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Providers for Zip Code 78250

Obamacare 2016 Marketplace Rates For Bexar County, Texas

Thursday, April 25th, 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 Bexar County, Texas.

Obamacare Providers, Plans and 2016 Rates for Bexar County

Bexar County is in “Rating Area 19” of Texas.

Currently, there are 5 providers offering 61 plans to Rating Area 19.

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 San Antonio, TX area accept this insurance coverage as within the plan's "network".
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Oscar Insurance Company of Texas

Local: 1-855-672-2755 | Toll Free: 1-855-672-2755

Plan: (EPO) Market Secure

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-672-2755 - Provider Directory for This Plan: (Oscar Insurance Company of Texas)

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
$168.09
$234.90
$356.95
$263.04
$298.56
$336.18
$469.80
$713.90
$346.56
$382.08
$419.70
$553.32
$430.08
$465.60
$503.22
$636.84
$513.60
$549.12
$586.74
$720.36
$215.04
$232.80
$251.61
$318.42
$298.56
$316.32
$335.13
$401.94
$382.08
$399.84
$418.65
$485.46
$83.52

Plan: (EPO) Market Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-672-2755 - Provider Directory for This Plan: (Oscar Insurance Company of Texas)

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
$152.49
$173.07
$194.88
$272.34
$413.85
$304.98
$346.14
$389.76
$544.68
$827.70
$401.81
$442.97
$486.59
$641.51
$498.64
$539.80
$583.42
$738.34
$595.47
$636.63
$680.25
$835.17
$249.32
$269.90
$291.71
$369.17
$346.15
$366.73
$388.54
$466.00
$442.98
$463.56
$485.37
$562.83
$96.83

Plan: (EPO) Market Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-672-2755 - Provider Directory for This Plan: (Oscar Insurance Company of Texas)

Deductible: Individual: $2,000 : Family: $4,000
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
$189.52
$215.10
$242.20
$338.48
$514.35
$379.04
$430.20
$484.40
$676.96
$1028.70
$499.38
$550.54
$604.74
$797.30
$619.72
$670.88
$725.08
$917.64
$740.06
$791.22
$845.42
$1037.98
$309.86
$335.44
$362.54
$458.82
$430.20
$455.78
$482.88
$579.16
$550.54
$576.12
$603.22
$699.50
$120.34

Plan: (EPO) Market Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-672-2755 - Provider Directory for This Plan: (Oscar Insurance Company of Texas)

Deductible: Individual: $600 : Family: $1,200
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
$228.98
$259.90
$292.64
$408.96
$621.46
$457.96
$519.80
$585.28
$817.92
$1242.92
$603.36
$665.20
$730.68
$963.32
$748.76
$810.60
$876.08
$1108.72
$894.16
$956.00
$1021.48
$1254.12
$374.38
$405.30
$438.04
$554.36
$519.78
$550.70
$583.44
$699.76
$665.18
$696.10
$728.84
$845.16
$145.40

Plan: (EPO) Classic Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-672-2755 - Provider Directory for This Plan: (Oscar Insurance Company of Texas)

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
$153.44
$174.16
$196.10
$274.05
$416.44
$306.88
$348.32
$392.20
$548.10
$832.88
$404.32
$445.76
$489.64
$645.54
$501.76
$543.20
$587.08
$742.98
$599.20
$640.64
$684.52
$840.42
$250.88
$271.60
$293.54
$371.49
$348.32
$369.04
$390.98
$468.93
$445.76
$466.48
$488.42
$566.37
$97.44

Plan: (EPO) Classic Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-672-2755 - Provider Directory for This Plan: (Oscar Insurance Company of Texas)

Deductible: Individual: $4,500 : Family: $9,000
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
$175.20
$198.86
$223.91
$312.92
$475.51
$350.40
$397.72
$447.82
$625.84
$951.02
$461.65
$508.97
$559.07
$737.09
$572.90
$620.22
$670.32
$848.34
$684.15
$731.47
$781.57
$959.59
$286.45
$310.11
$335.16
$424.17
$397.70
$421.36
$446.41
$535.42
$508.95
$532.61
$557.66
$646.67
$111.25

Plan: (EPO) Classic Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-672-2755 - Provider Directory for This Plan: (Oscar Insurance Company of Texas)

Deductible: Individual: $1,000 : Family: $2,000
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
$226.89
$257.52
$289.97
$405.23
$615.79
$453.78
$515.04
$579.94
$810.46
$1231.58
$597.86
$659.12
$724.02
$954.54
$741.94
$803.20
$868.10
$1098.62
$886.02
$947.28
$1012.18
$1242.70
$370.97
$401.60
$434.05
$549.31
$515.05
$545.68
$578.13
$693.39
$659.13
$689.76
$722.21
$837.47
$144.08

Plan: (EPO) Simple Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-672-2755 - Provider Directory for This Plan: (Oscar Insurance Company of Texas)

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
$154.55
$175.41
$197.51
$276.02
$419.44
$309.10
$350.82
$395.02
$552.04
$838.88
$407.24
$448.96
$493.16
$650.18
$505.38
$547.10
$591.30
$748.32
$603.52
$645.24
$689.44
$846.46
$252.69
$273.55
$295.65
$374.16
$350.83
$371.69
$393.79
$472.30
$448.97
$469.83
$491.93
$570.44
$98.14

Plan: (EPO) Simple Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-672-2755 - Provider Directory for This Plan: (Oscar Insurance Company of Texas)

Deductible: Individual: $5,900 : Family: $11,800
Out of Pocket Maximum per year: Individual: $5,900 : Family: $11,800

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
$177.57
$201.55
$226.94
$317.15
$481.94
$355.14
$403.10
$453.88
$634.30
$963.88
$467.90
$515.86
$566.64
$747.06
$580.66
$628.62
$679.40
$859.82
$693.42
$741.38
$792.16
$972.58
$290.33
$314.31
$339.70
$429.91
$403.09
$427.07
$452.46
$542.67
$515.85
$539.83
$565.22
$655.43
$112.76

Plan: (EPO) Simple Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-672-2755 - Provider Directory for This Plan: (Oscar Insurance Company of Texas)

Deductible: Individual: $3,000 : Family: $6,000
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
$221.23
$251.10
$282.74
$395.12
$600.43
$442.46
$502.20
$565.48
$790.24
$1200.86
$582.94
$642.68
$705.96
$930.72
$723.42
$783.16
$846.44
$1071.20
$863.90
$923.64
$986.92
$1211.68
$361.71
$391.58
$423.22
$535.60
$502.19
$532.06
$563.70
$676.08
$642.67
$672.54
$704.18
$816.56
$140.48

Plan: (EPO) Simple+ Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-672-2755 - Provider Directory for This Plan: (Oscar Insurance Company of Texas)

Deductible: Individual: $5,900 : Family: $11,800
Out of Pocket Maximum per year: Individual: $5,900 : Family: $11,800

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
$183.59
$208.37
$234.62
$327.89
$498.26
$367.18
$416.74
$469.24
$655.78
$996.52
$483.76
$533.32
$585.82
$772.36
$600.34
$649.90
$702.40
$888.94
$716.92
$766.48
$818.98
$1005.52
$300.17
$324.95
$351.20
$444.47
$416.75
$441.53
$467.78
$561.05
$533.33
$558.11
$584.36
$677.63
$116.58

Plan: (EPO) Simple+ Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-672-2755 - Provider Directory for This Plan: (Oscar Insurance Company of Texas)

Deductible: Individual: $3,000 : Family: $6,000
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
$225.08
$255.47
$287.66
$402.00
$610.87
$450.16
$510.94
$575.32
$804.00
$1221.74
$593.09
$653.87
$718.25
$946.93
$736.02
$796.80
$861.18
$1089.86
$878.95
$939.73
$1004.11
$1232.79
$368.01
$398.40
$430.59
$544.93
$510.94
$541.33
$573.52
$687.86
$653.87
$684.26
$716.45
$830.79
$142.93
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Celtic Insurance Company

Local: 1-877-687-1196 | Toll Free: 1-800-735-2989

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$240.97
$273.49
$307.95
$430.36
$653.97
$481.94
$546.98
$615.90
$860.72
$1307.94
$634.95
$699.99
$768.91
$1013.73
$787.96
$853.00
$921.92
$1166.74
$940.97
$1006.01
$1074.93
$1319.75
$393.98
$426.50
$460.96
$583.37
$546.99
$579.51
$613.97
$736.38
$700.00
$732.52
$766.98
$889.39
$153.01

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$186.97
$212.20
$238.94
$333.92
$507.42
$373.94
$424.40
$477.88
$667.84
$1014.84
$492.66
$543.12
$596.60
$786.56
$611.38
$661.84
$715.32
$905.28
$730.10
$780.56
$834.04
$1024.00
$305.69
$330.92
$357.66
$452.64
$424.41
$449.64
$476.38
$571.36
$543.13
$568.36
$595.10
$690.08
$118.72

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$184.94
$209.89
$236.34
$330.28
$501.90
$369.88
$419.78
$472.68
$660.56
$1003.80
$487.31
$537.21
$590.11
$777.99
$604.74
$654.64
$707.54
$895.42
$722.17
$772.07
$824.97
$1012.85
$302.37
$327.32
$353.77
$447.71
$419.80
$444.75
$471.20
$565.14
$537.23
$562.18
$588.63
$682.57
$117.43

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$193.08
$219.13
$246.74
$344.81
$523.98
$386.16
$438.26
$493.48
$689.62
$1047.96
$508.76
$560.86
$616.08
$812.22
$631.36
$683.46
$738.68
$934.82
$753.96
$806.06
$861.28
$1057.42
$315.68
$341.73
$369.34
$467.41
$438.28
$464.33
$491.94
$590.01
$560.88
$586.93
$614.54
$712.61
$122.60

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$162.38
$184.29
$207.51
$289.99
$440.66
$324.76
$368.58
$415.02
$579.98
$881.32
$427.86
$471.68
$518.12
$683.08
$530.96
$574.78
$621.22
$786.18
$634.06
$677.88
$724.32
$889.28
$265.48
$287.39
$310.61
$393.09
$368.58
$390.49
$413.71
$496.19
$471.68
$493.59
$516.81
$599.29
$103.10

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$167.74
$190.37
$214.36
$299.57
$455.22
$335.48
$380.74
$428.72
$599.14
$910.44
$441.99
$487.25
$535.23
$705.65
$548.50
$593.76
$641.74
$812.16
$655.01
$700.27
$748.25
$918.67
$274.25
$296.88
$320.87
$406.08
$380.76
$403.39
$427.38
$512.59
$487.27
$509.90
$533.89
$619.10
$106.51

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$191.65
$217.51
$244.91
$342.26
$520.10
$383.30
$435.02
$489.82
$684.52
$1040.20
$504.99
$556.71
$611.51
$806.21
$626.68
$678.40
$733.20
$927.90
$748.37
$800.09
$854.89
$1049.59
$313.34
$339.20
$366.60
$463.95
$435.03
$460.89
$488.29
$585.64
$556.72
$582.58
$609.98
$707.33
$121.69

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$189.56
$215.14
$242.25
$338.54
$514.44
$379.12
$430.28
$484.50
$677.08
$1028.88
$499.49
$550.65
$604.87
$797.45
$619.86
$671.02
$725.24
$917.82
$740.23
$791.39
$845.61
$1038.19
$309.93
$335.51
$362.62
$458.91
$430.30
$455.88
$482.99
$579.28
$550.67
$576.25
$603.36
$699.65
$120.37

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$197.90
$224.61
$252.91
$353.43
$537.08
$395.80
$449.22
$505.82
$706.86
$1074.16
$521.46
$574.88
$631.48
$832.52
$647.12
$700.54
$757.14
$958.18
$772.78
$826.20
$882.80
$1083.84
$323.56
$350.27
$378.57
$479.09
$449.22
$475.93
$504.23
$604.75
$574.88
$601.59
$629.89
$730.41
$125.66

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$166.44
$188.89
$212.69
$297.24
$451.68
$332.88
$377.78
$425.38
$594.48
$903.36
$438.56
$483.46
$531.06
$700.16
$544.24
$589.14
$636.74
$805.84
$649.92
$694.82
$742.42
$911.52
$272.12
$294.57
$318.37
$402.92
$377.80
$400.25
$424.05
$508.60
$483.48
$505.93
$529.73
$614.28
$105.68

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-735-2989 - Provider Directory for This Plan: (Celtic Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$171.93
$195.13
$219.72
$307.05
$466.60
$343.86
$390.26
$439.44
$614.10
$933.20
$453.03
$499.43
$548.61
$723.27
$562.20
$608.60
$657.78
$832.44
$671.37
$717.77
$766.95
$941.61
$281.10
$304.30
$328.89
$416.22
$390.27
$413.47
$438.06
$525.39
$499.44
$522.64
$547.23
$634.56
$109.17
ADVERTISEMENT

Humana Health Plan of Texas, Inc.

Local: 1-877-720-4854 | Toll Free: 1-877-720-4854

TTY: 1-800-325-2028

Plan: (HMO) Humana Basic 6850/San Antonio HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Health Plan of Texas, 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
$138.24
$156.90
$176.67
$246.90
$375.18
$276.48
$313.80
$353.34
$493.80
$750.36
$364.26
$401.58
$441.12
$581.58
$452.04
$489.36
$528.90
$669.36
$539.82
$577.14
$616.68
$757.14
$226.02
$244.68
$264.45
$334.68
$313.80
$332.46
$352.23
$422.46
$401.58
$420.24
$440.01
$510.24
$87.78

Plan: (HMO) Humana Bronze 6450/San Antonio HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Health Plan of Texas, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$185.63
$210.69
$237.24
$331.54
$503.80
$371.26
$421.38
$474.48
$663.08
$1007.60
$489.14
$539.26
$592.36
$780.96
$607.02
$657.14
$710.24
$898.84
$724.90
$775.02
$828.12
$1016.72
$303.51
$328.57
$355.12
$449.42
$421.39
$446.45
$473.00
$567.30
$539.27
$564.33
$590.88
$685.18
$117.88

Plan: (HMO) Humana Bronze 4850/San Antonio HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Health Plan of Texas, Inc.)

Deductible: Individual: $4,850 : Family: $9,700
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$202.16
$229.45
$258.36
$361.06
$548.66
$404.32
$458.90
$516.72
$722.12
$1097.32
$532.69
$587.27
$645.09
$850.49
$661.06
$715.64
$773.46
$978.86
$789.43
$844.01
$901.83
$1107.23
$330.53
$357.82
$386.73
$489.43
$458.90
$486.19
$515.10
$617.80
$587.27
$614.56
$643.47
$746.17
$128.37

Plan: (HMO) Humana Silver 3800/San Antonio HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Health Plan of Texas, Inc.)

Deductible: Individual: $3,800 : Family: $7,600
Out of Pocket Maximum per year: Individual: $6,300 : Family: $12,600

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$218.91
$248.46
$279.77
$390.97
$594.12
$437.82
$496.92
$559.54
$781.94
$1188.24
$576.83
$635.93
$698.55
$920.95
$715.84
$774.94
$837.56
$1059.96
$854.85
$913.95
$976.57
$1198.97
$357.92
$387.47
$418.78
$529.98
$496.93
$526.48
$557.79
$668.99
$635.94
$665.49
$696.80
$808.00
$139.01

Plan: (HMO) Humana Gold 2250/San Antonio HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Health Plan of Texas, Inc.)

Deductible: Individual: $2,250 : Family: $4,500
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$258.48
$293.37
$330.34
$461.65
$701.51
$516.96
$586.74
$660.68
$923.30
$1403.02
$681.09
$750.87
$824.81
$1087.43
$845.22
$915.00
$988.94
$1251.56
$1009.35
$1079.13
$1153.07
$1415.69
$422.61
$457.50
$494.47
$625.78
$586.74
$621.63
$658.60
$789.91
$750.87
$785.76
$822.73
$954.04
$164.13

Plan: (HMO) Humana Platinum 0/San Antonio HMOx

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-720-4854 - Provider Directory for This Plan: (Humana Health Plan of Texas, Inc.)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: Individual: $1,500 : Family: $3,000

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
Platinum 21
30
40
50
60
$321.50
$364.90
$410.88
$574.20
$872.55
$643.00
$729.80
$821.76
$1148.40
$1745.10
$847.15
$933.95
$1025.91
$1352.55
$1051.30
$1138.10
$1230.06
$1556.70
$1255.45
$1342.25
$1434.21
$1760.85
$525.65
$569.05
$615.03
$778.35
$729.80
$773.20
$819.18
$982.50
$933.95
$977.35
$1023.33
$1186.65
$204.15
ADVERTISEMENT

Blue Cross Blue Shield of Texas

Local: 1-888-697-0683 | Toll Free: 1-888-697-0683

TTY: 1-800-735-2989

Plan: (HMO) Blue Advantage Bronze HMO? 006

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $6,000 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,000 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$184.67
$209.60
$236.01
$329.82
$501.19
$369.34
$419.20
$472.02
$659.64
$1002.38
$486.60
$536.46
$589.28
$776.90
$603.86
$653.72
$706.54
$894.16
$721.12
$770.98
$823.80
$1011.42
$301.93
$326.86
$353.27
$447.08
$419.19
$444.12
$470.53
$564.34
$536.45
$561.38
$587.79
$681.60
$117.26

Plan: (HMO) Blue Advantage Gold HMO? 101

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $500 : Family: $1,500
Out of Pocket Maximum per year: Individual: $5,250 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$288.25
$327.16
$368.38
$514.81
$782.30
$576.50
$654.32
$736.76
$1029.62
$1564.60
$759.54
$837.36
$919.80
$1212.66
$942.58
$1020.40
$1102.84
$1395.70
$1125.62
$1203.44
$1285.88
$1578.74
$471.29
$510.20
$551.42
$697.85
$654.33
$693.24
$734.46
$880.89
$837.37
$876.28
$917.50
$1063.93
$183.04

Plan: (HMO) Blue Advantage Silver HMO? 102

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$248.86
$282.45
$318.04
$444.46
$675.40
$497.72
$564.90
$636.08
$888.92
$1350.80
$655.74
$722.92
$794.10
$1046.94
$813.76
$880.94
$952.12
$1204.96
$971.78
$1038.96
$1110.14
$1362.98
$406.88
$440.47
$476.06
$602.48
$564.90
$598.49
$634.08
$760.50
$722.92
$756.51
$792.10
$918.52
$158.02

Plan: (HMO) Blue Advantage Silver HMO? 103

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$235.39
$267.17
$300.83
$420.41
$638.86
$470.78
$534.34
$601.66
$840.82
$1277.72
$620.25
$683.81
$751.13
$990.29
$769.72
$833.28
$900.60
$1139.76
$919.19
$982.75
$1050.07
$1289.23
$384.86
$416.64
$450.30
$569.88
$534.33
$566.11
$599.77
$719.35
$683.80
$715.58
$749.24
$868.82
$149.47

Plan: (HMO) Blue Advantage Bronze HMO? 105 - Two $40 PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$179.07
$203.24
$228.85
$319.81
$485.98
$358.14
$406.48
$457.70
$639.62
$971.96
$471.85
$520.19
$571.41
$753.33
$585.56
$633.90
$685.12
$867.04
$699.27
$747.61
$798.83
$980.75
$292.78
$316.95
$342.56
$433.52
$406.49
$430.66
$456.27
$547.23
$520.20
$544.37
$569.98
$660.94
$113.71

Plan: (HMO) Blue Advantage Security HMO? 100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

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
$168.43
$191.17
$215.26
$300.82
$457.13
$336.86
$382.34
$430.52
$601.64
$914.26
$443.82
$489.30
$537.48
$708.60
$550.78
$596.26
$644.44
$815.56
$657.74
$703.22
$751.40
$922.52
$275.39
$298.13
$322.22
$407.78
$382.35
$405.09
$429.18
$514.74
$489.31
$512.05
$536.14
$621.70
$106.96

Plan: (HMO) Blue Advantage Plus Gold? 101

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $2,750 : Family: $8,250
Out of Pocket Maximum per year: Individual: $3,500 : Family: $10,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$333.18
$378.16
$425.81
$595.07
$904.26
$666.36
$756.32
$851.62
$1190.14
$1808.52
$877.93
$967.89
$1063.19
$1401.71
$1089.50
$1179.46
$1274.76
$1613.28
$1301.07
$1391.03
$1486.33
$1824.85
$544.75
$589.73
$637.38
$806.64
$756.32
$801.30
$848.95
$1018.21
$967.89
$1012.87
$1060.52
$1229.78
$211.57

Plan: (HMO) Blue Advantage Plus Silver? 102 - Three $0 PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $3,250 : Family: $9,750
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$266.00
$301.91
$339.95
$475.08
$721.93
$532.00
$603.82
$679.90
$950.16
$1443.86
$700.91
$772.73
$848.81
$1119.07
$869.82
$941.64
$1017.72
$1287.98
$1038.73
$1110.55
$1186.63
$1456.89
$434.91
$470.82
$508.86
$643.99
$603.82
$639.73
$677.77
$812.90
$772.73
$808.64
$846.68
$981.81
$168.91

Plan: (HMO) Blue Advantage Plus Bronze? 103 - One $0 PCP Visit

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

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

Monthly Premiums:

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

Plan: (HMO) Blue Advantage Plus Bronze? 104

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $4,500 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,450 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$211.04
$239.53
$269.71
$376.92
$572.77
$422.08
$479.06
$539.42
$753.84
$1145.54
$556.09
$613.07
$673.43
$887.85
$690.10
$747.08
$807.44
$1021.86
$824.11
$881.09
$941.45
$1155.87
$345.05
$373.54
$403.72
$510.93
$479.06
$507.55
$537.73
$644.94
$613.07
$641.56
$671.74
$778.95
$134.01

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $1,000 : Family: $3,000
Out of Pocket Maximum per year: Individual: $6,000 : 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
$318.61
$361.62
$407.18
$569.03
$864.70
$637.22
$723.24
$814.36
$1138.06
$1729.40
$839.53
$925.55
$1016.67
$1340.37
$1041.84
$1127.86
$1218.98
$1542.68
$1244.15
$1330.17
$1421.29
$1744.99
$520.92
$563.93
$609.49
$771.34
$723.23
$766.24
$811.80
$973.65
$925.54
$968.55
$1014.11
$1175.96
$202.31

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

Deductible: Individual: $3,750 : Family: $11,250
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$260.21
$295.33
$332.54
$464.73
$706.20
$520.42
$590.66
$665.08
$929.46
$1412.40
$685.65
$755.89
$830.31
$1094.69
$850.88
$921.12
$995.54
$1259.92
$1016.11
$1086.35
$1160.77
$1425.15
$425.44
$460.56
$497.77
$629.96
$590.67
$625.79
$663.00
$795.19
$755.90
$791.02
$828.23
$960.42
$165.23

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

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-697-0683 - Provider Directory for This Plan: (Blue Cross Blue Shield of Texas)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$200.64
$227.73
$256.42
$358.34
$544.54
$401.28
$455.46
$512.84
$716.68
$1089.08
$528.69
$582.87
$640.25
$844.09
$656.10
$710.28
$767.66
$971.50
$783.51
$837.69
$895.07
$1098.91
$328.05
$355.14
$383.83
$485.75
$455.46
$482.55
$511.24
$613.16
$582.87
$609.96
$638.65
$740.57
$127.41
ADVERTISEMENT

Community First Health Plans, Inc.

Local: 1-210-358-6400 | Toll Free: 1-888-512-2347

Plan: (HMO) Community First Silver Plus 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-512-2347 - Provider Directory for This Plan: (Community First Health Plans, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$200.26
$227.29
$255.93
$357.66
$543.50
$400.52
$454.58
$511.86
$715.32
$1087.00
$527.68
$581.74
$639.02
$842.48
$654.84
$708.90
$766.18
$969.64
$782.00
$836.06
$893.34
$1096.80
$327.42
$354.45
$383.09
$484.82
$454.58
$481.61
$510.25
$611.98
$581.74
$608.77
$637.41
$739.14
$127.16

Plan: (HMO) Community First Premier Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-512-2347 - Provider Directory for This Plan: (Community First Health Plans, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
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
$241.17
$273.72
$308.21
$430.72
$654.53
$482.34
$547.44
$616.42
$861.44
$1309.06
$635.48
$700.58
$769.56
$1014.58
$788.62
$853.72
$922.70
$1167.72
$941.76
$1006.86
$1075.84
$1320.86
$394.31
$426.86
$461.35
$583.86
$547.45
$580.00
$614.49
$737.00
$700.59
$733.14
$767.63
$890.14
$153.14

Plan: (HMO) Community First Bronze Value 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-512-2347 - Provider Directory for This Plan: (Community First Health Plans, Inc.)

Deductible: Individual: $5,250 : Family: $10,500
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$168.78
$191.56
$215.70
$301.44
$458.06
$337.56
$383.12
$431.40
$602.88
$916.12
$444.73
$490.29
$538.57
$710.05
$551.90
$597.46
$645.74
$817.22
$659.07
$704.63
$752.91
$924.39
$275.95
$298.73
$322.87
$408.61
$383.12
$405.90
$430.04
$515.78
$490.29
$513.07
$537.21
$622.95
$107.17

Plan: (HMO) Community First Silver Plus 2

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-512-2347 - Provider Directory for This Plan: (Community First Health Plans, Inc.)

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
Silver 21
30
40
50
60
$191.73
$217.61
$245.03
$342.42
$520.35
$383.46
$435.22
$490.06
$684.84
$1040.70
$505.20
$556.96
$611.80
$806.58
$626.94
$678.70
$733.54
$928.32
$748.68
$800.44
$855.28
$1050.06
$313.47
$339.35
$366.77
$464.16
$435.21
$461.09
$488.51
$585.90
$556.95
$582.83
$610.25
$707.64
$121.74

Plan: (HMO) Community First Bronze Value 2

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-512-2347 - Provider Directory for This Plan: (Community First Health Plans, 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
$163.26
$185.30
$208.64
$291.58
$443.08
$326.52
$370.60
$417.28
$583.16
$886.16
$430.19
$474.27
$520.95
$686.83
$533.86
$577.94
$624.62
$790.50
$637.53
$681.61
$728.29
$894.17
$266.93
$288.97
$312.31
$395.25
$370.60
$392.64
$415.98
$498.92
$474.27
$496.31
$519.65
$602.59
$103.67

Plan: (HMO) Community First Zero Deductible Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-512-2347 - Provider Directory for This Plan: (Community First Health Plans, 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
Silver 21
30
40
50
60
$214.40
$243.34
$274.00
$382.91
$581.88
$428.80
$486.68
$548.00
$765.82
$1163.76
$564.94
$622.82
$684.14
$901.96
$701.08
$758.96
$820.28
$1038.10
$837.22
$895.10
$956.42
$1174.24
$350.54
$379.48
$410.14
$519.05
$486.68
$515.62
$546.28
$655.19
$622.82
$651.76
$682.42
$791.33
$136.14

Plan: (HMO) Community First Zero Deductible Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-512-2347 - Provider Directory for This Plan: (Community First Health Plans, Inc.)

Deductible: Individual: $0 : Family: $0
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
Gold 21
30
40
50
60
$244.29
$277.26
$312.20
$436.30
$663.00
$488.58
$554.52
$624.40
$872.60
$1326.00
$643.70
$709.64
$779.52
$1027.72
$798.82
$864.76
$934.64
$1182.84
$953.94
$1019.88
$1089.76
$1337.96
$399.41
$432.38
$467.32
$591.42
$554.53
$587.50
$622.44
$746.54
$709.65
$742.62
$777.56
$901.66
$155.12

Plan: (HMO) Community First Silver 1 Coinsur + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-512-2347 - Provider Directory for This Plan: (Community First Health Plans, Inc.)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$202.90
$230.29
$259.30
$362.37
$550.67
$405.80
$460.58
$518.60
$724.74
$1101.34
$534.64
$589.42
$647.44
$853.58
$663.48
$718.26
$776.28
$982.42
$792.32
$847.10
$905.12
$1111.26
$331.74
$359.13
$388.14
$491.21
$460.58
$487.97
$516.98
$620.05
$589.42
$616.81
$645.82
$748.89
$128.84

Plan: (HMO) Community First Gold Coinsur + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-512-2347 - Provider Directory for This Plan: (Community First Health Plans, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
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
$244.00
$276.94
$311.83
$435.78
$662.21
$488.00
$553.88
$623.66
$871.56
$1324.42
$642.94
$708.82
$778.60
$1026.50
$797.88
$863.76
$933.54
$1181.44
$952.82
$1018.70
$1088.48
$1336.38
$398.94
$431.88
$466.77
$590.72
$553.88
$586.82
$621.71
$745.66
$708.82
$741.76
$776.65
$900.60
$154.94

Plan: (HMO) Community First Bronze 1 Coinsur + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-512-2347 - Provider Directory for This Plan: (Community First Health Plans, Inc.)

Deductible: Individual: $5,250 : Family: $10,500
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$171.15
$194.25
$218.72
$305.67
$464.50
$342.30
$388.50
$437.44
$611.34
$929.00
$450.98
$497.18
$546.12
$720.02
$559.66
$605.86
$654.80
$828.70
$668.34
$714.54
$763.48
$937.38
$279.83
$302.93
$327.40
$414.35
$388.51
$411.61
$436.08
$523.03
$497.19
$520.29
$544.76
$631.71
$108.68

Plan: (HMO) Community First Silver 2 Coinsur + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-512-2347 - Provider Directory for This Plan: (Community First Health Plans, Inc.)

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
Silver 21
30
40
50
60
$194.37
$220.60
$248.40
$347.14
$527.52
$388.74
$441.20
$496.80
$694.28
$1055.04
$512.16
$564.62
$620.22
$817.70
$635.58
$688.04
$743.64
$941.12
$759.00
$811.46
$867.06
$1064.54
$317.79
$344.02
$371.82
$470.56
$441.21
$467.44
$495.24
$593.98
$564.63
$590.86
$618.66
$717.40
$123.42

Plan: (HMO) Community First Bronze 2 Coinsur + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-512-2347 - Provider Directory for This Plan: (Community First Health Plans, 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
$165.63
$187.99
$211.67
$295.81
$449.51
$331.26
$375.98
$423.34
$591.62
$899.02
$436.43
$481.15
$528.51
$696.79
$541.60
$586.32
$633.68
$801.96
$646.77
$691.49
$738.85
$907.13
$270.80
$293.16
$316.84
$400.98
$375.97
$398.33
$422.01
$506.15
$481.14
$503.50
$527.18
$611.32
$105.17

Plan: (HMO) Community First Silver Copay + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-512-2347 - Provider Directory for This Plan: (Community First Health Plans, 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
Silver 21
30
40
50
60
$217.04
$246.34
$277.37
$387.63
$589.04
$434.08
$492.68
$554.74
$775.26
$1178.08
$571.90
$630.50
$692.56
$913.08
$709.72
$768.32
$830.38
$1050.90
$847.54
$906.14
$968.20
$1188.72
$354.86
$384.16
$415.19
$525.45
$492.68
$521.98
$553.01
$663.27
$630.50
$659.80
$690.83
$801.09
$137.82

Plan: (HMO) Community First Gold Copay + Vision

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-512-2347 - Provider Directory for This Plan: (Community First Health Plans, Inc.)

Deductible: Individual: $0 : Family: $0
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
Gold 21
30
40
50
60
$247.12
$280.48
$315.81
$441.35
$670.68
$494.24
$560.96
$631.62
$882.70
$1341.36
$651.16
$717.88
$788.54
$1039.62
$808.08
$874.80
$945.46
$1196.54
$965.00
$1031.72
$1102.38
$1353.46
$404.04
$437.40
$472.73
$598.27
$560.96
$594.32
$629.65
$755.19
$717.88
$751.24
$786.57
$912.11
$156.92
ADVERTISEMENT

Allegian Insurance Company

Local: 1-888-371-1249 | Toll Free: 1-888-371-1249

TTY: 1-866-489-9042

Plan: (HMO) Allegian Choice Gold HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-371-1249 - Provider Directory for This Plan: (Allegian Insurance Company)

Deductible: Individual: $1,500 : Family: $3,000
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
$265.98
$301.87
$339.91
$475.02
$721.83
$531.96
$603.74
$679.82
$950.04
$1443.66
$700.85
$772.63
$848.71
$1118.93
$869.74
$941.52
$1017.60
$1287.82
$1038.63
$1110.41
$1186.49
$1456.71
$434.87
$470.76
$508.80
$643.91
$603.76
$639.65
$677.69
$812.80
$772.65
$808.54
$846.58
$981.69
$168.89

Plan: (HMO) Allegian Choice Silver HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-371-1249 - Provider Directory for This Plan: (Allegian Insurance Company)

Deductible: Individual: $5,500 : Family: $11,000
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
$220.11
$249.82
$281.29
$393.10
$597.36
$440.22
$499.64
$562.58
$786.20
$1194.72
$579.99
$639.41
$702.35
$925.97
$719.76
$779.18
$842.12
$1065.74
$859.53
$918.95
$981.89
$1205.51
$359.88
$389.59
$421.06
$532.87
$499.65
$529.36
$560.83
$672.64
$639.42
$669.13
$700.60
$812.41
$139.77

Plan: (HMO) Allegian Choice Bronze HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-371-1249 - Provider Directory for This Plan: (Allegian Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$164.07
$186.21
$209.67
$293.01
$445.25
$328.14
$372.42
$419.34
$586.02
$890.50
$432.32
$476.60
$523.52
$690.20
$536.50
$580.78
$627.70
$794.38
$640.68
$684.96
$731.88
$898.56
$268.25
$290.39
$313.85
$397.19
$372.43
$394.57
$418.03
$501.37
$476.61
$498.75
$522.21
$605.55
$104.18

Plan: (PPO) Allegian Choice Gold PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-371-1249 - Provider Directory for This Plan: (Allegian Insurance Company)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$302.51
$343.34
$386.60
$540.27
$820.99
$605.02
$686.68
$773.20
$1080.54
$1641.98
$797.11
$878.77
$965.29
$1272.63
$989.20
$1070.86
$1157.38
$1464.72
$1181.29
$1262.95
$1349.47
$1656.81
$494.60
$535.43
$578.69
$732.36
$686.69
$727.52
$770.78
$924.45
$878.78
$919.61
$962.87
$1116.54
$192.09

Plan: (PPO) Allegian Choice Silver PPO 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-371-1249 - Provider Directory for This Plan: (Allegian 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
$257.88
$292.68
$329.56
$460.55
$699.86
$515.76
$585.36
$659.12
$921.10
$1399.72
$679.51
$749.11
$822.87
$1084.85
$843.26
$912.86
$986.62
$1248.60
$1007.01
$1076.61
$1150.37
$1412.35
$421.63
$456.43
$493.31
$624.30
$585.38
$620.18
$657.06
$788.05
$749.13
$783.93
$820.81
$951.80
$163.75

Plan: (PPO) Allegian Choice Silver PPO 5500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-371-1249 - Provider Directory for This Plan: (Allegian Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$252.49
$286.57
$322.67
$450.93
$685.24
$504.98
$573.14
$645.34
$901.86
$1370.48
$665.31
$733.47
$805.67
$1062.19
$825.64
$893.80
$966.00
$1222.52
$985.97
$1054.13
$1126.33
$1382.85
$412.82
$446.90
$483.00
$611.26
$573.15
$607.23
$643.33
$771.59
$733.48
$767.56
$803.66
$931.92
$160.33

Plan: (PPO) Allegian Choice Bronze PPO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-371-1249 - Provider Directory for This Plan: (Allegian 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
$196.38
$222.88
$250.96
$350.72
$532.95
$392.76
$445.76
$501.92
$701.44
$1065.90
$517.45
$570.45
$626.61
$826.13
$642.14
$695.14
$751.30
$950.82
$766.83
$819.83
$875.99
$1075.51
$321.07
$347.57
$375.65
$475.41
$445.76
$472.26
$500.34
$600.10
$570.45
$596.95
$625.03
$724.79
$124.69
ADVERTISEMENT

All Savers Insurance Company

Local: 1-877-887-0443 | Toll Free: 1-877-887-0443

Plan: (EPO) Gold Compass Balanced 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - 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
$245.16
$278.24
$313.30
$437.84
$665.33
$490.32
$556.48
$626.60
$875.68
$1330.66
$645.99
$712.15
$782.27
$1031.35
$801.66
$867.82
$937.94
$1187.02
$957.33
$1023.49
$1093.61
$1342.69
$400.83
$433.91
$468.97
$593.51
$556.50
$589.58
$624.64
$749.18
$712.17
$745.25
$780.31
$904.85
$155.67

Plan: (EPO) Gold Compass Balanced 500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - Provider Directory for This Plan: (All Savers Insurance Company)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$243.89
$276.81
$311.68
$435.57
$661.89
$487.78
$553.62
$623.36
$871.14
$1323.78
$642.64
$708.48
$778.22
$1026.00
$797.50
$863.34
$933.08
$1180.86
$952.36
$1018.20
$1087.94
$1335.72
$398.75
$431.67
$466.54
$590.43
$553.61
$586.53
$621.40
$745.29
$708.47
$741.39
$776.26
$900.15
$154.86

Plan: (EPO) Silver Compass Balanced HSA 3000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - 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
$203.53
$230.99
$260.09
$363.48
$552.34
$407.06
$461.98
$520.18
$726.96
$1104.68
$536.29
$591.21
$649.41
$856.19
$665.52
$720.44
$778.64
$985.42
$794.75
$849.67
$907.87
$1114.65
$332.76
$360.22
$389.32
$492.71
$461.99
$489.45
$518.55
$621.94
$591.22
$618.68
$647.78
$751.17
$129.23

Plan: (EPO) Silver Compass Balanced 2000 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - 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
$211.77
$240.35
$270.63
$378.20
$574.71
$423.54
$480.70
$541.26
$756.40
$1149.42
$558.01
$615.17
$675.73
$890.87
$692.48
$749.64
$810.20
$1025.34
$826.95
$884.11
$944.67
$1159.81
$346.24
$374.82
$405.10
$512.67
$480.71
$509.29
$539.57
$647.14
$615.18
$643.76
$674.04
$781.61
$134.47

Plan: (EPO) Silver Compass Balanced 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - 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
$213.46
$242.26
$272.79
$381.22
$579.30
$426.92
$484.52
$545.58
$762.44
$1158.60
$562.46
$620.06
$681.12
$897.98
$698.00
$755.60
$816.66
$1033.52
$833.54
$891.14
$952.20
$1169.06
$349.00
$377.80
$408.33
$516.76
$484.54
$513.34
$543.87
$652.30
$620.08
$648.88
$679.41
$787.84
$135.54

Plan: (EPO) Silver Compass Balanced 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - 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
$215.15
$244.18
$274.95
$384.24
$583.89
$430.30
$488.36
$549.90
$768.48
$1167.78
$566.91
$624.97
$686.51
$905.09
$703.52
$761.58
$823.12
$1041.70
$840.13
$898.19
$959.73
$1178.31
$351.76
$380.79
$411.56
$520.85
$488.37
$517.40
$548.17
$657.46
$624.98
$654.01
$684.78
$794.07
$136.61

Plan: (EPO) Silver Compass Balanced 4500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - 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
$220.01
$249.70
$281.16
$392.92
$597.08
$440.02
$499.40
$562.32
$785.84
$1194.16
$579.72
$639.10
$702.02
$925.54
$719.42
$778.80
$841.72
$1065.24
$859.12
$918.50
$981.42
$1204.94
$359.71
$389.40
$420.86
$532.62
$499.41
$529.10
$560.56
$672.32
$639.11
$668.80
$700.26
$812.02
$139.70

Plan: (EPO) Bronze Compass Balanced HSA 5500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - 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
$177.53
$201.49
$226.87
$317.05
$481.79
$355.06
$402.98
$453.74
$634.10
$963.58
$467.79
$515.71
$566.47
$746.83
$580.52
$628.44
$679.20
$859.56
$693.25
$741.17
$791.93
$972.29
$290.26
$314.22
$339.60
$429.78
$402.99
$426.95
$452.33
$542.51
$515.72
$539.68
$565.06
$655.24
$112.73

Plan: (EPO) Bronze Compass Balanced 6500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - 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
$187.04
$212.28
$239.03
$334.04
$507.60
$374.08
$424.56
$478.06
$668.08
$1015.20
$492.85
$543.33
$596.83
$786.85
$611.62
$662.10
$715.60
$905.62
$730.39
$780.87
$834.37
$1024.39
$305.81
$331.05
$357.80
$452.81
$424.58
$449.82
$476.57
$571.58
$543.35
$568.59
$595.34
$690.35
$118.77

Plan: (EPO) Gold Compass Balanced 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0443 - 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
$241.36
$273.93
$308.44
$431.04
$655.01
$482.72
$547.86
$616.88
$862.08
$1310.02
$635.97
$701.11
$770.13
$1015.33
$789.22
$854.36
$923.38
$1168.58
$942.47
$1007.61
$1076.63
$1321.83
$394.61
$427.18
$461.69
$584.29
$547.86
$580.43
$614.94
$737.54
$701.11
$733.68
$768.19
$890.79
$153.25
ADVERTISEMENT

Aetna Life Insurance Company

Local: 1-855-632-6274 | Toll Free: 1-855-632-6274

TTY: 1-855-632-6274

Plan: (EPO) Aetna Gold $10 Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-632-6274 - Provider Directory for This Plan: (Aetna Life Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$287.18
$325.95
$367.02
$512.91
$779.41
$574.36
$651.90
$734.04
$1025.82
$1558.82
$756.72
$834.26
$916.40
$1208.18
$939.08
$1016.62
$1098.76
$1390.54
$1121.44
$1198.98
$1281.12
$1572.90
$469.54
$508.31
$549.38
$695.27
$651.90
$690.67
$731.74
$877.63
$834.26
$873.03
$914.10
$1059.99
$182.36

Plan: (EPO) Aetna Gold $10 Copay San Antonio Community Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-632-6274 - Provider Directory for This Plan: (Aetna Life Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$286.58
$325.26
$366.24
$511.82
$777.77
$573.16
$650.52
$732.48
$1023.64
$1555.54
$755.14
$832.50
$914.46
$1205.62
$937.12
$1014.48
$1096.44
$1387.60
$1119.10
$1196.46
$1278.42
$1569.58
$468.56
$507.24
$548.22
$693.80
$650.54
$689.22
$730.20
$875.78
$832.52
$871.20
$912.18
$1057.76
$181.98

Plan: (EPO) Aetna Silver $10 Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-632-6274 - Provider Directory for This Plan: (Aetna Life Insurance Company)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$247.91
$281.38
$316.83
$442.77
$672.84
$495.82
$562.76
$633.66
$885.54
$1345.68
$653.24
$720.18
$791.08
$1042.96
$810.66
$877.60
$948.50
$1200.38
$968.08
$1035.02
$1105.92
$1357.80
$405.33
$438.80
$474.25
$600.19
$562.75
$596.22
$631.67
$757.61
$720.17
$753.64
$789.09
$915.03
$157.42

Plan: (EPO) Aetna Silver $10 Copay San Antonio Community Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-632-6274 - Provider Directory for This Plan: (Aetna Life Insurance Company)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$247.38
$280.77
$316.15
$441.81
$671.38
$494.76
$561.54
$632.30
$883.62
$1342.76
$651.84
$718.62
$789.38
$1040.70
$808.92
$875.70
$946.46
$1197.78
$966.00
$1032.78
$1103.54
$1354.86
$404.46
$437.85
$473.23
$598.89
$561.54
$594.93
$630.31
$755.97
$718.62
$752.01
$787.39
$913.05
$157.08

Plan: (EPO) Aetna Bronze $15 Copay

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-632-6274 - Provider Directory for This Plan: (Aetna Life 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
$197.25
$223.88
$252.08
$352.28
$535.33
$394.50
$447.76
$504.16
$704.56
$1070.66
$519.75
$573.01
$629.41
$829.81
$645.00
$698.26
$754.66
$955.06
$770.25
$823.51
$879.91
$1080.31
$322.50
$349.13
$377.33
$477.53
$447.75
$474.38
$502.58
$602.78
$573.00
$599.63
$627.83
$728.03
$125.25

Plan: (EPO) Aetna Bronze HSA Eligible

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-632-6274 - Provider Directory for This Plan: (Aetna Life Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$184.37
$209.26
$235.63
$329.29
$500.38
$368.74
$418.52
$471.26
$658.58
$1000.76
$485.82
$535.60
$588.34
$775.66
$602.90
$652.68
$705.42
$892.74
$719.98
$769.76
$822.50
$1009.82
$301.45
$326.34
$352.71
$446.37
$418.53
$443.42
$469.79
$563.45
$535.61
$560.50
$586.87
$680.53
$117.08

Plan: (EPO) Aetna Bronze $15 Copay San Antonio Community Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-632-6274 - Provider Directory for This Plan: (Aetna Life 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
$196.84
$223.42
$251.57
$351.56
$534.24
$393.68
$446.84
$503.14
$703.12
$1068.48
$518.68
$571.84
$628.14
$828.12
$643.68
$696.84
$753.14
$953.12
$768.68
$821.84
$878.14
$1078.12
$321.84
$348.42
$376.57
$476.56
$446.84
$473.42
$501.57
$601.56
$571.84
$598.42
$626.57
$726.56
$125.00

Plan: (EPO) Aetna Bronze HSA Eligible San Antonio Community Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-632-6274 - Provider Directory for This Plan: (Aetna Life Insurance Company)

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$183.97
$208.80
$235.11
$328.57
$499.29
$367.94
$417.60
$470.22
$657.14
$998.58
$484.76
$534.42
$587.04
$773.96
$601.58
$651.24
$703.86
$890.78
$718.40
$768.06
$820.68
$1007.60
$300.79
$325.62
$351.93
$445.39
$417.61
$442.44
$468.75
$562.21
$534.43
$559.26
$585.57
$679.03
$116.82

†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 Bexar County here.

 

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