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Providers for Zip Code 75165

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ObamacareByZipCode.com

Obamacare 2016 Marketplace Rates For Ellis County, Texas

Wednesday, April 17th, 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 Ellis County, Texas.

Obamacare Providers, Plans and 2016 Rates for Ellis County

Ellis County is in “Rating Area 8” of Texas.

Currently, there are 5 providers offering 46 plans to Rating Area 8. †

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 Waxahachie, TX area accept this insurance coverage as within the plan's "network".
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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		 $204.93
$232.60
$261.91
$366.01
$556.19		 $409.86
$465.20
$523.82
$732.02
$1112.38		 $539.99
$595.33
$653.95
$862.15		 $670.12
$725.46
$784.08
$992.28		 $800.25
$855.59
$914.21
$1122.41		 $335.06
$362.73
$392.04
$496.14		 $465.19
$492.86
$522.17
$626.27		 $595.32
$622.99
$652.30
$756.40		 $130.13

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		 $319.88
$363.06
$408.81
$571.31
$868.16		 $639.76
$726.12
$817.62
$1142.62
$1736.32		 $842.88
$929.24
$1020.74
$1345.74		 $1046.00
$1132.36
$1223.86
$1548.86		 $1249.12
$1335.48
$1426.98
$1751.98		 $523.00
$566.18
$611.93
$774.43		 $726.12
$769.30
$815.05
$977.55		 $929.24
$972.42
$1018.17
$1180.67		 $203.12

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		 $276.17
$313.45
$352.94
$493.24
$749.52		 $552.34
$626.90
$705.88
$986.48
$1499.04		 $727.71
$802.27
$881.25
$1161.85		 $903.08
$977.64
$1056.62
$1337.22		 $1078.45
$1153.01
$1231.99
$1512.59		 $451.54
$488.82
$528.31
$668.61		 $626.91
$664.19
$703.68
$843.98		 $802.28
$839.56
$879.05
$1019.35		 $175.37

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		 $261.23
$296.49
$333.85
$466.55
$708.97		 $522.46
$592.98
$667.70
$933.10
$1417.94		 $688.34
$758.86
$833.58
$1098.98		 $854.22
$924.74
$999.46
$1264.86		 $1020.10
$1090.62
$1165.34
$1430.74		 $427.11
$462.37
$499.73
$632.43		 $592.99
$628.25
$665.61
$798.31		 $758.87
$794.13
$831.49
$964.19		 $165.88

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		 $198.72
$225.54
$253.96
$354.91
$539.32		 $397.44
$451.08
$507.92
$709.82
$1078.64		 $523.63
$577.27
$634.11
$836.01		 $649.82
$703.46
$760.30
$962.20		 $776.01
$829.65
$886.49
$1088.39		 $324.91
$351.73
$380.15
$481.10		 $451.10
$477.92
$506.34
$607.29		 $577.29
$604.11
$632.53
$733.48		 $126.19

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		 $186.92
$212.15
$238.88
$333.84
$507.30		 $373.84
$424.30
$477.76
$667.68
$1014.60		 $492.53
$542.99
$596.45
$786.37		 $611.22
$661.68
$715.14
$905.06		 $729.91
$780.37
$833.83
$1023.75		 $305.61
$330.84
$357.57
$452.53		 $424.30
$449.53
$476.26
$571.22		 $542.99
$568.22
$594.95
$689.91		 $118.69

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		 $369.75
$419.66
$472.54
$660.37
$1003.50		 $739.50
$839.32
$945.08
$1320.74
$2007.00		 $974.29
$1074.11
$1179.87
$1555.53		 $1209.08
$1308.90
$1414.66
$1790.32		 $1443.87
$1543.69
$1649.45
$2025.11		 $604.54
$654.45
$707.33
$895.16		 $839.33
$889.24
$942.12
$1129.95		 $1074.12
$1124.03
$1176.91
$1364.74		 $234.79

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		 $295.20
$335.05
$377.26
$527.22
$801.16		 $590.40
$670.10
$754.52
$1054.44
$1602.32		 $777.85
$857.55
$941.97
$1241.89		 $965.30
$1045.00
$1129.42
$1429.34		 $1152.75
$1232.45
$1316.87
$1616.79		 $482.65
$522.50
$564.71
$714.67		 $670.10
$709.95
$752.16
$902.12		 $857.55
$897.40
$939.61
$1089.57		 $187.45

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		 $227.32
$258.01
$290.51
$405.99
$616.94		 $454.64
$516.02
$581.02
$811.98
$1233.88		 $598.99
$660.37
$725.37
$956.33		 $743.34
$804.72
$869.72
$1100.68		 $887.69
$949.07
$1014.07
$1245.03		 $371.67
$402.36
$434.86
$550.34		 $516.02
$546.71
$579.21
$694.69		 $660.37
$691.06
$723.56
$839.04		 $144.35

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		 $234.20
$265.82
$299.31
$418.29
$635.63		 $468.40
$531.64
$598.62
$836.58
$1271.26		 $617.12
$680.36
$747.34
$985.30		 $765.84
$829.08
$896.06
$1134.02		 $914.56
$977.80
$1044.78
$1282.74		 $382.92
$414.54
$448.03
$567.01		 $531.64
$563.26
$596.75
$715.73		 $680.36
$711.98
$745.47
$864.45		 $148.72

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		 $353.57
$401.30
$451.86
$631.48
$959.59		 $707.14
$802.60
$903.72
$1262.96
$1919.18		 $931.66
$1027.12
$1128.24
$1487.48		 $1156.18
$1251.64
$1352.76
$1712.00		 $1380.70
$1476.16
$1577.28
$1936.52		 $578.09
$625.82
$676.38
$856.00		 $802.61
$850.34
$900.90
$1080.52		 $1027.13
$1074.86
$1125.42
$1305.04		 $224.52

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		 $288.76
$327.74
$369.04
$515.73
$783.70		 $577.52
$655.48
$738.08
$1031.46
$1567.40		 $760.88
$838.84
$921.44
$1214.82		 $944.24
$1022.20
$1104.80
$1398.18		 $1127.60
$1205.56
$1288.16
$1581.54		 $472.12
$511.10
$552.40
$699.09		 $655.48
$694.46
$735.76
$882.45		 $838.84
$877.82
$919.12
$1065.81		 $183.36

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		 $222.66
$252.72
$284.56
$397.67
$604.30		 $445.32
$505.44
$569.12
$795.34
$1208.60		 $586.71
$646.83
$710.51
$936.73		 $728.10
$788.22
$851.90
$1078.12		 $869.49
$929.61
$993.29
$1219.51		 $364.05
$394.11
$425.95
$539.06		 $505.44
$535.50
$567.34
$680.45		 $646.83
$676.89
$708.73
$821.84		 $141.39
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Insurance Company of Scott & White

Local: 1-254-298-3000 x20300 | Toll Free: 1-800-321-7947

TTY: 1-800-735-2989

Plan: (PPO) PPO Premier 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Insurance Company of Scott & White)

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		 $358.06
$406.40
$457.60
$639.49
$971.77		 $716.12
$812.80
$915.20
$1278.98
$1943.54		 $943.49
$1040.17
$1142.57
$1506.35		 $1170.86
$1267.54
$1369.94
$1733.72		 $1398.23
$1494.91
$1597.31
$1961.09		 $585.43
$633.77
$684.97
$866.86		 $812.80
$861.14
$912.34
$1094.23		 $1040.17
$1088.51
$1139.71
$1321.60		 $227.37

Plan: (PPO) PPO Premier 750

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Insurance Company of Scott & White)

Deductible: Individual: $750 : Family: $1,500
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		 $368.30
$418.02
$470.69
$657.78
$999.57		 $736.60
$836.04
$941.38
$1315.56
$1999.14		 $970.47
$1069.91
$1175.25
$1549.43		 $1204.34
$1303.78
$1409.12
$1783.30		 $1438.21
$1537.65
$1642.99
$2017.17		 $602.17
$651.89
$704.56
$891.65		 $836.04
$885.76
$938.43
$1125.52		 $1069.91
$1119.63
$1172.30
$1359.39		 $233.87

Plan: (PPO) PPO Premier 500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Insurance Company of Scott & White)

Deductible: Individual: $500 : Family: $1,000
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		 $371.81
$422.00
$475.17
$664.05
$1009.08		 $743.62
$844.00
$950.34
$1328.10
$2018.16		 $979.72
$1080.10
$1186.44
$1564.20		 $1215.82
$1316.20
$1422.54
$1800.30		 $1451.92
$1552.30
$1658.64
$2036.40		 $607.91
$658.10
$711.27
$900.15		 $844.01
$894.20
$947.37
$1136.25		 $1080.11
$1130.30
$1183.47
$1372.35		 $236.10

Plan: (PPO) PPO 1500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Insurance Company of Scott & White)

Deductible: Individual: $1,500 : Family: $3,000
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		 $336.57
$382.00
$430.13
$601.11
$913.44		 $673.14
$764.00
$860.26
$1202.22
$1826.88		 $886.86
$977.72
$1073.98
$1415.94		 $1100.58
$1191.44
$1287.70
$1629.66		 $1314.30
$1405.16
$1501.42
$1843.38		 $550.29
$595.72
$643.85
$814.83		 $764.01
$809.44
$857.57
$1028.55		 $977.73
$1023.16
$1071.29
$1242.27		 $213.72

Plan: (PPO) PPO 5000 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Insurance Company of Scott & White)

Deductible: Individual: $5,000 : Family: $10,000
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		 $264.86
$300.61
$338.49
$473.03
$718.82		 $529.72
$601.22
$676.98
$946.06
$1437.64		 $697.90
$769.40
$845.16
$1114.24		 $866.08
$937.58
$1013.34
$1282.42		 $1034.26
$1105.76
$1181.52
$1450.60		 $433.04
$468.79
$506.67
$641.21		 $601.22
$636.97
$674.85
$809.39		 $769.40
$805.15
$843.03
$977.57		 $168.18

Plan: (PPO) PPO 6600

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Insurance Company of Scott & White)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $276.64
$313.99
$353.55
$494.08
$750.81		 $553.28
$627.98
$707.10
$988.16
$1501.62		 $728.95
$803.65
$882.77
$1163.83		 $904.62
$979.32
$1058.44
$1339.50		 $1080.29
$1154.99
$1234.11
$1515.17		 $452.31
$489.66
$529.22
$669.75		 $627.98
$665.33
$704.89
$845.42		 $803.65
$841.00
$880.56
$1021.09		 $175.67

Plan: (PPO) PPO 5000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Insurance Company of Scott & White)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $265.90
$301.80
$339.82
$474.90
$721.66		 $531.80
$603.60
$679.64
$949.80
$1443.32		 $700.65
$772.45
$848.49
$1118.65		 $869.50
$941.30
$1017.34
$1287.50		 $1038.35
$1110.15
$1186.19
$1456.35		 $434.75
$470.65
$508.67
$643.75		 $603.60
$639.50
$677.52
$812.60		 $772.45
$808.35
$846.37
$981.45		 $168.85

Plan: (PPO) PPO 2500 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Insurance Company of Scott & White)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $318.81
$361.85
$407.44
$569.39
$865.25		 $637.62
$723.70
$814.88
$1138.78
$1730.50		 $840.06
$926.14
$1017.32
$1341.22		 $1042.50
$1128.58
$1219.76
$1543.66		 $1244.94
$1331.02
$1422.20
$1746.10		 $521.25
$564.29
$609.88
$771.83		 $723.69
$766.73
$812.32
$974.27		 $926.13
$969.17
$1014.76
$1176.71		 $202.44

Plan: (PPO) PPO 2500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Insurance Company of Scott & White)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $305.33
$346.55
$390.21
$545.32
$828.67		 $610.66
$693.10
$780.42
$1090.64
$1657.34		 $804.55
$886.99
$974.31
$1284.53		 $998.44
$1080.88
$1168.20
$1478.42		 $1192.33
$1274.77
$1362.09
$1672.31		 $499.22
$540.44
$584.10
$739.21		 $693.11
$734.33
$777.99
$933.10		 $887.00
$928.22
$971.88
$1126.99		 $193.89
ADVERTISEMENT

Scott and White Health Plan

Local: 1-254-298-3000 x20300 | Toll Free: 1-800-321-7947

TTY: 1-800-735-2989

Plan: (HMO) Scott and White Health Plan Catastrophic 6850

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Scott and White Health Plan)

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		 $257.01
$291.70
$328.45
$459.01
$697.52		 $514.02
$583.40
$656.90
$918.02
$1395.04		 $677.22
$746.60
$820.10
$1081.22		 $840.42
$909.80
$983.30
$1244.42		 $1003.62
$1073.00
$1146.50
$1407.62		 $420.21
$454.90
$491.65
$622.21		 $583.41
$618.10
$654.85
$785.41		 $746.61
$781.30
$818.05
$948.61		 $163.20

Plan: (HMO) Scott and White Health Plan Bronze 6000/50Ov

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Scott and White Health Plan)

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		 $256.45
$291.07
$327.74
$458.02
$696.01		 $512.90
$582.14
$655.48
$916.04
$1392.02		 $675.75
$744.99
$818.33
$1078.89		 $838.60
$907.84
$981.18
$1241.74		 $1001.45
$1070.69
$1144.03
$1404.59		 $419.30
$453.92
$490.59
$620.87		 $582.15
$616.77
$653.44
$783.72		 $745.00
$779.62
$816.29
$946.57		 $162.85

Plan: (HMO) Scott and White Health Plan Bronze 5500 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Scott and White Health Plan)

Deductible: Individual: $5,500 : Family: $11,000
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		 $293.28
$332.87
$374.81
$523.80
$795.96		 $586.56
$665.74
$749.62
$1047.60
$1591.92		 $772.79
$851.97
$935.85
$1233.83		 $959.02
$1038.20
$1122.08
$1420.06		 $1145.25
$1224.43
$1308.31
$1606.29		 $479.51
$519.10
$561.04
$710.03		 $665.74
$705.33
$747.27
$896.26		 $851.97
$891.56
$933.50
$1082.49		 $186.23

Plan: (HMO) Scott and White Health Plan Bronze 6600/60OV

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Scott and White Health Plan)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $285.34
$323.86
$364.66
$509.61
$774.41		 $570.68
$647.72
$729.32
$1019.22
$1548.82		 $751.87
$828.91
$910.51
$1200.41		 $933.06
$1010.10
$1091.70
$1381.60		 $1114.25
$1191.29
$1272.89
$1562.79		 $466.53
$505.05
$545.85
$690.80		 $647.72
$686.24
$727.04
$871.99		 $828.91
$867.43
$908.23
$1053.18		 $181.19

Plan: (HMO) Scott and White Health Plan Silver 3000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Scott and White Health Plan)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $303.38
$344.34
$387.72
$541.84
$823.38		 $606.76
$688.68
$775.44
$1083.68
$1646.76		 $799.41
$881.33
$968.09
$1276.33		 $992.06
$1073.98
$1160.74
$1468.98		 $1184.71
$1266.63
$1353.39
$1661.63		 $496.03
$536.99
$580.37
$734.49		 $688.68
$729.64
$773.02
$927.14		 $881.33
$922.29
$965.67
$1119.79		 $192.65

Plan: (HMO) Scott and White Health Plan Silver 2750 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Scott and White Health Plan)

Deductible: Individual: $2,750 : Family: $5,500
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		 $342.19
$388.39
$437.32
$611.16
$928.71		 $684.38
$776.78
$874.64
$1222.32
$1857.42		 $901.67
$994.07
$1091.93
$1439.61		 $1118.96
$1211.36
$1309.22
$1656.90		 $1336.25
$1428.65
$1526.51
$1874.19		 $559.48
$605.68
$654.61
$828.45		 $776.77
$822.97
$871.90
$1045.74		 $994.06
$1040.26
$1089.19
$1263.03		 $217.29

Plan: (HMO) Scott and White Health Plan Silver 2500/OV35

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Scott and White Health Plan)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $5,800 : Family: $11,600

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $307.64
$349.17
$393.16
$549.44
$834.93		 $615.28
$698.34
$786.32
$1098.88
$1669.86		 $810.63
$893.69
$981.67
$1294.23		 $1005.98
$1089.04
$1177.02
$1489.58		 $1201.33
$1284.39
$1372.37
$1684.93		 $502.99
$544.52
$588.51
$744.79		 $698.34
$739.87
$783.86
$940.14		 $893.69
$935.22
$979.21
$1135.49		 $195.35

Plan: (HMO) Scott and White Health Plan Silver 2500/30OV

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Scott and White Health Plan)

Deductible: Individual: $2,500 : Family: $5,000
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		 $299.87
$340.36
$383.24
$535.57
$813.85		 $599.74
$680.72
$766.48
$1071.14
$1627.70		 $790.16
$871.14
$956.90
$1261.56		 $980.58
$1061.56
$1147.32
$1451.98		 $1171.00
$1251.98
$1337.74
$1642.40		 $490.29
$530.78
$573.66
$725.99		 $680.71
$721.20
$764.08
$916.41		 $871.13
$911.62
$954.50
$1106.83		 $190.42

Plan: (HMO) Scott and White Health Plan Gold 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Scott and White Health Plan)

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		 $376.95
$427.84
$481.74
$673.23
$1023.04		 $753.90
$855.68
$963.48
$1346.46
$2046.08		 $993.26
$1095.04
$1202.84
$1585.82		 $1232.62
$1334.40
$1442.20
$1825.18		 $1471.98
$1573.76
$1681.56
$2064.54		 $616.31
$667.20
$721.10
$912.59		 $855.67
$906.56
$960.46
$1151.95		 $1095.03
$1145.92
$1199.82
$1391.31		 $239.36

Plan: (HMO) Scott and White Health Plan Gold 1400 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Scott and White Health Plan)

Deductible: Individual: $1,400 : Family: $2,800
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		 $387.87
$440.23
$495.70
$692.74
$1052.68		 $775.74
$880.46
$991.40
$1385.48
$2105.36		 $1022.04
$1126.76
$1237.70
$1631.78		 $1268.34
$1373.06
$1484.00
$1878.08		 $1514.64
$1619.36
$1730.30
$2124.38		 $634.17
$686.53
$742.00
$939.04		 $880.47
$932.83
$988.30
$1185.34		 $1126.77
$1179.13
$1234.60
$1431.64		 $246.30

Plan: (HMO) Scott and White Health Plan Gold HMO 30

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-321-7947 - Provider Directory for This Plan: (Scott and White Health Plan)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: Individual: $6,400 : Family: $12,800

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
Gold 21
30
40
50
60		 $418.65
$475.17
$535.03
$747.71
$1136.22		 $837.30
$950.34
$1070.06
$1495.42
$2272.44		 $1103.14
$1216.18
$1335.90
$1761.26		 $1368.98
$1482.02
$1601.74
$2027.10		 $1634.82
$1747.86
$1867.58
$2292.94		 $684.49
$741.01
$800.87
$1013.55		 $950.33
$1006.85
$1066.71
$1279.39		 $1216.17
$1272.69
$1332.55
$1545.23		 $265.84
ADVERTISEMENT

Cigna Health and Life Insurance Company

Local: 1-877-900-1237 | Toll Free: 1-877-900-1237

Plan: (EPO) Cigna FocusIn HSA Bronze 6000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna Health and Life Insurance Company)

Deductible: Individual: $6,000 : Family: $12,000
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		 $244.74
$277.78
$312.78
$437.11
$664.22		 $489.48
$555.56
$625.56
$874.22
$1328.44		 $644.89
$710.97
$780.97
$1029.63		 $800.30
$866.38
$936.38
$1185.04		 $955.71
$1021.79
$1091.79
$1340.45		 $400.15
$433.19
$468.19
$592.52		 $555.56
$588.60
$623.60
$747.93		 $710.97
$744.01
$779.01
$903.34		 $155.41

Plan: (EPO) Cigna FocusIn Flex Bronze 6400

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna Health and Life Insurance Company)

Deductible: Individual: $6,400 : Family: $12,800
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
Bronze 21
30
40
50
60		 $253.28
$287.47
$323.69
$452.35
$687.39		 $506.56
$574.94
$647.38
$904.70
$1374.78		 $667.39
$735.77
$808.21
$1065.53		 $828.22
$896.60
$969.04
$1226.36		 $989.05
$1057.43
$1129.87
$1387.19		 $414.11
$448.30
$484.52
$613.18		 $574.94
$609.13
$645.35
$774.01		 $735.77
$769.96
$806.18
$934.84		 $160.83

Plan: (EPO) Cigna FocusIn HSA Silver 2700

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna Health and Life Insurance Company)

Deductible: Individual: $2,700 : Family: $5,400
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		 $288.14
$327.04
$368.24
$514.61
$782.00		 $576.28
$654.08
$736.48
$1029.22
$1564.00		 $759.25
$837.05
$919.45
$1212.19		 $942.22
$1020.02
$1102.42
$1395.16		 $1125.19
$1202.99
$1285.39
$1578.13		 $471.11
$510.01
$551.21
$697.58		 $654.08
$692.98
$734.18
$880.55		 $837.05
$875.95
$917.15
$1063.52		 $182.97

Plan: (EPO) Cigna FocusIn Flex Silver 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna Health and Life Insurance Company)

Deductible: Individual: $4,000 : Family: $8,000
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		 $304.08
$345.13
$388.62
$543.09
$825.28		 $608.16
$690.26
$777.24
$1086.18
$1650.56		 $801.25
$883.35
$970.33
$1279.27		 $994.34
$1076.44
$1163.42
$1472.36		 $1187.43
$1269.53
$1356.51
$1665.45		 $497.17
$538.22
$581.71
$736.18		 $690.26
$731.31
$774.80
$929.27		 $883.35
$924.40
$967.89
$1122.36		 $193.09

Plan: (EPO) Cigna FocusIn Flex Silver 5000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna Health and Life Insurance Company)

Deductible: Individual: $5,000 : Family: $10,000
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		 $301.30
$341.98
$385.07
$538.13
$817.74		 $602.60
$683.96
$770.14
$1076.26
$1635.48		 $793.93
$875.29
$961.47
$1267.59		 $985.26
$1066.62
$1152.80
$1458.92		 $1176.59
$1257.95
$1344.13
$1650.25		 $492.63
$533.31
$576.40
$729.46		 $683.96
$724.64
$767.73
$920.79		 $875.29
$915.97
$959.06
$1112.12		 $191.33

Plan: (EPO) Cigna FocusIn Flex Silver 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna Health and Life Insurance Company)

Deductible: Individual: $2,000 : Family: $4,000
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		 $322.84
$366.42
$412.59
$576.59
$876.18		 $645.68
$732.84
$825.18
$1153.18
$1752.36		 $850.68
$937.84
$1030.18
$1358.18		 $1055.68
$1142.84
$1235.18
$1563.18		 $1260.68
$1347.84
$1440.18
$1768.18		 $527.84
$571.42
$617.59
$781.59		 $732.84
$776.42
$822.59
$986.59		 $937.84
$981.42
$1027.59
$1191.59		 $205.00

Plan: (EPO) Cigna FocusIn Flex Gold 1000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-900-1237 - Provider Directory for This Plan: (Cigna Health and Life Insurance Company)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $385.20
$437.20
$492.28
$687.97
$1045.43		 $770.40
$874.40
$984.56
$1375.94
$2090.86		 $1015.00
$1119.00
$1229.16
$1620.54		 $1259.60
$1363.60
$1473.76
$1865.14		 $1504.20
$1608.20
$1718.36
$2109.74		 $629.80
$681.80
$736.88
$932.57		 $874.40
$926.40
$981.48
$1177.17		 $1119.00
$1171.00
$1226.08
$1421.77		 $244.60
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		 $327.85
$372.11
$418.99
$585.54
$889.78		 $655.70
$744.22
$837.98
$1171.08
$1779.56		 $863.88
$952.40
$1046.16
$1379.26		 $1072.06
$1160.58
$1254.34
$1587.44		 $1280.24
$1368.76
$1462.52
$1795.62		 $536.03
$580.29
$627.17
$793.72		 $744.21
$788.47
$835.35
$1001.90		 $952.39
$996.65
$1043.53
$1210.08		 $208.18

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		 $283.02
$321.23
$361.70
$505.48
$768.12		 $566.04
$642.46
$723.40
$1010.96
$1536.24		 $745.76
$822.18
$903.12
$1190.68		 $925.48
$1001.90
$1082.84
$1370.40		 $1105.20
$1181.62
$1262.56
$1550.12		 $462.74
$500.95
$541.42
$685.20		 $642.46
$680.67
$721.14
$864.92		 $822.18
$860.39
$900.86
$1044.64		 $179.72

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		 $225.18
$255.58
$287.78
$402.17
$611.14		 $450.36
$511.16
$575.56
$804.34
$1222.28		 $593.35
$654.15
$718.55
$947.33		 $736.34
$797.14
$861.54
$1090.32		 $879.33
$940.13
$1004.53
$1233.31		 $368.17
$398.57
$430.77
$545.16		 $511.16
$541.56
$573.76
$688.15		 $654.15
$684.55
$716.75
$831.14		 $142.99

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		 $210.48
$238.90
$268.99
$375.92
$571.25		 $420.96
$477.80
$537.98
$751.84
$1142.50		 $554.62
$611.46
$671.64
$885.50		 $688.28
$745.12
$805.30
$1019.16		 $821.94
$878.78
$938.96
$1152.82		 $344.14
$372.56
$402.65
$509.58		 $477.80
$506.22
$536.31
$643.24		 $611.46
$639.88
$669.97
$776.90		 $133.66

†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 Ellis County here.

 

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