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 Fond Du Lac County, Wisconsin.
Obamacare Providers, Plans and 2016 Rates for Fond Du Lac County
Fond Du Lac County is in “Rating Area 11” of Wisconsin.
Currently, there are 8 providers offering 181 plans to Rating Area 11. †
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 Fond Du Lac, WI area accept this insurance coverage as within the plan's "network".
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Managed Health Services Insurance CorporationLocal: 1-855-745-5506 | Toll Free: 1-855-745-5506 TTY: 1-877-941-9236 |
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Plan: (HMO) Ambetter Secure Care 1 (2016) with 3 Free PCP VisitsSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-745-5506 - Provider Directory for This Plan: (Managed Health Services Insurance Corporation)
Deductible: Individual:
$1,000
: Family:
$2,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$370.34 $420.33 $473.29 $661.42 $1005.09 |
$740.68 $840.66 $946.58 $1322.84 $2010.18 |
$975.84 $1075.82 $1181.74 $1558.00 |
$1211.00 $1310.98 $1416.90 $1793.16 |
$1446.16 $1546.14 $1652.06 $2028.32 |
$605.50 $655.49 $708.45 $896.58 |
$840.66 $890.65 $943.61 $1131.74 |
$1075.82 $1125.81 $1178.77 $1366.90 |
$235.16 |
Plan: (HMO) Ambetter Essential Care 1 (2016)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-745-5506 - Provider Directory for This Plan: (Managed Health Services Insurance Corporation)
Deductible: Individual:
$6,800
: Family:
$13,600 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple 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 |
$261.73 $297.06 $334.48 $467.44 $710.32 |
$523.46 $594.12 $668.96 $934.88 $1420.64 |
$689.65 $760.31 $835.15 $1101.07 |
$855.84 $926.50 $1001.34 $1267.26 |
$1022.03 $1092.69 $1167.53 $1433.45 |
$427.92 $463.25 $500.67 $633.63 |
$594.11 $629.44 $666.86 $799.82 |
$760.30 $795.63 $833.05 $966.01 |
$166.19 |
Plan: (HMO) Ambetter Balanced Care 2 (2016)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-745-5506 - Provider Directory for This Plan: (Managed Health Services Insurance Corporation)
Deductible: Individual:
$6,500
: Family:
$13,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$292.76 $332.28 $374.14 $522.86 $794.54 |
$585.52 $664.56 $748.28 $1045.72 $1589.08 |
$771.42 $850.46 $934.18 $1231.62 |
$957.32 $1036.36 $1120.08 $1417.52 |
$1143.22 $1222.26 $1305.98 $1603.42 |
$478.66 $518.18 $560.04 $708.76 |
$664.56 $704.08 $745.94 $894.66 |
$850.46 $889.98 $931.84 $1080.56 |
$185.90 |
Plan: (HMO) Ambetter Balanced Care 10 (2016)Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-745-5506 - Provider Directory for This Plan: (Managed Health Services Insurance Corporation)
Deductible: Individual:
$4,500
: Family:
$9,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple 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 |
$303.60 $344.57 $387.98 $542.21 $823.93 |
$607.20 $689.14 $775.96 $1084.42 $1647.86 |
$799.98 $881.92 $968.74 $1277.20 |
$992.76 $1074.70 $1161.52 $1469.98 |
$1185.54 $1267.48 $1354.30 $1662.76 |
$496.38 $537.35 $580.76 $734.99 |
$689.16 $730.13 $773.54 $927.77 |
$881.94 $922.91 $966.32 $1120.55 |
$192.78 |
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Unity Health Plans Insurance CorporationLocal: 1-608-643-2491 | Toll Free: 1-800-362-3310 TTY: 1-608-643-1421 |
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Plan: (HMO) Unity Elite Platinum 30/60 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$500
: Family:
$1,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple 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 |
$405.92 $460.71 $518.76 $724.96 $1101.65 |
$811.84 $921.42 $1037.52 $1449.92 $2203.30 |
$1069.60 $1179.18 $1295.28 $1707.68 |
$1327.36 $1436.94 $1553.04 $1965.44 |
$1585.12 $1694.70 $1810.80 $2223.20 |
$663.68 $718.47 $776.52 $982.72 |
$921.44 $976.23 $1034.28 $1240.48 |
$1179.20 $1233.99 $1292.04 $1498.24 |
$257.76 |
Plan: (HMO) Unity Elite Platinum 25/50 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$0
: Family:
$0 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple 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 |
$454.28 $515.60 $580.56 $811.34 $1232.90 |
$908.56 $1031.20 $1161.12 $1622.68 $2465.80 |
$1197.02 $1319.66 $1449.58 $1911.14 |
$1485.48 $1608.12 $1738.04 $2199.60 |
$1773.94 $1896.58 $2026.50 $2488.06 |
$742.74 $804.06 $869.02 $1099.80 |
$1031.20 $1092.52 $1157.48 $1388.26 |
$1319.66 $1380.98 $1445.94 $1676.72 |
$288.46 |
Plan: (HMO) Unity Elite Gold 30/60 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,350
: Family:
$2,700 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple 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 |
$346.90 $393.73 $443.33 $619.56 $941.48 |
$693.80 $787.46 $886.66 $1239.12 $1882.96 |
$914.08 $1007.74 $1106.94 $1459.40 |
$1134.36 $1228.02 $1327.22 $1679.68 |
$1354.64 $1448.30 $1547.50 $1899.96 |
$567.18 $614.01 $663.61 $839.84 |
$787.46 $834.29 $883.89 $1060.12 |
$1007.74 $1054.57 $1104.17 $1280.40 |
$220.28 |
Plan: (HMO) Unity Elite Gold 20/40 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,000
: Family:
$2,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$365.94 $415.33 $467.66 $653.56 $993.14 |
$731.88 $830.66 $935.32 $1307.12 $1986.28 |
$964.25 $1063.03 $1167.69 $1539.49 |
$1196.62 $1295.40 $1400.06 $1771.86 |
$1428.99 $1527.77 $1632.43 $2004.23 |
$598.31 $647.70 $700.03 $885.93 |
$830.68 $880.07 $932.40 $1118.30 |
$1063.05 $1112.44 $1164.77 $1350.67 |
$232.37 |
Plan: (HMO) Unity Elite Silver Plus with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$4,550
: Family:
$9,100 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple 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 |
$289.26 $328.31 $369.67 $516.61 $785.05 |
$578.52 $656.62 $739.34 $1033.22 $1570.10 |
$762.20 $840.30 $923.02 $1216.90 |
$945.88 $1023.98 $1106.70 $1400.58 |
$1129.56 $1207.66 $1290.38 $1584.26 |
$472.94 $511.99 $553.35 $700.29 |
$656.62 $695.67 $737.03 $883.97 |
$840.30 $879.35 $920.71 $1067.65 |
$183.68 |
Plan: (HMO) Unity Elite Silver Choice Value with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$306.87 $348.29 $392.17 $548.06 $832.82 |
$613.74 $696.58 $784.34 $1096.12 $1665.64 |
$808.60 $891.44 $979.20 $1290.98 |
$1003.46 $1086.30 $1174.06 $1485.84 |
$1198.32 $1281.16 $1368.92 $1680.70 |
$501.73 $543.15 $587.03 $742.92 |
$696.59 $738.01 $781.89 $937.78 |
$891.45 $932.87 $976.75 $1132.64 |
$194.86 |
Plan: (HMO) Unity Elite Silver Exclusive Value with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$4,000
: Family:
$8,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple 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 |
$283.85 $322.17 $362.76 $506.95 $770.37 |
$567.70 $644.34 $725.52 $1013.90 $1540.74 |
$747.94 $824.58 $905.76 $1194.14 |
$928.18 $1004.82 $1086.00 $1374.38 |
$1108.42 $1185.06 $1266.24 $1554.62 |
$464.09 $502.41 $543.00 $687.19 |
$644.33 $682.65 $723.24 $867.43 |
$824.57 $862.89 $903.48 $1047.67 |
$180.24 |
Plan: (HMO) Unity Elite Bronze 55/150 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$6,300
: Family:
$12,600 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple 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 |
$268.64 $304.90 $343.31 $479.77 $729.06 |
$537.28 $609.80 $686.62 $959.54 $1458.12 |
$707.86 $780.38 $857.20 $1130.12 |
$878.44 $950.96 $1027.78 $1300.70 |
$1049.02 $1121.54 $1198.36 $1471.28 |
$439.22 $475.48 $513.89 $650.35 |
$609.80 $646.06 $684.47 $820.93 |
$780.38 $816.64 $855.05 $991.51 |
$170.58 |
Plan: (HMO) Unity Elite Silver Maintenance with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,500
: Family:
$3,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple 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 |
$313.60 $355.93 $400.78 $560.08 $851.10 |
$627.20 $711.86 $801.56 $1120.16 $1702.20 |
$826.33 $910.99 $1000.69 $1319.29 |
$1025.46 $1110.12 $1199.82 $1518.42 |
$1224.59 $1309.25 $1398.95 $1717.55 |
$512.73 $555.06 $599.91 $759.21 |
$711.86 $754.19 $799.04 $958.34 |
$910.99 $953.32 $998.17 $1157.47 |
$199.13 |
Plan: (HMO) Unity Elite Platinum 20/40 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$200
: Family:
$400 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple 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 |
$427.02 $484.67 $545.73 $762.66 $1158.93 |
$854.04 $969.34 $1091.46 $1525.32 $2317.86 |
$1125.20 $1240.50 $1362.62 $1796.48 |
$1396.36 $1511.66 $1633.78 $2067.64 |
$1667.52 $1782.82 $1904.94 $2338.80 |
$698.18 $755.83 $816.89 $1033.82 |
$969.34 $1026.99 $1088.05 $1304.98 |
$1240.50 $1298.15 $1359.21 $1576.14 |
$271.16 |
Plan: (HMO) Unity Elite Bronze 45/125 Value with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$6,600
: Family:
$13,200 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple 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 |
$266.25 $302.19 $340.26 $475.51 $722.59 |
$532.50 $604.38 $680.52 $951.02 $1445.18 |
$701.57 $773.45 $849.59 $1120.09 |
$870.64 $942.52 $1018.66 $1289.16 |
$1039.71 $1111.59 $1187.73 $1458.23 |
$435.32 $471.26 $509.33 $644.58 |
$604.39 $640.33 $678.40 $813.65 |
$773.46 $809.40 $847.47 $982.72 |
$169.07 |
Plan: (HMO) Unity Elite Platinum 30/60Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$500
: Family:
$1,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple 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 |
$379.24 $430.43 $484.66 $677.31 $1029.24 |
$758.48 $860.86 $969.32 $1354.62 $2058.48 |
$999.29 $1101.67 $1210.13 $1595.43 |
$1240.10 $1342.48 $1450.94 $1836.24 |
$1480.91 $1583.29 $1691.75 $2077.05 |
$620.05 $671.24 $725.47 $918.12 |
$860.86 $912.05 $966.28 $1158.93 |
$1101.67 $1152.86 $1207.09 $1399.74 |
$240.81 |
Plan: (HMO) Unity Elite Platinum 25/50Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$0
: Family:
$0 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple 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 |
$424.42 $481.71 $542.40 $758.01 $1151.86 |
$848.84 $963.42 $1084.80 $1516.02 $2303.72 |
$1118.34 $1232.92 $1354.30 $1785.52 |
$1387.84 $1502.42 $1623.80 $2055.02 |
$1657.34 $1771.92 $1893.30 $2324.52 |
$693.92 $751.21 $811.90 $1027.51 |
$963.42 $1020.71 $1081.40 $1297.01 |
$1232.92 $1290.21 $1350.90 $1566.51 |
$269.50 |
Plan: (HMO) Unity Elite Gold 30/60Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,350
: Family:
$2,700 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple 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 |
$324.10 $367.85 $414.19 $578.83 $879.59 |
$648.20 $735.70 $828.38 $1157.66 $1759.18 |
$854.00 $941.50 $1034.18 $1363.46 |
$1059.80 $1147.30 $1239.98 $1569.26 |
$1265.60 $1353.10 $1445.78 $1775.06 |
$529.90 $573.65 $619.99 $784.63 |
$735.70 $779.45 $825.79 $990.43 |
$941.50 $985.25 $1031.59 $1196.23 |
$205.80 |
Plan: (HMO) Unity Elite Gold 20/40Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,000
: Family:
$2,000 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 |
$341.89 $388.03 $436.92 $610.60 $927.86 |
$683.78 $776.06 $873.84 $1221.20 $1855.72 |
$900.87 $993.15 $1090.93 $1438.29 |
$1117.96 $1210.24 $1308.02 $1655.38 |
$1335.05 $1427.33 $1525.11 $1872.47 |
$558.98 $605.12 $654.01 $827.69 |
$776.07 $822.21 $871.10 $1044.78 |
$993.16 $1039.30 $1088.19 $1261.87 |
$217.09 |
Plan: (HMO) Unity Elite Silver PlusSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$4,550
: Family:
$9,100 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 |
Silver | 21 30 40 50 60 |
$270.25 $306.73 $345.37 $482.66 $733.44 |
$540.50 $613.46 $690.74 $965.32 $1466.88 |
$712.11 $785.07 $862.35 $1136.93 |
$883.72 $956.68 $1033.96 $1308.54 |
$1055.33 $1128.29 $1205.57 $1480.15 |
$441.86 $478.34 $516.98 $654.27 |
$613.47 $649.95 $688.59 $825.88 |
$785.08 $821.56 $860.20 $997.49 |
$171.61 |
Plan: (HMO) Unity Elite Silver Choice ValueSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: 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 |
Silver | 21 30 40 50 60 |
$286.70 $325.40 $366.39 $512.03 $778.08 |
$573.40 $650.80 $732.78 $1024.06 $1556.16 |
$755.45 $832.85 $914.83 $1206.11 |
$937.50 $1014.90 $1096.88 $1388.16 |
$1119.55 $1196.95 $1278.93 $1570.21 |
$468.75 $507.45 $548.44 $694.08 |
$650.80 $689.50 $730.49 $876.13 |
$832.85 $871.55 $912.54 $1058.18 |
$182.05 |
Plan: (HMO) Unity Elite Silver Exclusive ValueSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: 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 |
$265.20 $300.99 $338.91 $473.63 $719.73 |
$530.40 $601.98 $677.82 $947.26 $1439.46 |
$698.80 $770.38 $846.22 $1115.66 |
$867.20 $938.78 $1014.62 $1284.06 |
$1035.60 $1107.18 $1183.02 $1452.46 |
$433.60 $469.39 $507.31 $642.03 |
$602.00 $637.79 $675.71 $810.43 |
$770.40 $806.19 $844.11 $978.83 |
$168.40 |
Plan: (HMO) Unity Elite Bronze 55/150Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$6,300
: Family:
$12,600 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$250.98 $284.85 $320.74 $448.24 $681.14 |
$501.96 $569.70 $641.48 $896.48 $1362.28 |
$661.33 $729.07 $800.85 $1055.85 |
$820.70 $888.44 $960.22 $1215.22 |
$980.07 $1047.81 $1119.59 $1374.59 |
$410.35 $444.22 $480.11 $607.61 |
$569.72 $603.59 $639.48 $766.98 |
$729.09 $762.96 $798.85 $926.35 |
$159.37 |
Plan: (HMO) Unity Elite Silver MaintenanceSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: 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 |
Silver | 21 30 40 50 60 |
$292.99 $332.54 $374.43 $523.27 $795.16 |
$585.98 $665.08 $748.86 $1046.54 $1590.32 |
$772.02 $851.12 $934.90 $1232.58 |
$958.06 $1037.16 $1120.94 $1418.62 |
$1144.10 $1223.20 $1306.98 $1604.66 |
$479.03 $518.58 $560.47 $709.31 |
$665.07 $704.62 $746.51 $895.35 |
$851.11 $890.66 $932.55 $1081.39 |
$186.04 |
Plan: (HMO) Unity Elite Platinum 20/40Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$200
: Family:
$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 |
Platinum | 21 30 40 50 60 |
$398.96 $452.81 $509.86 $712.53 $1082.75 |
$797.92 $905.62 $1019.72 $1425.06 $2165.50 |
$1051.25 $1158.95 $1273.05 $1678.39 |
$1304.58 $1412.28 $1526.38 $1931.72 |
$1557.91 $1665.61 $1779.71 $2185.05 |
$652.29 $706.14 $763.19 $965.86 |
$905.62 $959.47 $1016.52 $1219.19 |
$1158.95 $1212.80 $1269.85 $1472.52 |
$253.33 |
Plan: (HMO) Unity Elite Bronze 45/125 ValueSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: 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 |
$248.75 $282.32 $317.89 $444.26 $675.09 |
$497.50 $564.64 $635.78 $888.52 $1350.18 |
$655.45 $722.59 $793.73 $1046.47 |
$813.40 $880.54 $951.68 $1204.42 |
$971.35 $1038.49 $1109.63 $1362.37 |
$406.70 $440.27 $475.84 $602.21 |
$564.65 $598.22 $633.79 $760.16 |
$722.60 $756.17 $791.74 $918.11 |
$157.95 |
Plan: (HMO) Unity Elite Gold DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,400
: Family:
$2,800 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 |
$334.11 $379.21 $426.98 $596.71 $906.75 |
$668.22 $758.42 $853.96 $1193.42 $1813.50 |
$880.38 $970.58 $1066.12 $1405.58 |
$1092.54 $1182.74 $1278.28 $1617.74 |
$1304.70 $1394.90 $1490.44 $1829.90 |
$546.27 $591.37 $639.14 $808.87 |
$758.43 $803.53 $851.30 $1021.03 |
$970.59 $1015.69 $1063.46 $1233.19 |
$212.16 |
Plan: (HMO) Unity Elite Silver DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$2,500
: Family:
$5,000 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 |
$279.27 $316.96 $356.90 $498.76 $757.91 |
$558.54 $633.92 $713.80 $997.52 $1515.82 |
$735.87 $811.25 $891.13 $1174.85 |
$913.20 $988.58 $1068.46 $1352.18 |
$1090.53 $1165.91 $1245.79 $1529.51 |
$456.60 $494.29 $534.23 $676.09 |
$633.93 $671.62 $711.56 $853.42 |
$811.26 $848.95 $888.89 $1030.75 |
$177.33 |
Plan: (HMO) Unity Elite Bronze HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$211.84 $240.43 $270.73 $378.34 $574.92 |
$423.68 $480.86 $541.46 $756.68 $1149.84 |
$558.20 $615.38 $675.98 $891.20 |
$692.72 $749.90 $810.50 $1025.72 |
$827.24 $884.42 $945.02 $1160.24 |
$346.36 $374.95 $405.25 $512.86 |
$480.88 $509.47 $539.77 $647.38 |
$615.40 $643.99 $674.29 $781.90 |
$134.52 |
Plan: (HMO) Unity Elite CatastrophicSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: 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 |
$170.42 $193.43 $217.80 $304.37 $462.52 |
$340.84 $386.86 $435.60 $608.74 $925.04 |
$449.06 $495.08 $543.82 $716.96 |
$557.28 $603.30 $652.04 $825.18 |
$665.50 $711.52 $760.26 $933.40 |
$278.64 $301.65 $326.02 $412.59 |
$386.86 $409.87 $434.24 $520.81 |
$495.08 $518.09 $542.46 $629.03 |
++ |
ADVERTISEMENT
|
||||||||||
Dean Health PlanLocal: 1-608-828-1301 | Toll Free: 1-800-279-1301 TTY: 1-608-827-4086 |
||||||||||
Plan: (HMO) Dean Catastrophic Safety NetSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1301 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: 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 |
$118.97 $135.04 $152.05 $212.49 $322.91 |
$237.94 $270.08 $304.10 $424.98 $645.82 |
$313.49 $345.63 $379.65 $500.53 |
$389.04 $421.18 $455.20 $576.08 |
$464.59 $496.73 $530.75 $651.63 |
$194.52 $210.59 $227.60 $288.04 |
$270.07 $286.14 $303.15 $363.59 |
$345.62 $361.69 $378.70 $439.14 |
$75.55 |
Plan: (HMO) Dean Silver Copay Plus 2000XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1301 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$2,000
: Family:
$4,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$241.39 $273.98 $308.50 $431.13 $655.14 |
$482.78 $547.96 $617.00 $862.26 $1310.28 |
$636.06 $701.24 $770.28 $1015.54 |
$789.34 $854.52 $923.56 $1168.82 |
$942.62 $1007.80 $1076.84 $1322.10 |
$394.67 $427.26 $461.78 $584.41 |
$547.95 $580.54 $615.06 $737.69 |
$701.23 $733.82 $768.34 $890.97 |
$153.28 |
Plan: (HMO) Dean Silver Classic 2500XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1301 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$2,500
: Family:
$5,000 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 |
$231.11 $262.31 $295.36 $412.76 $627.23 |
$462.22 $524.62 $590.72 $825.52 $1254.46 |
$608.97 $671.37 $737.47 $972.27 |
$755.72 $818.12 $884.22 $1119.02 |
$902.47 $964.87 $1030.97 $1265.77 |
$377.86 $409.06 $442.11 $559.51 |
$524.61 $555.81 $588.86 $706.26 |
$671.36 $702.56 $735.61 $853.01 |
$146.75 |
Plan: (HMO) Dean Silver Classic 4500XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1301 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$4,500
: Family:
$9,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$209.26 $237.51 $267.44 $373.75 $567.95 |
$418.52 $475.02 $534.88 $747.50 $1135.90 |
$551.40 $607.90 $667.76 $880.38 |
$684.28 $740.78 $800.64 $1013.26 |
$817.16 $873.66 $933.52 $1146.14 |
$342.14 $370.39 $400.32 $506.63 |
$475.02 $503.27 $533.20 $639.51 |
$607.90 $636.15 $666.08 $772.39 |
$132.88 |
Plan: (HMO) Dean Silver Value Copay 5150XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1301 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$5,150
: Family:
$10,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$201.04 $228.18 $256.93 $359.07 $545.64 |
$402.08 $456.36 $513.86 $718.14 $1091.28 |
$529.74 $584.02 $641.52 $845.80 |
$657.40 $711.68 $769.18 $973.46 |
$785.06 $839.34 $896.84 $1101.12 |
$328.70 $355.84 $384.59 $486.73 |
$456.36 $483.50 $512.25 $614.39 |
$584.02 $611.16 $639.91 $742.05 |
$127.66 |
Plan: (HMO) Dean Bronze Value Copay 5500XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1301 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: 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 |
Bronze | 21 30 40 50 60 |
$184.08 $208.93 $235.25 $328.77 $499.60 |
$368.16 $417.86 $470.50 $657.54 $999.20 |
$485.05 $534.75 $587.39 $774.43 |
$601.94 $651.64 $704.28 $891.32 |
$718.83 $768.53 $821.17 $1008.21 |
$300.97 $325.82 $352.14 $445.66 |
$417.86 $442.71 $469.03 $562.55 |
$534.75 $559.60 $585.92 $679.44 |
$116.89 |
Plan: (HMO) Dean Gold Classic 1500XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1301 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: 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 |
Gold | 21 30 40 50 60 |
$262.42 $297.85 $335.38 $468.69 $712.23 |
$524.84 $595.70 $670.76 $937.38 $1424.46 |
$691.48 $762.34 $837.40 $1104.02 |
$858.12 $928.98 $1004.04 $1270.66 |
$1024.76 $1095.62 $1170.68 $1437.30 |
$429.06 $464.49 $502.02 $635.33 |
$595.70 $631.13 $668.66 $801.97 |
$762.34 $797.77 $835.30 $968.61 |
$166.64 |
Plan: (HMO) Dean Gold Value Copay 2250XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1301 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$2,250
: Family:
$4,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$249.23 $282.87 $318.51 $445.12 $676.41 |
$498.46 $565.74 $637.02 $890.24 $1352.82 |
$656.72 $724.00 $795.28 $1048.50 |
$814.98 $882.26 $953.54 $1206.76 |
$973.24 $1040.52 $1111.80 $1365.02 |
$407.49 $441.13 $476.77 $603.38 |
$565.75 $599.39 $635.03 $761.64 |
$724.01 $757.65 $793.29 $919.90 |
$158.26 |
Plan: (HMO) Dean Gold HSA 2000XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1301 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$2,000
: Family:
$4,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$256.20 $290.79 $327.42 $457.57 $695.33 |
$512.40 $581.58 $654.84 $915.14 $1390.66 |
$675.08 $744.26 $817.52 $1077.82 |
$837.76 $906.94 $980.20 $1240.50 |
$1000.44 $1069.62 $1142.88 $1403.18 |
$418.88 $453.47 $490.10 $620.25 |
$581.56 $616.15 $652.78 $782.93 |
$744.24 $778.83 $815.46 $945.61 |
$162.68 |
Plan: (HMO) Dean Bronze Value Copay 6750XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1301 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$6,750
: Family:
$13,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$178.15 $202.20 $227.68 $318.18 $483.51 |
$356.30 $404.40 $455.36 $636.36 $967.02 |
$469.42 $517.52 $568.48 $749.48 |
$582.54 $630.64 $681.60 $862.60 |
$695.66 $743.76 $794.72 $975.72 |
$291.27 $315.32 $340.80 $431.30 |
$404.39 $428.44 $453.92 $544.42 |
$517.51 $541.56 $567.04 $657.54 |
$113.12 |
Plan: (HMO) Dean Bronze HSA-E 6000XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1301 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$6,000
: Family:
$12,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$178.75 $202.89 $228.45 $319.26 $485.15 |
$357.50 $405.78 $456.90 $638.52 $970.30 |
$471.01 $519.29 $570.41 $752.03 |
$584.52 $632.80 $683.92 $865.54 |
$698.03 $746.31 $797.43 $979.05 |
$292.26 $316.40 $341.96 $432.77 |
$405.77 $429.91 $455.47 $546.28 |
$519.28 $543.42 $568.98 $659.79 |
$113.51 |
Plan: (HMO) Dean Bronze HSA-E 6450XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1301 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: 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 |
$170.95 $194.03 $218.48 $305.32 $463.97 |
$341.90 $388.06 $436.96 $610.64 $927.94 |
$450.45 $496.61 $545.51 $719.19 |
$559.00 $605.16 $654.06 $827.74 |
$667.55 $713.71 $762.61 $936.29 |
$279.50 $302.58 $327.03 $413.87 |
$388.05 $411.13 $435.58 $522.42 |
$496.60 $519.68 $544.13 $630.97 |
$108.55 |
Plan: (HMO) Dean Silver HSA-E 3400XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1301 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$3,400
: Family:
$6,800 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$226.16 $256.69 $289.04 $403.93 $613.81 |
$452.32 $513.38 $578.08 $807.86 $1227.62 |
$595.93 $656.99 $721.69 $951.47 |
$739.54 $800.60 $865.30 $1095.08 |
$883.15 $944.21 $1008.91 $1238.69 |
$369.77 $400.30 $432.65 $547.54 |
$513.38 $543.91 $576.26 $691.15 |
$656.99 $687.52 $719.87 $834.76 |
$143.61 |
Plan: (HMO) Dean Platinum Copay Plus 500XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1301 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$500
: Family:
$1,000 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 |
$307.90 $349.47 $393.50 $549.92 $835.65 |
$615.80 $698.94 $787.00 $1099.84 $1671.30 |
$811.32 $894.46 $982.52 $1295.36 |
$1006.84 $1089.98 $1178.04 $1490.88 |
$1202.36 $1285.50 $1373.56 $1686.40 |
$503.42 $544.99 $589.02 $745.44 |
$698.94 $740.51 $784.54 $940.96 |
$894.46 $936.03 $980.06 $1136.48 |
$195.52 |
Plan: (HMO) Dean Gold Copay Plus 1000XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1301 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$1,000
: Family:
$2,000 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 |
$275.65 $312.87 $352.28 $492.32 $748.13 |
$551.30 $625.74 $704.56 $984.64 $1496.26 |
$726.34 $800.78 $879.60 $1159.68 |
$901.38 $975.82 $1054.64 $1334.72 |
$1076.42 $1150.86 $1229.68 $1509.76 |
$450.69 $487.91 $527.32 $667.36 |
$625.73 $662.95 $702.36 $842.40 |
$800.77 $837.99 $877.40 $1017.44 |
$175.04 |
Plan: (HMO) Dean Silver Copay Plus 3500XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1301 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$243.13 $275.95 $310.72 $434.23 $659.85 |
$486.26 $551.90 $621.44 $868.46 $1319.70 |
$640.64 $706.28 $775.82 $1022.84 |
$795.02 $860.66 $930.20 $1177.22 |
$949.40 $1015.04 $1084.58 $1331.60 |
$397.51 $430.33 $465.10 $588.61 |
$551.89 $584.71 $619.48 $742.99 |
$706.27 $739.09 $773.86 $897.37 |
$154.38 |
ADVERTISEMENT
|
||||||||||
All Savers Insurance CompanyLocal: 1-877-887-0450 | Toll Free: 1-877-887-0450 |
||||||||||
Plan: (EPO) Gold Compass 1000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0450 - Provider Directory for This Plan: (All Savers Insurance Company)
Deductible: Individual:
$1,000
: Family:
$2,000 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 |
$346.35 $393.10 $442.62 $618.57 $939.97 |
$692.70 $786.20 $885.24 $1237.14 $1879.94 |
$912.63 $1006.13 $1105.17 $1457.07 |
$1132.56 $1226.06 $1325.10 $1677.00 |
$1352.49 $1445.99 $1545.03 $1896.93 |
$566.28 $613.03 $662.55 $838.50 |
$786.21 $832.96 $882.48 $1058.43 |
$1006.14 $1052.89 $1102.41 $1278.36 |
$219.93 |
Plan: (EPO) Gold Compass 500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0450 - Provider Directory for This Plan: (All Savers Insurance Company)
Deductible: Individual:
$500
: Family:
$1,000 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 |
$344.87 $391.42 $440.73 $615.92 $935.95 |
$689.74 $782.84 $881.46 $1231.84 $1871.90 |
$908.73 $1001.83 $1100.45 $1450.83 |
$1127.72 $1220.82 $1319.44 $1669.82 |
$1346.71 $1439.81 $1538.43 $1888.81 |
$563.86 $610.41 $659.72 $834.91 |
$782.85 $829.40 $878.71 $1053.90 |
$1001.84 $1048.39 $1097.70 $1272.89 |
$218.99 |
Plan: (EPO) Silver Compass HSA 3000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0450 - Provider Directory for This Plan: (All Savers Insurance Company)
Deductible: 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 |
Silver | 21 30 40 50 60 |
$287.64 $326.46 $367.59 $513.71 $780.63 |
$575.28 $652.92 $735.18 $1027.42 $1561.26 |
$757.92 $835.56 $917.82 $1210.06 |
$940.56 $1018.20 $1100.46 $1392.70 |
$1123.20 $1200.84 $1283.10 $1575.34 |
$470.28 $509.10 $550.23 $696.35 |
$652.92 $691.74 $732.87 $878.99 |
$835.56 $874.38 $915.51 $1061.63 |
$182.64 |
Plan: (EPO) Silver Compass 2000 1Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0450 - Provider Directory for This Plan: (All Savers Insurance Company)
Deductible: Individual:
$2,000
: Family:
$4,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$299.50 $339.92 $382.75 $534.89 $812.82 |
$599.00 $679.84 $765.50 $1069.78 $1625.64 |
$789.18 $870.02 $955.68 $1259.96 |
$979.36 $1060.20 $1145.86 $1450.14 |
$1169.54 $1250.38 $1336.04 $1640.32 |
$489.68 $530.10 $572.93 $725.07 |
$679.86 $720.28 $763.11 $915.25 |
$870.04 $910.46 $953.29 $1105.43 |
$190.18 |
Plan: (EPO) Silver Compass 2000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0450 - Provider Directory for This Plan: (All Savers Insurance Company)
Deductible: Individual:
$2,000
: Family:
$4,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$301.87 $342.61 $385.78 $539.13 $819.26 |
$603.74 $685.22 $771.56 $1078.26 $1638.52 |
$795.42 $876.90 $963.24 $1269.94 |
$987.10 $1068.58 $1154.92 $1461.62 |
$1178.78 $1260.26 $1346.60 $1653.30 |
$493.55 $534.29 $577.46 $730.81 |
$685.23 $725.97 $769.14 $922.49 |
$876.91 $917.65 $960.82 $1114.17 |
$191.68 |
Plan: (EPO) Silver Compass 3500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0450 - Provider Directory for This Plan: (All Savers Insurance Company)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$303.95 $344.97 $388.43 $542.83 $824.89 |
$607.90 $689.94 $776.86 $1085.66 $1649.78 |
$800.90 $882.94 $969.86 $1278.66 |
$993.90 $1075.94 $1162.86 $1471.66 |
$1186.90 $1268.94 $1355.86 $1664.66 |
$496.95 $537.97 $581.43 $735.83 |
$689.95 $730.97 $774.43 $928.83 |
$882.95 $923.97 $967.43 $1121.83 |
$193.00 |
Plan: (EPO) Silver Compass 4500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0450 - Provider Directory for This Plan: (All Savers Insurance Company)
Deductible: Individual:
$4,500
: Family:
$9,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$310.77 $352.71 $397.15 $555.02 $843.40 |
$621.54 $705.42 $794.30 $1110.04 $1686.80 |
$818.87 $902.75 $991.63 $1307.37 |
$1016.20 $1100.08 $1188.96 $1504.70 |
$1213.53 $1297.41 $1386.29 $1702.03 |
$508.10 $550.04 $594.48 $752.35 |
$705.43 $747.37 $791.81 $949.68 |
$902.76 $944.70 $989.14 $1147.01 |
$197.33 |
Plan: (EPO) Bronze Compass HSA 5500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0450 - Provider Directory for This Plan: (All Savers Insurance Company)
Deductible: 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 |
Bronze | 21 30 40 50 60 |
$250.87 $284.73 $320.60 $448.04 $680.84 |
$501.74 $569.46 $641.20 $896.08 $1361.68 |
$661.04 $728.76 $800.50 $1055.38 |
$820.34 $888.06 $959.80 $1214.68 |
$979.64 $1047.36 $1119.10 $1373.98 |
$410.17 $444.03 $479.90 $607.34 |
$569.47 $603.33 $639.20 $766.64 |
$728.77 $762.63 $798.50 $925.94 |
$159.30 |
Plan: (EPO) Bronze Compass 6500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0450 - Provider Directory for This Plan: (All Savers Insurance Company)
Deductible: 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 |
$264.51 $300.21 $338.03 $472.40 $717.86 |
$529.02 $600.42 $676.06 $944.80 $1435.72 |
$696.98 $768.38 $844.02 $1112.76 |
$864.94 $936.34 $1011.98 $1280.72 |
$1032.90 $1104.30 $1179.94 $1448.68 |
$432.47 $468.17 $505.99 $640.36 |
$600.43 $636.13 $673.95 $808.32 |
$768.39 $804.09 $841.91 $976.28 |
$167.96 |
Plan: (EPO) Gold Compass 0Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-887-0450 - Provider Directory for This Plan: (All Savers Insurance Company)
Deductible: Individual:
$0
: Family:
$0 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$341.01 $387.04 $435.80 $609.03 $925.49 |
$682.02 $774.08 $871.60 $1218.06 $1850.98 |
$898.56 $990.62 $1088.14 $1434.60 |
$1115.10 $1207.16 $1304.68 $1651.14 |
$1331.64 $1423.70 $1521.22 $1867.68 |
$557.55 $603.58 $652.34 $825.57 |
$774.09 $820.12 $868.88 $1042.11 |
$990.63 $1036.66 $1085.42 $1258.65 |
$216.54 |
ADVERTISEMENT
|
||||||||||
Molina Healthcare of Wisconsin, Inc.Local: 1-855-540-1979 | Toll Free: 1-855-540-1979 |
||||||||||
Plan: (HMO) Molina Marketplace Gold PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-540-1979 - Provider Directory for This Plan: (Molina Healthcare of Wisconsin, Inc.)
Deductible: Individual:
$500
: Family:
$1,000 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 |
$274.02 $311.01 $350.19 $489.39 $743.68 |
$548.04 $622.02 $700.38 $978.78 $1487.36 |
$722.04 $796.02 $874.38 $1152.78 |
$896.04 $970.02 $1048.38 $1326.78 |
$1070.04 $1144.02 $1222.38 $1500.78 |
$448.02 $485.01 $524.19 $663.39 |
$622.02 $659.01 $698.19 $837.39 |
$796.02 $833.01 $872.19 $1011.39 |
$174.00 |
Plan: (HMO) Molina Marketplace Silver PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-540-1979 - Provider Directory for This Plan: (Molina Healthcare of Wisconsin, Inc.)
Deductible: Individual:
$2,000
: Family:
$4,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$219.69 $249.35 $280.77 $392.37 $596.24 |
$439.38 $498.70 $561.54 $784.74 $1192.48 |
$578.88 $638.20 $701.04 $924.24 |
$718.38 $777.70 $840.54 $1063.74 |
$857.88 $917.20 $980.04 $1203.24 |
$359.19 $388.85 $420.27 $531.87 |
$498.69 $528.35 $559.77 $671.37 |
$638.19 $667.85 $699.27 $810.87 |
$139.50 |
Plan: (HMO) Molina Marketplace Bronze PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-540-1979 - Provider Directory for This Plan: (Molina Healthcare of Wisconsin, Inc.)
Deductible: 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 |
Bronze | 21 30 40 50 60 |
$189.94 $215.58 $242.74 $339.23 $515.49 |
$379.88 $431.16 $485.48 $678.46 $1030.98 |
$500.49 $551.77 $606.09 $799.07 |
$621.10 $672.38 $726.70 $919.68 |
$741.71 $792.99 $847.31 $1040.29 |
$310.55 $336.19 $363.35 $459.84 |
$431.16 $456.80 $483.96 $580.45 |
$551.77 $577.41 $604.57 $701.06 |
$120.61 |
ADVERTISEMENT
|
||||||||||
Compcare Health Serv Ins Co(Anthem BCBS)Local: 1-855-748-1813 | Toll Free: 1-855-748-1813 |
||||||||||
Plan: (POS) Anthem Catastrophic Blue Priority X WI 6850/0%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: 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 |
$195.72 $222.14 $250.13 $349.56 $531.18 |
$391.44 $444.28 $500.26 $699.12 $1062.36 |
$515.72 $568.56 $624.54 $823.40 |
$640.00 $692.84 $748.82 $947.68 |
$764.28 $817.12 $873.10 $1071.96 |
$320.00 $346.42 $374.41 $473.84 |
$444.28 $470.70 $498.69 $598.12 |
$568.56 $594.98 $622.97 $722.40 |
$124.28 |
Plan: (POS) Anthem Bronze Blue Priority X WI 5850 20Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$5,850
: Family:
$11,700 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 |
$253.19 $287.37 $323.58 $452.20 $687.16 |
$506.38 $574.74 $647.16 $904.40 $1374.32 |
$667.16 $735.52 $807.94 $1065.18 |
$827.94 $896.30 $968.72 $1225.96 |
$988.72 $1057.08 $1129.50 $1386.74 |
$413.97 $448.15 $484.36 $612.98 |
$574.75 $608.93 $645.14 $773.76 |
$735.53 $769.71 $805.92 $934.54 |
$160.78 |
Plan: (POS) Anthem Bronze Blue Priority X WI 6050 25Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$6,050
: Family:
$12,100 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 |
$249.89 $283.63 $319.36 $446.30 $678.20 |
$499.78 $567.26 $638.72 $892.60 $1356.40 |
$658.46 $725.94 $797.40 $1051.28 |
$817.14 $884.62 $956.08 $1209.96 |
$975.82 $1043.30 $1114.76 $1368.64 |
$408.57 $442.31 $478.04 $604.98 |
$567.25 $600.99 $636.72 $763.66 |
$725.93 $759.67 $795.40 $922.34 |
$158.68 |
Plan: (POS) Anthem Bronze Blue Priority X WI 0 for HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$249.53 $283.22 $318.90 $445.66 $677.22 |
$499.06 $566.44 $637.80 $891.32 $1354.44 |
$657.51 $724.89 $796.25 $1049.77 |
$815.96 $883.34 $954.70 $1208.22 |
$974.41 $1041.79 $1113.15 $1366.67 |
$407.98 $441.67 $477.35 $604.11 |
$566.43 $600.12 $635.80 $762.56 |
$724.88 $758.57 $794.25 $921.01 |
$158.45 |
Plan: (POS) Anthem Bronze Blue Priority X WI 30 for HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$4,650
: Family:
$9,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$244.66 $277.69 $312.68 $436.96 $664.01 |
$489.32 $555.38 $625.36 $873.92 $1328.02 |
$644.68 $710.74 $780.72 $1029.28 |
$800.04 $866.10 $936.08 $1184.64 |
$955.40 $1021.46 $1091.44 $1340.00 |
$400.02 $433.05 $468.04 $592.32 |
$555.38 $588.41 $623.40 $747.68 |
$710.74 $743.77 $778.76 $903.04 |
$155.36 |
Plan: (POS) Anthem Silver Blue Priority X WI 3750 10Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$3,750
: Family:
$7,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$269.19 $305.53 $344.02 $480.77 $730.58 |
$538.38 $611.06 $688.04 $961.54 $1461.16 |
$709.32 $782.00 $858.98 $1132.48 |
$880.26 $952.94 $1029.92 $1303.42 |
$1051.20 $1123.88 $1200.86 $1474.36 |
$440.13 $476.47 $514.96 $651.71 |
$611.07 $647.41 $685.90 $822.65 |
$782.01 $818.35 $856.84 $993.59 |
$170.94 |
Plan: (POS) Anthem Silver Blue Priority X WI 2500/10%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$282.72 $320.89 $361.32 $504.94 $767.30 |
$565.44 $641.78 $722.64 $1009.88 $1534.60 |
$744.97 $821.31 $902.17 $1189.41 |
$924.50 $1000.84 $1081.70 $1368.94 |
$1104.03 $1180.37 $1261.23 $1548.47 |
$462.25 $500.42 $540.85 $684.47 |
$641.78 $679.95 $720.38 $864.00 |
$821.31 $859.48 $899.91 $1043.53 |
$179.53 |
Plan: (POS) Anthem Silver Blue Priority X WI 10 for HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: 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 |
Silver | 21 30 40 50 60 |
$271.99 $308.71 $347.60 $485.77 $738.18 |
$543.98 $617.42 $695.20 $971.54 $1476.36 |
$716.69 $790.13 $867.91 $1144.25 |
$889.40 $962.84 $1040.62 $1316.96 |
$1062.11 $1135.55 $1213.33 $1489.67 |
$444.70 $481.42 $520.31 $658.48 |
$617.41 $654.13 $693.02 $831.19 |
$790.12 $826.84 $865.73 $1003.90 |
$172.71 |
Plan: (POS) Anthem Silver Blue Priority X WI 1850/20%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$1,850
: Family:
$3,700 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$281.96 $320.02 $360.34 $503.58 $765.24 |
$563.92 $640.04 $720.68 $1007.16 $1530.48 |
$742.96 $819.08 $899.72 $1186.20 |
$922.00 $998.12 $1078.76 $1365.24 |
$1101.04 $1177.16 $1257.80 $1544.28 |
$461.00 $499.06 $539.38 $682.62 |
$640.04 $678.10 $718.42 $861.66 |
$819.08 $857.14 $897.46 $1040.70 |
$179.04 |
Plan: (POS) Anthem Bronze Blue Priority X WI 40 for HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: 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 |
Bronze | 21 30 40 50 60 |
$236.88 $268.86 $302.73 $423.07 $642.89 |
$473.76 $537.72 $605.46 $846.14 $1285.78 |
$624.18 $688.14 $755.88 $996.56 |
$774.60 $838.56 $906.30 $1146.98 |
$925.02 $988.98 $1056.72 $1297.40 |
$387.30 $419.28 $453.15 $573.49 |
$537.72 $569.70 $603.57 $723.91 |
$688.14 $720.12 $753.99 $874.33 |
$150.42 |
Plan: (POS) Anthem Bronze Blue Priority X WI 5450 30Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$5,450
: Family:
$10,900 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 |
$239.52 $271.86 $306.11 $427.78 $650.06 |
$479.04 $543.72 $612.22 $855.56 $1300.12 |
$631.14 $695.82 $764.32 $1007.66 |
$783.24 $847.92 $916.42 $1159.76 |
$935.34 $1000.02 $1068.52 $1311.86 |
$391.62 $423.96 $458.21 $579.88 |
$543.72 $576.06 $610.31 $731.98 |
$695.82 $728.16 $762.41 $884.08 |
$152.10 |
Plan: (POS) Anthem Silver Blue Priority X WI 4000 25Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$4,000
: Family:
$8,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$260.65 $295.84 $333.11 $465.52 $707.40 |
$521.30 $591.68 $666.22 $931.04 $1414.80 |
$686.81 $757.19 $831.73 $1096.55 |
$852.32 $922.70 $997.24 $1262.06 |
$1017.83 $1088.21 $1162.75 $1427.57 |
$426.16 $461.35 $498.62 $631.03 |
$591.67 $626.86 $664.13 $796.54 |
$757.18 $792.37 $829.64 $962.05 |
$165.51 |
Plan: (POS) Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$1,750
: Family:
$3,500 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 |
$285.08 $323.57 $364.33 $509.15 $773.71 |
$570.16 $647.14 $728.66 $1018.30 $1547.42 |
$751.19 $828.17 $909.69 $1199.33 |
$932.22 $1009.20 $1090.72 $1380.36 |
$1113.25 $1190.23 $1271.75 $1561.39 |
$466.11 $504.60 $545.36 $690.18 |
$647.14 $685.63 $726.39 $871.21 |
$828.17 $866.66 $907.42 $1052.24 |
$181.03 |
Plan: (POS) Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$1,000
: Family:
$2,000 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 |
$385.48 $437.52 $492.64 $688.47 $1046.19 |
$770.96 $875.04 $985.28 $1376.94 $2092.38 |
$1015.74 $1119.82 $1230.06 $1621.72 |
$1260.52 $1364.60 $1474.84 $1866.50 |
$1505.30 $1609.38 $1719.62 $2111.28 |
$630.26 $682.30 $737.42 $933.25 |
$875.04 $927.08 $982.20 $1178.03 |
$1119.82 $1171.86 $1226.98 $1422.81 |
$244.78 |
ADVERTISEMENT
|
||||||||||
WPS Health Plan, Inc.Local: 1-920-490-6900 | Toll Free: 1-888-711-1444 TTY: 1-888-332-0144 |
||||||||||
Plan: (HMO) Aurora HMO 1500 Featuring the AboutHealth NetworkSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-711-1444 - Provider Directory for This Plan: (WPS Health Plan, Inc.)
Deductible: 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 |
Gold | 21 30 40 50 60 |
$369.38 $419.25 $472.07 $659.71 $1002.50 |
$738.76 $838.50 $944.14 $1319.42 $2005.00 |
$973.32 $1073.06 $1178.70 $1553.98 |
$1207.88 $1307.62 $1413.26 $1788.54 |
$1442.44 $1542.18 $1647.82 $2023.10 |
$603.94 $653.81 $706.63 $894.27 |
$838.50 $888.37 $941.19 $1128.83 |
$1073.06 $1122.93 $1175.75 $1363.39 |
$234.56 |
Plan: (HMO) Aurora HMO 4000 Featuring the AboutHealth NetworkSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-711-1444 - Provider Directory for This Plan: (WPS Health Plan, Inc.)
Deductible: 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 |
$290.23 $329.41 $370.91 $518.35 $787.68 |
$580.46 $658.82 $741.82 $1036.70 $1575.36 |
$764.76 $843.12 $926.12 $1221.00 |
$949.06 $1027.42 $1110.42 $1405.30 |
$1133.36 $1211.72 $1294.72 $1589.60 |
$474.53 $513.71 $555.21 $702.65 |
$658.83 $698.01 $739.51 $886.95 |
$843.13 $882.31 $923.81 $1071.25 |
$184.30 |
Plan: (HMO) Aurora HMO 3500 HDHP Featuring the AboutHealth NetworkSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-711-1444 - Provider Directory for This Plan: (WPS Health Plan, Inc.)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$293.08 $332.65 $374.56 $523.44 $795.42 |
$586.16 $665.30 $749.12 $1046.88 $1590.84 |
$772.27 $851.41 $935.23 $1232.99 |
$958.38 $1037.52 $1121.34 $1419.10 |
$1144.49 $1223.63 $1307.45 $1605.21 |
$479.19 $518.76 $560.67 $709.55 |
$665.30 $704.87 $746.78 $895.66 |
$851.41 $890.98 $932.89 $1081.77 |
$186.11 |
Plan: (HMO) Aurora HMO 2600 HDHP Featuring the AboutHealth NetworkSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-711-1444 - Provider Directory for This Plan: (WPS Health Plan, Inc.)
Deductible: Individual:
$2,600
: Family:
$5,200 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$296.21 $336.20 $378.56 $529.03 $803.91 |
$592.42 $672.40 $757.12 $1058.06 $1607.82 |
$780.51 $860.49 $945.21 $1246.15 |
$968.60 $1048.58 $1133.30 $1434.24 |
$1156.69 $1236.67 $1321.39 $1622.33 |
$484.30 $524.29 $566.65 $717.12 |
$672.39 $712.38 $754.74 $905.21 |
$860.48 $900.47 $942.83 $1093.30 |
$188.09 |
Plan: (HMO) Aurora HMO 6450 HDHP Featuring the AboutHealth NetworkSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-711-1444 - Provider Directory for This Plan: (WPS Health Plan, Inc.)
Deductible: 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 |
$229.59 $260.58 $293.42 $410.05 $623.11 |
$459.18 $521.16 $586.84 $820.10 $1246.22 |
$604.97 $666.95 $732.63 $965.89 |
$750.76 $812.74 $878.42 $1111.68 |
$896.55 $958.53 $1024.21 $1257.47 |
$375.38 $406.37 $439.21 $555.84 |
$521.17 $552.16 $585.00 $701.63 |
$666.96 $697.95 $730.79 $847.42 |
$145.79 |
Plan: (HMO) Aurora HMO 5500 HDHP Featuring the AboutHealth NetworkSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-711-1444 - Provider Directory for This Plan: (WPS Health Plan, Inc.)
Deductible: 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 |
Bronze | 21 30 40 50 60 |
$233.46 $264.98 $298.36 $416.96 $633.61 |
$466.92 $529.96 $596.72 $833.92 $1267.22 |
$615.17 $678.21 $744.97 $982.17 |
$763.42 $826.46 $893.22 $1130.42 |
$911.67 $974.71 $1041.47 $1278.67 |
$381.71 $413.23 $446.61 $565.21 |
$529.96 $561.48 $594.86 $713.46 |
$678.21 $709.73 $743.11 $861.71 |
$148.25 |
Plan: (HMO) Aurora HMO 6850 Catastrophic Featuring the AboutHealth NetworkSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-711-1444 - Provider Directory for This Plan: (WPS Health Plan, Inc.)
Deductible: 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 |
$198.06 $224.80 $253.12 $353.74 $537.53 |
$396.12 $449.60 $506.24 $707.48 $1075.06 |
$521.89 $575.37 $632.01 $833.25 |
$647.66 $701.14 $757.78 $959.02 |
$773.43 $826.91 $883.55 $1084.79 |
$323.83 $350.57 $378.89 $479.51 |
$449.60 $476.34 $504.66 $605.28 |
$575.37 $602.11 $630.43 $731.05 |
$125.77 |
Plan: (HMO) Aurora HMO 5000 Featuring the AboutHealth NetworkSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-711-1444 - Provider Directory for This Plan: (WPS Health Plan, Inc.)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$288.73 $327.71 $369.00 $515.67 $783.61 |
$577.46 $655.42 $738.00 $1031.34 $1567.22 |
$760.80 $838.76 $921.34 $1214.68 |
$944.14 $1022.10 $1104.68 $1398.02 |
$1127.48 $1205.44 $1288.02 $1581.36 |
$472.07 $511.05 $552.34 $699.01 |
$655.41 $694.39 $735.68 $882.35 |
$838.75 $877.73 $919.02 $1065.69 |
$183.34 |
Plan: (HMO) Aurora HMO 6000 Featuring the AboutHealth NetworkSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-711-1444 - Provider Directory for This Plan: (WPS Health Plan, Inc.)
Deductible: 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 |
$287.10 $325.86 $366.91 $512.76 $779.19 |
$574.20 $651.72 $733.82 $1025.52 $1558.38 |
$756.51 $834.03 $916.13 $1207.83 |
$938.82 $1016.34 $1098.44 $1390.14 |
$1121.13 $1198.65 $1280.75 $1572.45 |
$469.41 $508.17 $549.22 $695.07 |
$651.72 $690.48 $731.53 $877.38 |
$834.03 $872.79 $913.84 $1059.69 |
$182.31 |
Plan: (HMO) Aurora HMO 6850 Featuring the AboutHealth NetworkSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-711-1444 - Provider Directory for This Plan: (WPS Health Plan, Inc.)
Deductible: 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 |
$282.44 $320.57 $360.96 $504.44 $766.54 |
$564.88 $641.14 $721.92 $1008.88 $1533.08 |
$744.23 $820.49 $901.27 $1188.23 |
$923.58 $999.84 $1080.62 $1367.58 |
$1102.93 $1179.19 $1259.97 $1546.93 |
$461.79 $499.92 $540.31 $683.79 |
$641.14 $679.27 $719.66 $863.14 |
$820.49 $858.62 $899.01 $1042.49 |
$179.35 |
Plan: (POS) Aurora 4000 Featuring the AboutHealth NetworkSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-711-1444 - Provider Directory for This Plan: (WPS Health Plan, Inc.)
Deductible: 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 |
$319.28 $362.38 $408.04 $570.23 $866.53 |
$638.56 $724.76 $816.08 $1140.46 $1733.06 |
$841.30 $927.50 $1018.82 $1343.20 |
$1044.04 $1130.24 $1221.56 $1545.94 |
$1246.78 $1332.98 $1424.30 $1748.68 |
$522.02 $565.12 $610.78 $772.97 |
$724.76 $767.86 $813.52 $975.71 |
$927.50 $970.60 $1016.26 $1178.45 |
$202.74 |
Plan: (POS) Aurora 2600 HDHP Featuring the AboutHealth NetworkSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-711-1444 - Provider Directory for This Plan: (WPS Health Plan, Inc.)
Deductible: Individual:
$2,600
: Family:
$5,200 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$325.86 $369.85 $416.45 $581.99 $884.38 |
$651.72 $739.70 $832.90 $1163.98 $1768.76 |
$858.64 $946.62 $1039.82 $1370.90 |
$1065.56 $1153.54 $1246.74 $1577.82 |
$1272.48 $1360.46 $1453.66 $1784.74 |
$532.78 $576.77 $623.37 $788.91 |
$739.70 $783.69 $830.29 $995.83 |
$946.62 $990.61 $1037.21 $1202.75 |
$206.92 |
Plan: (POS) Aurora 5500 HDHP Featuring the AboutHealth NetworkSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-711-1444 - Provider Directory for This Plan: (WPS Health Plan, Inc.)
Deductible: 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 |
Bronze | 21 30 40 50 60 |
$256.83 $291.50 $328.23 $458.70 $697.04 |
$513.66 $583.00 $656.46 $917.40 $1394.08 |
$676.75 $746.09 $819.55 $1080.49 |
$839.84 $909.18 $982.64 $1243.58 |
$1002.93 $1072.27 $1145.73 $1406.67 |
$419.92 $454.59 $491.32 $621.79 |
$583.01 $617.68 $654.41 $784.88 |
$746.10 $780.77 $817.50 $947.97 |
$163.09 |
Plan: (POS) Aurora 6850 Featuring the AboutHealth NetworkSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-711-1444 - Provider Directory for This Plan: (WPS Health Plan, Inc.)
Deductible: 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 |
$310.72 $352.67 $397.10 $554.95 $843.29 |
$621.44 $705.34 $794.20 $1109.90 $1686.58 |
$818.75 $902.65 $991.51 $1307.21 |
$1016.06 $1099.96 $1188.82 $1504.52 |
$1213.37 $1297.27 $1386.13 $1701.83 |
$508.03 $549.98 $594.41 $752.26 |
$705.34 $747.29 $791.72 $949.57 |
$902.65 $944.60 $989.03 $1146.88 |
$197.31 |
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||||||||||
Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 TTY: 1-855-643-5001 |
||||||||||
Plan: (PPO) Envision Aurora Bellin PPO - Gold 600/80Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$600
: Family:
$1,200 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$302.47 $343.29 $386.54 $540.19 $820.88 |
$604.94 $686.58 $773.08 $1080.38 $1641.76 |
$797.00 $878.64 $965.14 $1272.44 |
$989.06 $1070.70 $1157.20 $1464.50 |
$1181.12 $1262.76 $1349.26 $1656.56 |
$494.53 $535.35 $578.60 $732.25 |
$686.59 $727.41 $770.66 $924.31 |
$878.65 $919.47 $962.72 $1116.37 |
$192.06 |
Plan: (PPO) Envision Aurora Bellin PPO - Gold 1000/90Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$1,000
: Family:
$2,000 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 |
$321.20 $364.56 $410.49 $573.65 $871.72 |
$642.40 $729.12 $820.98 $1147.30 $1743.44 |
$846.36 $933.08 $1024.94 $1351.26 |
$1050.32 $1137.04 $1228.90 $1555.22 |
$1254.28 $1341.00 $1432.86 $1759.18 |
$525.16 $568.52 $614.45 $777.61 |
$729.12 $772.48 $818.41 $981.57 |
$933.08 $976.44 $1022.37 $1185.53 |
$203.96 |
Plan: (PPO) Envision Aurora Bellin PPO - Silver 3600/80Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$3,600
: Family:
$7,200 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$251.76 $285.73 $321.73 $449.62 $683.24 |
$503.52 $571.46 $643.46 $899.24 $1366.48 |
$663.38 $731.32 $803.32 $1059.10 |
$823.24 $891.18 $963.18 $1218.96 |
$983.10 $1051.04 $1123.04 $1378.82 |
$411.62 $445.59 $481.59 $609.48 |
$571.48 $605.45 $641.45 $769.34 |
$731.34 $765.31 $801.31 $929.20 |
$159.86 |
Plan: (PPO) Envision Aurora Bellin PPO - Silver 2400/80/Copay35Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$2,400
: Family:
$4,800 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 |
$267.92 $304.08 $342.39 $478.49 $727.11 |
$535.84 $608.16 $684.78 $956.98 $1454.22 |
$705.96 $778.28 $854.90 $1127.10 |
$876.08 $948.40 $1025.02 $1297.22 |
$1046.20 $1118.52 $1195.14 $1467.34 |
$438.04 $474.20 $512.51 $648.61 |
$608.16 $644.32 $682.63 $818.73 |
$778.28 $814.44 $852.75 $988.85 |
$170.12 |
Plan: (PPO) Envision Aurora Bellin PPO - Silver 2400/80Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$2,400
: Family:
$4,800 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 |
$253.82 $288.08 $324.38 $453.31 $688.85 |
$507.64 $576.16 $648.76 $906.62 $1377.70 |
$668.81 $737.33 $809.93 $1067.79 |
$829.98 $898.50 $971.10 $1228.96 |
$991.15 $1059.67 $1132.27 $1390.13 |
$414.99 $449.25 $485.55 $614.48 |
$576.16 $610.42 $646.72 $775.65 |
$737.33 $771.59 $807.89 $936.82 |
$161.17 |
Plan: (PPO) Envision Aurora Bellin PPO - Silver 1800/80Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$1,800
: Family:
$3,600 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 |
$262.09 $297.46 $334.93 $468.07 $711.28 |
$524.18 $594.92 $669.86 $936.14 $1422.56 |
$690.60 $761.34 $836.28 $1102.56 |
$857.02 $927.76 $1002.70 $1268.98 |
$1023.44 $1094.18 $1169.12 $1435.40 |
$428.51 $463.88 $501.35 $634.49 |
$594.93 $630.30 $667.77 $800.91 |
$761.35 $796.72 $834.19 $967.33 |
$166.42 |
Plan: (PPO) Envision Aurora Bellin PPO - Catastrophic 6850/100Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$6,850
: Family:
$13,700 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Catastrophic | 21 30 40 50 60 |
$166.30 $188.74 $212.52 $296.99 $451.31 |
$332.60 $377.48 $425.04 $593.98 $902.62 |
$438.19 $483.07 $530.63 $699.57 |
$543.78 $588.66 $636.22 $805.16 |
$649.37 $694.25 $741.81 $910.75 |
$271.89 $294.33 $318.11 $402.58 |
$377.48 $399.92 $423.70 $508.17 |
$483.07 $505.51 $529.29 $613.76 |
$105.59 |
Plan: (PPO) Envision Aurora Bellin PPO - Bronze 6850/100Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: 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 |
$196.18 $222.65 $250.71 $350.36 $532.41 |
$392.36 $445.30 $501.42 $700.72 $1064.82 |
$516.93 $569.87 $625.99 $825.29 |
$641.50 $694.44 $750.56 $949.86 |
$766.07 $819.01 $875.13 $1074.43 |
$320.75 $347.22 $375.28 $474.93 |
$445.32 $471.79 $499.85 $599.50 |
$569.89 $596.36 $624.42 $724.07 |
$124.57 |
Plan: (PPO) Envision Aurora Bellin PPO - HSA Silver 3000/80Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: 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 |
Silver | 21 30 40 50 60 |
$250.26 $284.04 $319.83 $446.95 $679.19 |
$500.52 $568.08 $639.66 $893.90 $1358.38 |
$659.43 $726.99 $798.57 $1052.81 |
$818.34 $885.90 $957.48 $1211.72 |
$977.25 $1044.81 $1116.39 $1370.63 |
$409.17 $442.95 $478.74 $605.86 |
$568.08 $601.86 $637.65 $764.77 |
$726.99 $760.77 $796.56 $923.68 |
$158.91 |
Plan: (PPO) Envision Aurora Bellin PPO - HSA Bronze 5650/90Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$5,650
: Family:
$11,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$203.86 $231.37 $260.52 $364.07 $553.24 |
$407.72 $462.74 $521.04 $728.14 $1106.48 |
$537.16 $592.18 $650.48 $857.58 |
$666.60 $721.62 $779.92 $987.02 |
$796.04 $851.06 $909.36 $1116.46 |
$333.30 $360.81 $389.96 $493.51 |
$462.74 $490.25 $519.40 $622.95 |
$592.18 $619.69 $648.84 $752.39 |
$129.44 |
†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 Fond Du Lac County here.