Blue Option Silver 6850

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, 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
Silver 21
30
40
50
60		 $208.34
$236.46
$266.25
$372.09
$565.43		 $416.68
$472.92
$532.50
$744.18
$1130.86		 $548.97
$605.21
$664.79
$876.47		 $681.26
$737.50
$797.08
$1008.76		 $813.55
$869.79
$929.37
$1141.05		 $340.63
$368.75
$398.54
$504.38		 $472.92
$501.04
$530.83
$636.67		 $605.21
$633.33
$663.12
$768.96		 $132.29

Plan: (EPO) Blue Option Gold 1004

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $1,000 : Family: $2,000
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		 $290.46
$329.68
$371.21
$518.77
$788.32		 $580.92
$659.36
$742.42
$1037.54
$1576.64		 $765.36
$843.80
$926.86
$1221.98		 $949.80
$1028.24
$1111.30
$1406.42		 $1134.24
$1212.68
$1295.74
$1590.86		 $474.90
$514.12
$555.65
$703.21		 $659.34
$698.56
$740.09
$887.65		 $843.78
$883.00
$924.53
$1072.09		 $184.44

Plan: (EPO) Blue Option Gold 2001

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $273.51
$310.43
$349.55
$488.49
$742.31		 $547.02
$620.86
$699.10
$976.98
$1484.62		 $720.70
$794.54
$872.78
$1150.66		 $894.38
$968.22
$1046.46
$1324.34		 $1068.06
$1141.90
$1220.14
$1498.02		 $447.19
$484.11
$523.23
$662.17		 $620.87
$657.79
$696.91
$835.85		 $794.55
$831.47
$870.59
$1009.53		 $173.68

Plan: (EPO) Blue Option Silver 6002

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $211.72
$240.31
$270.58
$378.14
$574.62		 $423.44
$480.62
$541.16
$756.28
$1149.24		 $557.88
$615.06
$675.60
$890.72		 $692.32
$749.50
$810.04
$1025.16		 $826.76
$883.94
$944.48
$1159.60		 $346.16
$374.75
$405.02
$512.58		 $480.60
$509.19
$539.46
$647.02		 $615.04
$643.63
$673.90
$781.46		 $134.44

Plan: (EPO) Blue Option Silver 1250

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $1,250 : Family: $2,500
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
Silver 21
30
40
50
60		 $229.74
$260.75
$293.60
$410.31
$623.50		 $459.48
$521.50
$587.20
$820.62
$1247.00		 $605.36
$667.38
$733.08
$966.50		 $751.24
$813.26
$878.96
$1112.38		 $897.12
$959.14
$1024.84
$1258.26		 $375.62
$406.63
$439.48
$556.19		 $521.50
$552.51
$585.36
$702.07		 $667.38
$698.39
$731.24
$847.95		 $145.88

Plan: (EPO) Blue Option Silver 3001

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, Inc.)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $223.93
$254.16
$286.18
$399.94
$607.75		 $447.86
$508.32
$572.36
$799.88
$1215.50		 $590.06
$650.52
$714.56
$942.08		 $732.26
$792.72
$856.76
$1084.28		 $874.46
$934.92
$998.96
$1226.48		 $366.13
$396.36
$428.38
$542.14		 $508.33
$538.56
$570.58
$684.34		 $650.53
$680.76
$712.78
$826.54		 $142.20

Plan: (EPO) Blue Option Bronze 6500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-433-2132 - Provider Directory for This Plan: (BlueChoice HealthPlan of South Carolina, 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		 $198.53
$225.33
$253.72
$354.58
$538.81		 $397.06
$450.66
$507.44
$709.16
$1077.62		 $523.13
$576.73
$633.51
$835.23		 $649.20
$702.80
$759.58
$961.30		 $775.27
$828.87
$885.65
$1087.37		 $324.60
$351.40
$379.79
$480.65		 $450.67
$477.47
$505.86
$606.72		 $576.74
$603.54
$631.93
$732.79		 $126.07
ADVERTISEMENT

Consumers' Choice Health Insurance Company

Local: 1-800-580-8736 | Toll Free: 1-800-580-8736

TTY: 1-800-545-8279

Plan: (EPO) Consumers' Choice Gold 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8736 - Provider Directory for This Plan: (Consumers' Choice Health Insurance Company)

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $297.96
$338.18
$380.79
$532.15
$808.65		 $595.92
$676.36
$761.58
$1064.30
$1617.30		 $785.12
$865.56
$950.78
$1253.50		 $974.32
$1054.76
$1139.98
$1442.70		 $1163.52
$1243.96
$1329.18
$1631.90		 $487.16
$527.38
$569.99
$721.35		 $676.36
$716.58
$759.19
$910.55		 $865.56
$905.78
$948.39
$1099.75		 $189.20

Plan: (EPO) Consumers' Choice Gold 2

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8736 - Provider Directory for This Plan: (Consumers' Choice Health Insurance Company)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $288.04
$326.91
$368.10
$514.41
$781.70		 $576.08
$653.82
$736.20
$1028.82
$1563.40		 $758.98
$836.72
$919.10
$1211.72		 $941.88
$1019.62
$1102.00
$1394.62		 $1124.78
$1202.52
$1284.90
$1577.52		 $470.94
$509.81
$551.00
$697.31		 $653.84
$692.71
$733.90
$880.21		 $836.74
$875.61
$916.80
$1063.11		 $182.90

Plan: (EPO) Consumers' Choice Silver 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8736 - Provider Directory for This Plan: (Consumers' Choice Health Insurance Company)

Deductible: Individual: $2,750 : Family: $5,500
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		 $235.14
$266.88
$300.50
$419.95
$638.15		 $470.28
$533.76
$601.00
$839.90
$1276.30		 $619.59
$683.07
$750.31
$989.21		 $768.90
$832.38
$899.62
$1138.52		 $918.21
$981.69
$1048.93
$1287.83		 $384.45
$416.19
$449.81
$569.26		 $533.76
$565.50
$599.12
$718.57		 $683.07
$714.81
$748.43
$867.88		 $149.31

Plan: (EPO) Consumers' Choice Silver 2

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8736 - Provider Directory for This Plan: (Consumers' Choice Health Insurance Company)

Deductible: Individual: $3,750 : Family: $7,500
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		 $229.58
$260.57
$293.40
$410.02
$623.07		 $459.16
$521.14
$586.80
$820.04
$1246.14		 $604.94
$666.92
$732.58
$965.82		 $750.72
$812.70
$878.36
$1111.60		 $896.50
$958.48
$1024.14
$1257.38		 $375.36
$406.35
$439.18
$555.80		 $521.14
$552.13
$584.96
$701.58		 $666.92
$697.91
$730.74
$847.36		 $145.78

Plan: (EPO) Consumers' Choice Silver HDP 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8736 - Provider Directory for This Plan: (Consumers' Choice Health Insurance Company)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $244.47
$277.46
$312.42
$436.60
$663.46		 $488.94
$554.92
$624.84
$873.20
$1326.92		 $644.17
$710.15
$780.07
$1028.43		 $799.40
$865.38
$935.30
$1183.66		 $954.63
$1020.61
$1090.53
$1338.89		 $399.70
$432.69
$467.65
$591.83		 $554.93
$587.92
$622.88
$747.06		 $710.16
$743.15
$778.11
$902.29		 $155.23

Plan: (EPO) Consumers' Choice Bronze 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8736 - Provider Directory for This Plan: (Consumers' Choice Health Insurance Company)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $174.34
$197.86
$222.79
$311.35
$473.12		 $348.68
$395.72
$445.58
$622.70
$946.24		 $459.38
$506.42
$556.28
$733.40		 $570.08
$617.12
$666.98
$844.10		 $680.78
$727.82
$777.68
$954.80		 $285.04
$308.56
$333.49
$422.05		 $395.74
$419.26
$444.19
$532.75		 $506.44
$529.96
$554.89
$643.45		 $110.70

Plan: (EPO) Consumers' Choice Bronze HDP 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8736 - Provider Directory for This Plan: (Consumers' Choice Health Insurance Company)

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		 $182.32
$206.93
$233.00
$325.61
$494.80		 $364.64
$413.86
$466.00
$651.22
$989.60		 $480.41
$529.63
$581.77
$766.99		 $596.18
$645.40
$697.54
$882.76		 $711.95
$761.17
$813.31
$998.53		 $298.09
$322.70
$348.77
$441.38		 $413.86
$438.47
$464.54
$557.15		 $529.63
$554.24
$580.31
$672.92		 $115.77

Plan: (EPO) Consumers' Choice Value Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8736 - Provider Directory for This Plan: (Consumers' Choice Health Insurance Company)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Catastrophic 21
30
40
50
60		 $137.00
$155.48
$175.07
$244.66
$371.78		 $274.00
$310.96
$350.14
$489.32
$743.56		 $360.99
$397.95
$437.13
$576.31		 $447.98
$484.94
$524.12
$663.30		 $534.97
$571.93
$611.11
$750.29		 $223.99
$242.47
$262.06
$331.65		 $310.98
$329.46
$349.05
$418.64		 $397.97
$416.45
$436.04
$505.63		 $86.99

Plan: (EPO) Consumers' Choice Silver 10

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8736 - Provider Directory for This Plan: (Consumers' Choice Health Insurance Company)

Deductible: Individual: $4,000 : Family: $8,000
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		 $226.01
$256.52
$288.83
$403.64
$613.38		 $452.02
$513.04
$577.66
$807.28
$1226.76		 $595.53
$656.55
$721.17
$950.79		 $739.04
$800.06
$864.68
$1094.30		 $882.55
$943.57
$1008.19
$1237.81		 $369.52
$400.03
$432.34
$547.15		 $513.03
$543.54
$575.85
$690.66		 $656.54
$687.05
$719.36
$834.17		 $143.51

Plan: (EPO) Consumers' Choice Silver 11

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8736 - Provider Directory for This Plan: (Consumers' Choice Health 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
Silver 21
30
40
50
60		 $253.41
$287.61
$323.84
$452.57
$687.72		 $506.82
$575.22
$647.68
$905.14
$1375.44		 $667.73
$736.13
$808.59
$1066.05		 $828.64
$897.04
$969.50
$1226.96		 $989.55
$1057.95
$1130.41
$1387.87		 $414.32
$448.52
$484.75
$613.48		 $575.23
$609.43
$645.66
$774.39		 $736.14
$770.34
$806.57
$935.30		 $160.91

Plan: (EPO) Consumers' Choice Bronze 10

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8736 - Provider Directory for This Plan: (Consumers' Choice Health Insurance Company)

Deductible: Individual: $6,600 : Family: $13,200
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $171.24
$194.34
$218.83
$305.81
$464.71		 $342.48
$388.68
$437.66
$611.62
$929.42		 $451.21
$497.41
$546.39
$720.35		 $559.94
$606.14
$655.12
$829.08		 $668.67
$714.87
$763.85
$937.81		 $279.97
$303.07
$327.56
$414.54		 $388.70
$411.80
$436.29
$523.27		 $497.43
$520.53
$545.02
$632.00		 $108.73

Plan: (EPO) CO-OPtions Consumers' Choice Silver 12, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8736 - Provider Directory for This Plan: (Consumers' Choice Health Insurance Company)

Deductible: Individual: $3,400 : Family: $6,800
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $258.61
$293.51
$330.49
$461.86
$701.83		 $517.22
$587.02
$660.98
$923.72
$1403.66		 $681.43
$751.23
$825.19
$1087.93		 $845.64
$915.44
$989.40
$1252.14		 $1009.85
$1079.65
$1153.61
$1416.35		 $422.82
$457.72
$494.70
$626.07		 $587.03
$621.93
$658.91
$790.28		 $751.24
$786.14
$823.12
$954.49		 $164.21

Plan: (EPO) CO-OPtions Consumers' Choice Gold 4, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8736 - Provider Directory for This Plan: (Consumers' Choice Health Insurance Company)

Deductible: Individual: $1,750 : Family: $3,500
Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $303.82
$344.83
$388.27
$542.61
$824.55		 $607.64
$689.66
$776.54
$1085.22
$1649.10		 $800.56
$882.58
$969.46
$1278.14		 $993.48
$1075.50
$1162.38
$1471.06		 $1186.40
$1268.42
$1355.30
$1663.98		 $496.74
$537.75
$581.19
$735.53		 $689.66
$730.67
$774.11
$928.45		 $882.58
$923.59
$967.03
$1121.37		 $192.92

Plan: (EPO) Consumers' Choice Silver 20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8736 - Provider Directory for This Plan: (Consumers' Choice Health Insurance Company)

Deductible: Individual: $5,700 : Family: $11,400
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		 $226.47
$257.03
$289.41
$404.45
$614.60		 $452.94
$514.06
$578.82
$808.90
$1229.20		 $596.74
$657.86
$722.62
$952.70		 $740.54
$801.66
$866.42
$1096.50		 $884.34
$945.46
$1010.22
$1240.30		 $370.27
$400.83
$433.21
$548.25		 $514.07
$544.63
$577.01
$692.05		 $657.87
$688.43
$720.81
$835.85		 $143.80

Plan: (EPO) Consumers' Choice Bronze 20

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-580-8736 - Provider Directory for This Plan: (Consumers' Choice Health Insurance Company)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $165.10
$187.37
$210.98
$294.84
$448.04		 $330.20
$374.74
$421.96
$589.68
$896.08		 $435.03
$479.57
$526.79
$694.51		 $539.86
$584.40
$631.62
$799.34		 $644.69
$689.23
$736.45
$904.17		 $269.93
$292.20
$315.81
$399.67		 $374.76
$397.03
$420.64
$504.50		 $479.59
$501.86
$525.47
$609.33		 $104.83

†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 Jasper County here.

 

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