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 Rock County, Wisconsin.
Obamacare Providers, Plans and 2016 Rates for Rock County
Rock County is in “Rating Area 14” of Wisconsin.
Currently, there are 8 providers offering 166 plans to Rating Area 14. †
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 Beloit, WI area accept this insurance coverage as within the plan's "network".
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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 |
$392.13 $445.06 $501.14 $700.34 $1064.23 |
$784.26 $890.12 $1002.28 $1400.68 $2128.46 |
$1033.26 $1139.12 $1251.28 $1649.68 |
$1282.26 $1388.12 $1500.28 $1898.68 |
$1531.26 $1637.12 $1749.28 $2147.68 |
$641.13 $694.06 $750.14 $949.34 |
$890.13 $943.06 $999.14 $1198.34 |
$1139.13 $1192.06 $1248.14 $1447.34 |
$249.00 |
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 |
$438.85 $498.09 $560.84 $783.78 $1191.03 |
$877.70 $996.18 $1121.68 $1567.56 $2382.06 |
$1156.37 $1274.85 $1400.35 $1846.23 |
$1435.04 $1553.52 $1679.02 $2124.90 |
$1713.71 $1832.19 $1957.69 $2403.57 |
$717.52 $776.76 $839.51 $1062.45 |
$996.19 $1055.43 $1118.18 $1341.12 |
$1274.86 $1334.10 $1396.85 $1619.79 |
$278.67 |
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 |
$335.12 $380.35 $428.28 $598.51 $909.50 |
$670.24 $760.70 $856.56 $1197.02 $1819.00 |
$883.04 $973.50 $1069.36 $1409.82 |
$1095.84 $1186.30 $1282.16 $1622.62 |
$1308.64 $1399.10 $1494.96 $1835.42 |
$547.92 $593.15 $641.08 $811.31 |
$760.72 $805.95 $853.88 $1024.11 |
$973.52 $1018.75 $1066.68 $1236.91 |
$212.80 |
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 |
$353.51 $401.23 $451.78 $631.36 $959.41 |
$707.02 $802.46 $903.56 $1262.72 $1918.82 |
$931.50 $1026.94 $1128.04 $1487.20 |
$1155.98 $1251.42 $1352.52 $1711.68 |
$1380.46 $1475.90 $1577.00 $1936.16 |
$577.99 $625.71 $676.26 $855.84 |
$802.47 $850.19 $900.74 $1080.32 |
$1026.95 $1074.67 $1125.22 $1304.80 |
$224.48 |
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 |
$279.44 $317.16 $357.11 $499.07 $758.38 |
$558.88 $634.32 $714.22 $998.14 $1516.76 |
$736.32 $811.76 $891.66 $1175.58 |
$913.76 $989.20 $1069.10 $1353.02 |
$1091.20 $1166.64 $1246.54 $1530.46 |
$456.88 $494.60 $534.55 $676.51 |
$634.32 $672.04 $711.99 $853.95 |
$811.76 $849.48 $889.43 $1031.39 |
$177.44 |
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 |
$296.44 $336.46 $378.85 $529.44 $804.54 |
$592.88 $672.92 $757.70 $1058.88 $1609.08 |
$781.12 $861.16 $945.94 $1247.12 |
$969.36 $1049.40 $1134.18 $1435.36 |
$1157.60 $1237.64 $1322.42 $1623.60 |
$484.68 $524.70 $567.09 $717.68 |
$672.92 $712.94 $755.33 $905.92 |
$861.16 $901.18 $943.57 $1094.16 |
$188.24 |
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 |
$274.21 $311.23 $350.44 $489.73 $744.20 |
$548.42 $622.46 $700.88 $979.46 $1488.40 |
$722.54 $796.58 $875.00 $1153.58 |
$896.66 $970.70 $1049.12 $1327.70 |
$1070.78 $1144.82 $1223.24 $1501.82 |
$448.33 $485.35 $524.56 $663.85 |
$622.45 $659.47 $698.68 $837.97 |
$796.57 $833.59 $872.80 $1012.09 |
$174.12 |
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 |
$259.51 $294.54 $331.65 $463.48 $704.30 |
$519.02 $589.08 $663.30 $926.96 $1408.60 |
$683.81 $753.87 $828.09 $1091.75 |
$848.60 $918.66 $992.88 $1256.54 |
$1013.39 $1083.45 $1157.67 $1421.33 |
$424.30 $459.33 $496.44 $628.27 |
$589.09 $624.12 $661.23 $793.06 |
$753.88 $788.91 $826.02 $957.85 |
$164.79 |
Plan: (HMO) Unity Beloit One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$319.86 $363.04 $408.78 $571.26 $868.09 |
$639.72 $726.08 $817.56 $1142.52 $1736.18 |
$842.83 $929.19 $1020.67 $1345.63 |
$1045.94 $1132.30 $1223.78 $1548.74 |
$1249.05 $1335.41 $1426.89 $1751.85 |
$522.97 $566.15 $611.89 $774.37 |
$726.08 $769.26 $815.00 $977.48 |
$929.19 $972.37 $1018.11 $1180.59 |
$203.11 |
Plan: (HMO) Unity Beloit One 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 |
$273.36 $310.25 $349.34 $488.20 $741.87 |
$546.72 $620.50 $698.68 $976.40 $1483.74 |
$720.30 $794.08 $872.26 $1149.98 |
$893.88 $967.66 $1045.84 $1323.56 |
$1067.46 $1141.24 $1219.42 $1497.14 |
$446.94 $483.83 $522.92 $661.78 |
$620.52 $657.41 $696.50 $835.36 |
$794.10 $830.99 $870.08 $1008.94 |
$173.58 |
Plan: (HMO) Unity Beloit One 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 |
$223.67 $253.86 $285.85 $399.47 $607.04 |
$447.34 $507.72 $571.70 $798.94 $1214.08 |
$589.37 $649.75 $713.73 $940.97 |
$731.40 $791.78 $855.76 $1083.00 |
$873.43 $933.81 $997.79 $1225.03 |
$365.70 $395.89 $427.88 $541.50 |
$507.73 $537.92 $569.91 $683.53 |
$649.76 $679.95 $711.94 $825.56 |
$142.03 |
Plan: (HMO) Unity Beloit One 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 |
$211.68 $240.25 $270.52 $378.06 $574.49 |
$423.36 $480.50 $541.04 $756.12 $1148.98 |
$557.77 $614.91 $675.45 $890.53 |
$692.18 $749.32 $809.86 $1024.94 |
$826.59 $883.73 $944.27 $1159.35 |
$346.09 $374.66 $404.93 $512.47 |
$480.50 $509.07 $539.34 $646.88 |
$614.91 $643.48 $673.75 $781.29 |
$134.41 |
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 |
$302.95 $343.84 $387.16 $541.06 $822.19 |
$605.90 $687.68 $774.32 $1082.12 $1644.38 |
$798.27 $880.05 $966.69 $1274.49 |
$990.64 $1072.42 $1159.06 $1466.86 |
$1183.01 $1264.79 $1351.43 $1659.23 |
$495.32 $536.21 $579.53 $733.43 |
$687.69 $728.58 $771.90 $925.80 |
$880.06 $920.95 $964.27 $1118.17 |
$192.37 |
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 |
$412.52 $468.20 $527.19 $736.75 $1119.57 |
$825.04 $936.40 $1054.38 $1473.50 $2239.14 |
$1086.99 $1198.35 $1316.33 $1735.45 |
$1348.94 $1460.30 $1578.28 $1997.40 |
$1610.89 $1722.25 $1840.23 $2259.35 |
$674.47 $730.15 $789.14 $998.70 |
$936.42 $992.10 $1051.09 $1260.65 |
$1198.37 $1254.05 $1313.04 $1522.60 |
$261.95 |
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 |
$257.21 $291.92 $328.70 $459.36 $698.04 |
$514.42 $583.84 $657.40 $918.72 $1396.08 |
$677.74 $747.16 $820.72 $1082.04 |
$841.06 $910.48 $984.04 $1245.36 |
$1004.38 $1073.80 $1147.36 $1408.68 |
$420.53 $455.24 $492.02 $622.68 |
$583.85 $618.56 $655.34 $786.00 |
$747.17 $781.88 $818.66 $949.32 |
$163.32 |
Plan: (HMO) Unity Beloit One 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 |
$336.49 $381.91 $430.03 $600.96 $913.22 |
$672.98 $763.82 $860.06 $1201.92 $1826.44 |
$886.65 $977.49 $1073.73 $1415.59 |
$1100.32 $1191.16 $1287.40 $1629.26 |
$1313.99 $1404.83 $1501.07 $1842.93 |
$550.16 $595.58 $643.70 $814.63 |
$763.83 $809.25 $857.37 $1028.30 |
$977.50 $1022.92 $1071.04 $1241.97 |
$213.67 |
Plan: (HMO) Unity Beloit One 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 |
$209.80 $238.12 $268.12 $374.70 $569.39 |
$419.60 $476.24 $536.24 $749.40 $1138.78 |
$552.82 $609.46 $669.46 $882.62 |
$686.04 $742.68 $802.68 $1015.84 |
$819.26 $875.90 $935.90 $1149.06 |
$343.02 $371.34 $401.34 $507.92 |
$476.24 $504.56 $534.56 $641.14 |
$609.46 $637.78 $667.78 $774.36 |
$133.22 |
Plan: (HMO) Unity Beloit One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$357.97 $406.29 $457.48 $639.32 $971.51 |
$715.94 $812.58 $914.96 $1278.64 $1943.02 |
$943.25 $1039.89 $1142.27 $1505.95 |
$1170.56 $1267.20 $1369.58 $1733.26 |
$1397.87 $1494.51 $1596.89 $1960.57 |
$585.28 $633.60 $684.79 $866.63 |
$812.59 $860.91 $912.10 $1093.94 |
$1039.90 $1088.22 $1139.41 $1321.25 |
$227.31 |
Plan: (HMO) Unity Beloit One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$288.36 $327.28 $368.51 $514.99 $782.58 |
$576.72 $654.56 $737.02 $1029.98 $1565.16 |
$759.82 $837.66 $920.12 $1213.08 |
$942.92 $1020.76 $1103.22 $1396.18 |
$1126.02 $1203.86 $1286.32 $1579.28 |
$471.46 $510.38 $551.61 $698.09 |
$654.56 $693.48 $734.71 $881.19 |
$837.66 $876.58 $917.81 $1064.29 |
$183.10 |
Plan: (HMO) Unity Beloit One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$227.94 $258.70 $291.30 $407.08 $618.60 |
$455.88 $517.40 $582.60 $814.16 $1237.20 |
$600.62 $662.14 $727.34 $958.90 |
$745.36 $806.88 $872.08 $1103.64 |
$890.10 $951.62 $1016.82 $1248.38 |
$372.68 $403.44 $436.04 $551.82 |
$517.42 $548.18 $580.78 $696.56 |
$662.16 $692.92 $725.52 $841.30 |
$144.74 |
Plan: (HMO) Unity Beloit One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$247.11 $280.47 $315.81 $441.34 $670.66 |
$494.22 $560.94 $631.62 $882.68 $1341.32 |
$651.13 $717.85 $788.53 $1039.59 |
$808.04 $874.76 $945.44 $1196.50 |
$964.95 $1031.67 $1102.35 $1353.41 |
$404.02 $437.38 $472.72 $598.25 |
$560.93 $594.29 $629.63 $755.16 |
$717.84 $751.20 $786.54 $912.07 |
$156.91 |
Plan: (HMO) Unity Beloit One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$241.81 $274.45 $309.02 $431.86 $656.25 |
$483.62 $548.90 $618.04 $863.72 $1312.50 |
$637.17 $702.45 $771.59 $1017.27 |
$790.72 $856.00 $925.14 $1170.82 |
$944.27 $1009.55 $1078.69 $1324.37 |
$395.36 $428.00 $462.57 $585.41 |
$548.91 $581.55 $616.12 $738.96 |
$702.46 $735.10 $769.67 $892.51 |
$153.55 |
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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$366.36 $415.81 $468.20 $654.31 $994.28 |
$732.72 $831.62 $936.40 $1308.62 $1988.56 |
$965.35 $1064.25 $1169.03 $1541.25 |
$1197.98 $1296.88 $1401.66 $1773.88 |
$1430.61 $1529.51 $1634.29 $2006.51 |
$598.99 $648.44 $700.83 $886.94 |
$831.62 $881.07 $933.46 $1119.57 |
$1064.25 $1113.70 $1166.09 $1352.20 |
$232.63 |
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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$410.00 $465.35 $523.98 $732.26 $1112.74 |
$820.00 $930.70 $1047.96 $1464.52 $2225.48 |
$1080.35 $1191.05 $1308.31 $1724.87 |
$1340.70 $1451.40 $1568.66 $1985.22 |
$1601.05 $1711.75 $1829.01 $2245.57 |
$670.35 $725.70 $784.33 $992.61 |
$930.70 $986.05 $1044.68 $1252.96 |
$1191.05 $1246.40 $1305.03 $1513.31 |
$260.35 |
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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$313.09 $355.35 $400.12 $559.17 $849.72 |
$626.18 $710.70 $800.24 $1118.34 $1699.44 |
$824.99 $909.51 $999.05 $1317.15 |
$1023.80 $1108.32 $1197.86 $1515.96 |
$1222.61 $1307.13 $1396.67 $1714.77 |
$511.90 $554.16 $598.93 $757.98 |
$710.71 $752.97 $797.74 $956.79 |
$909.52 $951.78 $996.55 $1155.60 |
$198.81 |
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 |
$330.27 $374.85 $422.08 $589.86 $896.35 |
$660.54 $749.70 $844.16 $1179.72 $1792.70 |
$870.26 $959.42 $1053.88 $1389.44 |
$1079.98 $1169.14 $1263.60 $1599.16 |
$1289.70 $1378.86 $1473.32 $1808.88 |
$539.99 $584.57 $631.80 $799.58 |
$749.71 $794.29 $841.52 $1009.30 |
$959.43 $1004.01 $1051.24 $1219.02 |
$209.72 |
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 |
$261.07 $296.31 $333.64 $466.26 $708.53 |
$522.14 $592.62 $667.28 $932.52 $1417.06 |
$687.92 $758.40 $833.06 $1098.30 |
$853.70 $924.18 $998.84 $1264.08 |
$1019.48 $1089.96 $1164.62 $1429.86 |
$426.85 $462.09 $499.42 $632.04 |
$592.63 $627.87 $665.20 $797.82 |
$758.41 $793.65 $830.98 $963.60 |
$165.78 |
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 |
$276.96 $314.34 $353.95 $494.64 $751.65 |
$553.92 $628.68 $707.90 $989.28 $1503.30 |
$729.79 $804.55 $883.77 $1165.15 |
$905.66 $980.42 $1059.64 $1341.02 |
$1081.53 $1156.29 $1235.51 $1516.89 |
$452.83 $490.21 $529.82 $670.51 |
$628.70 $666.08 $705.69 $846.38 |
$804.57 $841.95 $881.56 $1022.25 |
$175.87 |
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 |
$256.19 $290.77 $327.40 $457.54 $695.28 |
$512.38 $581.54 $654.80 $915.08 $1390.56 |
$675.06 $744.22 $817.48 $1077.76 |
$837.74 $906.90 $980.16 $1240.44 |
$1000.42 $1069.58 $1142.84 $1403.12 |
$418.87 $453.45 $490.08 $620.22 |
$581.55 $616.13 $652.76 $782.90 |
$744.23 $778.81 $815.44 $945.58 |
$162.68 |
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 |
$242.45 $275.18 $309.85 $433.01 $658.01 |
$484.90 $550.36 $619.70 $866.02 $1316.02 |
$638.85 $704.31 $773.65 $1019.97 |
$792.80 $858.26 $927.60 $1173.92 |
$946.75 $1012.21 $1081.55 $1327.87 |
$396.40 $429.13 $463.80 $586.96 |
$550.35 $583.08 $617.75 $740.91 |
$704.30 $737.03 $771.70 $894.86 |
$153.95 |
Plan: (HMO) Unity Beloit One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$298.84 $339.17 $381.91 $533.71 $811.03 |
$597.68 $678.34 $763.82 $1067.42 $1622.06 |
$787.44 $868.10 $953.58 $1257.18 |
$977.20 $1057.86 $1143.34 $1446.94 |
$1166.96 $1247.62 $1333.10 $1636.70 |
$488.60 $528.93 $571.67 $723.47 |
$678.36 $718.69 $761.43 $913.23 |
$868.12 $908.45 $951.19 $1102.99 |
$189.76 |
Plan: (HMO) Unity Beloit One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$255.39 $289.86 $326.38 $456.11 $693.11 |
$510.78 $579.72 $652.76 $912.22 $1386.22 |
$672.95 $741.89 $814.93 $1074.39 |
$835.12 $904.06 $977.10 $1236.56 |
$997.29 $1066.23 $1139.27 $1398.73 |
$417.56 $452.03 $488.55 $618.28 |
$579.73 $614.20 $650.72 $780.45 |
$741.90 $776.37 $812.89 $942.62 |
$162.17 |
Plan: (HMO) Unity Beloit One 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 |
$208.97 $237.18 $267.06 $373.22 $567.14 |
$417.94 $474.36 $534.12 $746.44 $1134.28 |
$550.63 $607.05 $666.81 $879.13 |
$683.32 $739.74 $799.50 $1011.82 |
$816.01 $872.43 $932.19 $1144.51 |
$341.66 $369.87 $399.75 $505.91 |
$474.35 $502.56 $532.44 $638.60 |
$607.04 $635.25 $665.13 $771.29 |
$132.69 |
Plan: (HMO) Unity Beloit One 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 |
$197.77 $224.46 $252.74 $353.21 $536.73 |
$395.54 $448.92 $505.48 $706.42 $1073.46 |
$521.12 $574.50 $631.06 $832.00 |
$646.70 $700.08 $756.64 $957.58 |
$772.28 $825.66 $882.22 $1083.16 |
$323.35 $350.04 $378.32 $478.79 |
$448.93 $475.62 $503.90 $604.37 |
$574.51 $601.20 $629.48 $729.95 |
$125.58 |
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 |
$283.04 $321.24 $361.71 $505.50 $768.15 |
$566.08 $642.48 $723.42 $1011.00 $1536.30 |
$745.81 $822.21 $903.15 $1190.73 |
$925.54 $1001.94 $1082.88 $1370.46 |
$1105.27 $1181.67 $1262.61 $1550.19 |
$462.77 $500.97 $541.44 $685.23 |
$642.50 $680.70 $721.17 $864.96 |
$822.23 $860.43 $900.90 $1044.69 |
$179.73 |
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 |
$385.41 $437.43 $492.54 $688.32 $1045.98 |
$770.82 $874.86 $985.08 $1376.64 $2091.96 |
$1015.55 $1119.59 $1229.81 $1621.37 |
$1260.28 $1364.32 $1474.54 $1866.10 |
$1505.01 $1609.05 $1719.27 $2110.83 |
$630.14 $682.16 $737.27 $933.05 |
$874.87 $926.89 $982.00 $1177.78 |
$1119.60 $1171.62 $1226.73 $1422.51 |
$244.73 |
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 |
$240.30 $272.73 $307.10 $429.17 $652.16 |
$480.60 $545.46 $614.20 $858.34 $1304.32 |
$633.19 $698.05 $766.79 $1010.93 |
$785.78 $850.64 $919.38 $1163.52 |
$938.37 $1003.23 $1071.97 $1316.11 |
$392.89 $425.32 $459.69 $581.76 |
$545.48 $577.91 $612.28 $734.35 |
$698.07 $730.50 $764.87 $886.94 |
$152.59 |
Plan: (HMO) Unity Beloit One 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 |
$314.37 $356.81 $401.76 $561.46 $853.19 |
$628.74 $713.62 $803.52 $1122.92 $1706.38 |
$828.36 $913.24 $1003.14 $1322.54 |
$1027.98 $1112.86 $1202.76 $1522.16 |
$1227.60 $1312.48 $1402.38 $1721.78 |
$513.99 $556.43 $601.38 $761.08 |
$713.61 $756.05 $801.00 $960.70 |
$913.23 $955.67 $1000.62 $1160.32 |
$199.62 |
Plan: (HMO) Unity Beloit One 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 |
$196.01 $222.47 $250.50 $350.07 $531.96 |
$392.02 $444.94 $501.00 $700.14 $1063.92 |
$516.48 $569.40 $625.46 $824.60 |
$640.94 $693.86 $749.92 $949.06 |
$765.40 $818.32 $874.38 $1073.52 |
$320.47 $346.93 $374.96 $474.53 |
$444.93 $471.39 $499.42 $598.99 |
$569.39 $595.85 $623.88 $723.45 |
$124.46 |
Plan: (HMO) Unity Beloit One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$334.44 $379.58 $427.41 $597.30 $907.65 |
$668.88 $759.16 $854.82 $1194.60 $1815.30 |
$881.25 $971.53 $1067.19 $1406.97 |
$1093.62 $1183.90 $1279.56 $1619.34 |
$1305.99 $1396.27 $1491.93 $1831.71 |
$546.81 $591.95 $639.78 $809.67 |
$759.18 $804.32 $852.15 $1022.04 |
$971.55 $1016.69 $1064.52 $1234.41 |
$212.37 |
Plan: (HMO) Unity Beloit One 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 |
$269.40 $305.77 $344.29 $481.14 $731.14 |
$538.80 $611.54 $688.58 $962.28 $1462.28 |
$709.87 $782.61 $859.65 $1133.35 |
$880.94 $953.68 $1030.72 $1304.42 |
$1052.01 $1124.75 $1201.79 $1475.49 |
$440.47 $476.84 $515.36 $652.21 |
$611.54 $647.91 $686.43 $823.28 |
$782.61 $818.98 $857.50 $994.35 |
$171.07 |
Plan: (HMO) Unity Beloit One 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 |
$212.95 $241.70 $272.15 $380.33 $577.94 |
$425.90 $483.40 $544.30 $760.66 $1155.88 |
$561.12 $618.62 $679.52 $895.88 |
$696.34 $753.84 $814.74 $1031.10 |
$831.56 $889.06 $949.96 $1166.32 |
$348.17 $376.92 $407.37 $515.55 |
$483.39 $512.14 $542.59 $650.77 |
$618.61 $647.36 $677.81 $785.99 |
$135.22 |
Plan: (HMO) Unity Beloit One 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 |
$230.87 $262.03 $295.05 $412.33 $626.57 |
$461.74 $524.06 $590.10 $824.66 $1253.14 |
$608.34 $670.66 $736.70 $971.26 |
$754.94 $817.26 $883.30 $1117.86 |
$901.54 $963.86 $1029.90 $1264.46 |
$377.47 $408.63 $441.65 $558.93 |
$524.07 $555.23 $588.25 $705.53 |
$670.67 $701.83 $734.85 $852.13 |
$146.60 |
Plan: (HMO) Unity Beloit One 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 |
$225.91 $256.41 $288.71 $403.47 $613.12 |
$451.82 $512.82 $577.42 $806.94 $1226.24 |
$595.27 $656.27 $720.87 $950.39 |
$738.72 $799.72 $864.32 $1093.84 |
$882.17 $943.17 $1007.77 $1237.29 |
$369.36 $399.86 $432.16 $546.92 |
$512.81 $543.31 $575.61 $690.37 |
$656.26 $686.76 $719.06 $833.82 |
$143.45 |
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 |
$322.76 $366.33 $412.48 $576.44 $875.95 |
$645.52 $732.66 $824.96 $1152.88 $1751.90 |
$850.47 $937.61 $1029.91 $1357.83 |
$1055.42 $1142.56 $1234.86 $1562.78 |
$1260.37 $1347.51 $1439.81 $1767.73 |
$527.71 $571.28 $617.43 $781.39 |
$732.66 $776.23 $822.38 $986.34 |
$937.61 $981.18 $1027.33 $1191.29 |
$204.95 |
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 |
$269.78 $306.20 $344.77 $481.82 $732.17 |
$539.56 $612.40 $689.54 $963.64 $1464.34 |
$710.87 $783.71 $860.85 $1134.95 |
$882.18 $955.02 $1032.16 $1306.26 |
$1053.49 $1126.33 $1203.47 $1477.57 |
$441.09 $477.51 $516.08 $653.13 |
$612.40 $648.82 $687.39 $824.44 |
$783.71 $820.13 $858.70 $995.75 |
$171.31 |
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 |
$204.65 $232.27 $261.53 $365.49 $555.39 |
$409.30 $464.54 $523.06 $730.98 $1110.78 |
$539.25 $594.49 $653.01 $860.93 |
$669.20 $724.44 $782.96 $990.88 |
$799.15 $854.39 $912.91 $1120.83 |
$334.60 $362.22 $391.48 $495.44 |
$464.55 $492.17 $521.43 $625.39 |
$594.50 $622.12 $651.38 $755.34 |
$129.95 |
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 |
$164.64 $186.86 $210.40 $294.03 $446.81 |
$329.28 $373.72 $420.80 $588.06 $893.62 |
$433.82 $478.26 $525.34 $692.60 |
$538.36 $582.80 $629.88 $797.14 |
$642.90 $687.34 $734.42 $901.68 |
$269.18 $291.40 $314.94 $398.57 |
$373.72 $395.94 $419.48 $503.11 |
$478.26 $500.48 $524.02 $607.65 |
++ |
Plan: (HMO) Unity Beloit One 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 |
$220.06 $249.76 $281.23 $393.02 $597.23 |
$440.12 $499.52 $562.46 $786.04 $1194.46 |
$579.85 $639.25 $702.19 $925.77 |
$719.58 $778.98 $841.92 $1065.50 |
$859.31 $918.71 $981.65 $1205.23 |
$359.79 $389.49 $420.96 $532.75 |
$499.52 $529.22 $560.69 $672.48 |
$639.25 $668.95 $700.42 $812.21 |
$139.73 |
Plan: (HMO) Unity Beloit One 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 |
$166.93 $189.46 $213.33 $298.13 $453.03 |
$333.86 $378.92 $426.66 $596.26 $906.06 |
$439.86 $484.92 $532.66 $702.26 |
$545.86 $590.92 $638.66 $808.26 |
$651.86 $696.92 $744.66 $914.26 |
$272.93 $295.46 $319.33 $404.13 |
$378.93 $401.46 $425.33 $510.13 |
$484.93 $507.46 $531.33 $616.13 |
$106.00 |
Plan: (HMO) Unity Beloit One 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 |
$134.29 $152.42 $171.62 $239.84 $364.46 |
$268.58 $304.84 $343.24 $479.68 $728.92 |
$353.85 $390.11 $428.51 $564.95 |
$439.12 $475.38 $513.78 $650.22 |
$524.39 $560.65 $599.05 $735.49 |
$219.56 $237.69 $256.89 $325.11 |
$304.83 $322.96 $342.16 $410.38 |
$390.10 $408.23 $427.43 $495.65 |
++ |
Plan: (HMO) Unity Beloit One 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 |
$263.27 $298.81 $336.46 $470.20 $714.51 |
$526.54 $597.62 $672.92 $940.40 $1429.02 |
$693.72 $764.80 $840.10 $1107.58 |
$860.90 $931.98 $1007.28 $1274.76 |
$1028.08 $1099.16 $1174.46 $1441.94 |
$430.45 $465.99 $503.64 $637.38 |
$597.63 $633.17 $670.82 $804.56 |
$764.81 $800.35 $838.00 $971.74 |
$167.18 |
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 |
Plan: (EPO) Dean Focus Network 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 |
$176.95 $200.84 $226.14 $316.04 $480.25 |
$353.90 $401.68 $452.28 $632.08 $960.50 |
$466.26 $514.04 $564.64 $744.44 |
$578.62 $626.40 $677.00 $856.80 |
$690.98 $738.76 $789.36 $969.16 |
$289.31 $313.20 $338.50 $428.40 |
$401.67 $425.56 $450.86 $540.76 |
$514.03 $537.92 $563.22 $653.12 |
$112.36 |
Plan: (EPO) Dean Focus Network 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 |
$161.99 $183.86 $207.03 $289.32 $439.65 |
$323.98 $367.72 $414.06 $578.64 $879.30 |
$426.84 $470.58 $516.92 $681.50 |
$529.70 $573.44 $619.78 $784.36 |
$632.56 $676.30 $722.64 $887.22 |
$264.85 $286.72 $309.89 $392.18 |
$367.71 $389.58 $412.75 $495.04 |
$470.57 $492.44 $515.61 $597.90 |
$102.86 |
Plan: (EPO) Dean Focus Network 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 |
$156.78 $177.94 $200.36 $280.00 $425.50 |
$313.56 $355.88 $400.72 $560.00 $851.00 |
$413.11 $455.43 $500.27 $659.55 |
$512.66 $554.98 $599.82 $759.10 |
$612.21 $654.53 $699.37 $858.65 |
$256.33 $277.49 $299.91 $379.55 |
$355.88 $377.04 $399.46 $479.10 |
$455.43 $476.59 $499.01 $578.65 |
$99.55 |
Plan: (EPO) Dean Focus Network 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 |
$157.31 $178.54 $201.04 $280.95 $426.94 |
$314.62 $357.08 $402.08 $561.90 $853.88 |
$414.51 $456.97 $501.97 $661.79 |
$514.40 $556.86 $601.86 $761.68 |
$614.29 $656.75 $701.75 $861.57 |
$257.20 $278.43 $300.93 $380.84 |
$357.09 $378.32 $400.82 $480.73 |
$456.98 $478.21 $500.71 $580.62 |
$99.89 |
Plan: (EPO) Dean Focus Network 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 |
$150.44 $170.75 $192.26 $268.69 $408.30 |
$300.88 $341.50 $384.52 $537.38 $816.60 |
$396.41 $437.03 $480.05 $632.91 |
$491.94 $532.56 $575.58 $728.44 |
$587.47 $628.09 $671.11 $823.97 |
$245.97 $266.28 $287.79 $364.22 |
$341.50 $361.81 $383.32 $459.75 |
$437.03 $457.34 $478.85 $555.28 |
$95.53 |
Plan: (EPO) Dean Focus Network 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 |
$199.03 $225.89 $254.36 $355.46 $540.16 |
$398.06 $451.78 $508.72 $710.92 $1080.32 |
$524.44 $578.16 $635.10 $837.30 |
$650.82 $704.54 $761.48 $963.68 |
$777.20 $830.92 $887.86 $1090.06 |
$325.41 $352.27 $380.74 $481.84 |
$451.79 $478.65 $507.12 $608.22 |
$578.17 $605.03 $633.50 $734.60 |
$126.38 |
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 |
$383.77 $435.57 $490.45 $685.40 $1041.53 |
$767.54 $871.14 $980.90 $1370.80 $2083.06 |
$1011.23 $1114.83 $1224.59 $1614.49 |
$1254.92 $1358.52 $1468.28 $1858.18 |
$1498.61 $1602.21 $1711.97 $2101.87 |
$627.46 $679.26 $734.14 $929.09 |
$871.15 $922.95 $977.83 $1172.78 |
$1114.84 $1166.64 $1221.52 $1416.47 |
$243.69 |
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 |
$382.13 $433.71 $488.35 $682.47 $1037.08 |
$764.26 $867.42 $976.70 $1364.94 $2074.16 |
$1006.91 $1110.07 $1219.35 $1607.59 |
$1249.56 $1352.72 $1462.00 $1850.24 |
$1492.21 $1595.37 $1704.65 $2092.89 |
$624.78 $676.36 $731.00 $925.12 |
$867.43 $919.01 $973.65 $1167.77 |
$1110.08 $1161.66 $1216.30 $1410.42 |
$242.65 |
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 |
$318.72 $361.73 $407.31 $569.21 $864.97 |
$637.44 $723.46 $814.62 $1138.42 $1729.94 |
$839.82 $925.84 $1017.00 $1340.80 |
$1042.20 $1128.22 $1219.38 $1543.18 |
$1244.58 $1330.60 $1421.76 $1745.56 |
$521.10 $564.11 $609.69 $771.59 |
$723.48 $766.49 $812.07 $973.97 |
$925.86 $968.87 $1014.45 $1176.35 |
$202.38 |
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 |
$331.86 $376.65 $424.10 $592.68 $900.64 |
$663.72 $753.30 $848.20 $1185.36 $1801.28 |
$874.44 $964.02 $1058.92 $1396.08 |
$1085.16 $1174.74 $1269.64 $1606.80 |
$1295.88 $1385.46 $1480.36 $1817.52 |
$542.58 $587.37 $634.82 $803.40 |
$753.30 $798.09 $845.54 $1014.12 |
$964.02 $1008.81 $1056.26 $1224.84 |
$210.72 |
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 |
$334.49 $379.63 $427.46 $597.38 $907.78 |
$668.98 $759.26 $854.92 $1194.76 $1815.56 |
$881.37 $971.65 $1067.31 $1407.15 |
$1093.76 $1184.04 $1279.70 $1619.54 |
$1306.15 $1396.43 $1492.09 $1831.93 |
$546.88 $592.02 $639.85 $809.77 |
$759.27 $804.41 $852.24 $1022.16 |
$971.66 $1016.80 $1064.63 $1234.55 |
$212.39 |
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 |
$336.79 $382.24 $430.40 $601.49 $914.02 |
$673.58 $764.48 $860.80 $1202.98 $1828.04 |
$887.43 $978.33 $1074.65 $1416.83 |
$1101.28 $1192.18 $1288.50 $1630.68 |
$1315.13 $1406.03 $1502.35 $1844.53 |
$550.64 $596.09 $644.25 $815.34 |
$764.49 $809.94 $858.10 $1029.19 |
$978.34 $1023.79 $1071.95 $1243.04 |
$213.85 |
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 |
$344.35 $390.82 $440.06 $614.98 $934.53 |
$688.70 $781.64 $880.12 $1229.96 $1869.06 |
$907.35 $1000.29 $1098.77 $1448.61 |
$1126.00 $1218.94 $1317.42 $1667.26 |
$1344.65 $1437.59 $1536.07 $1885.91 |
$563.00 $609.47 $658.71 $833.63 |
$781.65 $828.12 $877.36 $1052.28 |
$1000.30 $1046.77 $1096.01 $1270.93 |
$218.65 |
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 |
$277.98 $315.49 $355.24 $496.45 $754.40 |
$555.96 $630.98 $710.48 $992.90 $1508.80 |
$732.47 $807.49 $886.99 $1169.41 |
$908.98 $984.00 $1063.50 $1345.92 |
$1085.49 $1160.51 $1240.01 $1522.43 |
$454.49 $492.00 $531.75 $672.96 |
$631.00 $668.51 $708.26 $849.47 |
$807.51 $845.02 $884.77 $1025.98 |
$176.51 |
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 |
$293.09 $332.65 $374.56 $523.44 $795.42 |
$586.18 $665.30 $749.12 $1046.88 $1590.84 |
$772.29 $851.41 $935.23 $1232.99 |
$958.40 $1037.52 $1121.34 $1419.10 |
$1144.51 $1223.63 $1307.45 $1605.21 |
$479.20 $518.76 $560.67 $709.55 |
$665.31 $704.87 $746.78 $895.66 |
$851.42 $890.98 $932.89 $1081.77 |
$186.11 |
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 |
$377.86 $428.86 $482.89 $674.84 $1025.48 |
$755.72 $857.72 $965.78 $1349.68 $2050.96 |
$995.65 $1097.65 $1205.71 $1589.61 |
$1235.58 $1337.58 $1445.64 $1829.54 |
$1475.51 $1577.51 $1685.57 $2069.47 |
$617.79 $668.79 $722.82 $914.77 |
$857.72 $908.72 $962.75 $1154.70 |
$1097.65 $1148.65 $1202.68 $1394.63 |
$239.93 |
ADVERTISEMENT
|
||||||||||
MercyCare HMO, Inc.Local: 1-800-895-2421 | Toll Free: 1-800-895-2421 |
||||||||||
Plan: (HMO) MercyCare HMO Gold Option ASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, 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 |
Gold | 21 30 40 50 60 |
$300.12 $340.62 $383.54 $536.00 $814.50 |
$600.24 $681.24 $767.08 $1072.00 $1629.00 |
$790.81 $871.81 $957.65 $1262.57 |
$981.38 $1062.38 $1148.22 $1453.14 |
$1171.95 $1252.95 $1338.79 $1643.71 |
$490.69 $531.19 $574.11 $726.57 |
$681.26 $721.76 $764.68 $917.14 |
$871.83 $912.33 $955.25 $1107.71 |
$190.57 |
Plan: (HMO) MercyCare HMO Silver Option ASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, 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 |
$246.04 $279.24 $314.43 $439.41 $667.73 |
$492.08 $558.48 $628.86 $878.82 $1335.46 |
$648.31 $714.71 $785.09 $1035.05 |
$804.54 $870.94 $941.32 $1191.28 |
$960.77 $1027.17 $1097.55 $1347.51 |
$402.27 $435.47 $470.66 $595.64 |
$558.50 $591.70 $626.89 $751.87 |
$714.73 $747.93 $783.12 $908.10 |
$156.23 |
Plan: (HMO) MercyCare HMO Bronze Option ASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, 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 |
$189.96 $215.59 $242.76 $339.25 $515.52 |
$379.92 $431.18 $485.52 $678.50 $1031.04 |
$500.54 $551.80 $606.14 $799.12 |
$621.16 $672.42 $726.76 $919.74 |
$741.78 $793.04 $847.38 $1040.36 |
$310.58 $336.21 $363.38 $459.87 |
$431.20 $456.83 $484.00 $580.49 |
$551.82 $577.45 $604.62 $701.11 |
$120.62 |
Plan: (HMO) MercyCare HMO Gold Option BSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
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 |
$314.81 $357.30 $402.31 $562.23 $854.37 |
$629.62 $714.60 $804.62 $1124.46 $1708.74 |
$829.52 $914.50 $1004.52 $1324.36 |
$1029.42 $1114.40 $1204.42 $1524.26 |
$1229.32 $1314.30 $1404.32 $1724.16 |
$514.71 $557.20 $602.21 $762.13 |
$714.61 $757.10 $802.11 $962.03 |
$914.51 $957.00 $1002.01 $1161.93 |
$199.90 |
Plan: (HMO) MercyCare HMO Gold Option CSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, 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 |
$315.14 $357.67 $402.74 $562.82 $855.26 |
$630.28 $715.34 $805.48 $1125.64 $1710.52 |
$830.39 $915.45 $1005.59 $1325.75 |
$1030.50 $1115.56 $1205.70 $1525.86 |
$1230.61 $1315.67 $1405.81 $1725.97 |
$515.25 $557.78 $602.85 $762.93 |
$715.36 $757.89 $802.96 $963.04 |
$915.47 $958.00 $1003.07 $1163.15 |
$200.11 |
Plan: (HMO) MercyCare HMO Silver Option BSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
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 |
$258.39 $293.26 $330.21 $461.47 $701.24 |
$516.78 $586.52 $660.42 $922.94 $1402.48 |
$680.85 $750.59 $824.49 $1087.01 |
$844.92 $914.66 $988.56 $1251.08 |
$1008.99 $1078.73 $1152.63 $1415.15 |
$422.46 $457.33 $494.28 $625.54 |
$586.53 $621.40 $658.35 $789.61 |
$750.60 $785.47 $822.42 $953.68 |
$164.07 |
Plan: (HMO) MercyCare HMO Silver Option CSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
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 |
$242.37 $275.08 $309.74 $432.85 $657.77 |
$484.74 $550.16 $619.48 $865.70 $1315.54 |
$638.64 $704.06 $773.38 $1019.60 |
$792.54 $857.96 $927.28 $1173.50 |
$946.44 $1011.86 $1081.18 $1327.40 |
$396.27 $428.98 $463.64 $586.75 |
$550.17 $582.88 $617.54 $740.65 |
$704.07 $736.78 $771.44 $894.55 |
$153.90 |
Plan: (HMO) MercyCare HMO Bronze Option BSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
Deductible: Individual:
$3,800
: Family:
$7,600 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 |
$202.65 $230.00 $258.97 $361.92 $549.96 |
$405.30 $460.00 $517.94 $723.84 $1099.92 |
$533.98 $588.68 $646.62 $852.52 |
$662.66 $717.36 $775.30 $981.20 |
$791.34 $846.04 $903.98 $1109.88 |
$331.33 $358.68 $387.65 $490.60 |
$460.01 $487.36 $516.33 $619.28 |
$588.69 $616.04 $645.01 $747.96 |
$128.68 |
Plan: (HMO) MercyCare HMO Bronze Option CSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
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 |
$174.27 $197.79 $222.70 $311.23 $472.94 |
$348.54 $395.58 $445.40 $622.46 $945.88 |
$459.20 $506.24 $556.06 $733.12 |
$569.86 $616.90 $666.72 $843.78 |
$680.52 $727.56 $777.38 $954.44 |
$284.93 $308.45 $333.36 $421.89 |
$395.59 $419.11 $444.02 $532.55 |
$506.25 $529.77 $554.68 $643.21 |
$110.66 |
ADVERTISEMENT
|
||||||||||
Physicians Plus Insurance CorporationLocal: 1-608-282-8900 | Toll Free: 1-800-545-5015 TTY: 1-608-260-7998 |
||||||||||
Plan: (HMO) 6850DSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-545-5015 - Provider Directory for This Plan: (Physicians Plus 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 |
$208.15 $236.25 $266.01 $371.75 $564.91 |
$416.30 $472.50 $532.02 $743.50 $1129.82 |
$548.47 $604.67 $664.19 $875.67 |
$680.64 $736.84 $796.36 $1007.84 |
$812.81 $869.01 $928.53 $1140.01 |
$340.32 $368.42 $398.18 $503.92 |
$472.49 $500.59 $530.35 $636.09 |
$604.66 $632.76 $662.52 $768.26 |
++ |
Plan: (HMO) 6600D OV 75 LTDSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-545-5015 - Provider Directory for This Plan: (Physicians Plus 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 |
$245.09 $278.17 $313.22 $437.73 $665.17 |
$490.18 $556.34 $626.44 $875.46 $1330.34 |
$645.81 $711.97 $782.07 $1031.09 |
$801.44 $867.60 $937.70 $1186.72 |
$957.07 $1023.23 $1093.33 $1342.35 |
$400.72 $433.80 $468.85 $593.36 |
$556.35 $589.43 $624.48 $748.99 |
$711.98 $745.06 $780.11 $904.62 |
$155.63 |
Plan: (HMO) 6550DSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-545-5015 - Provider Directory for This Plan: (Physicians Plus 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 |
$244.13 $277.08 $311.99 $436.01 $662.56 |
$488.26 $554.16 $623.98 $872.02 $1325.12 |
$643.28 $709.18 $779.00 $1027.04 |
$798.30 $864.20 $934.02 $1182.06 |
$953.32 $1019.22 $1089.04 $1337.08 |
$399.15 $432.10 $467.01 $591.03 |
$554.17 $587.12 $622.03 $746.05 |
$709.19 $742.14 $777.05 $901.07 |
$155.02 |
Plan: (HMO) 6600D 50 COINS OV 75 LTDSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-545-5015 - Provider Directory for This Plan: (Physicians Plus 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 |
$242.45 $275.18 $309.85 $433.01 $658.00 |
$484.90 $550.36 $619.70 $866.02 $1316.00 |
$638.85 $704.31 $773.65 $1019.97 |
$792.80 $858.26 $927.60 $1173.92 |
$946.75 $1012.21 $1081.55 $1327.87 |
$396.40 $429.13 $463.80 $586.96 |
$550.35 $583.08 $617.75 $740.91 |
$704.30 $737.03 $771.70 $894.86 |
$153.95 |
Plan: (HMO) 6600D 50 COINSSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-545-5015 - Provider Directory for This Plan: (Physicians Plus 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 |
$240.53 $273.00 $307.39 $429.58 $652.79 |
$481.06 $546.00 $614.78 $859.16 $1305.58 |
$633.79 $698.73 $767.51 $1011.89 |
$786.52 $851.46 $920.24 $1164.62 |
$939.25 $1004.19 $1072.97 $1317.35 |
$393.26 $425.73 $460.12 $582.31 |
$545.99 $578.46 $612.85 $735.04 |
$698.72 $731.19 $765.58 $887.77 |
$152.73 |
Plan: (HMO) 4000DSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-545-5015 - Provider Directory for This Plan: (Physicians Plus 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 |
$310.43 $352.33 $396.72 $554.42 $842.50 |
$620.86 $704.66 $793.44 $1108.84 $1685.00 |
$817.98 $901.78 $990.56 $1305.96 |
$1015.10 $1098.90 $1187.68 $1503.08 |
$1212.22 $1296.02 $1384.80 $1700.20 |
$507.55 $549.45 $593.84 $751.54 |
$704.67 $746.57 $790.96 $948.66 |
$901.79 $943.69 $988.08 $1145.78 |
$197.12 |
Plan: (HMO) 3000D 30 COINS OV 40Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-545-5015 - Provider Directory for This Plan: (Physicians Plus 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 |
$282.81 $320.98 $361.43 $505.09 $767.54 |
$565.62 $641.96 $722.86 $1010.18 $1535.08 |
$745.20 $821.54 $902.44 $1189.76 |
$924.78 $1001.12 $1082.02 $1369.34 |
$1104.36 $1180.70 $1261.60 $1548.92 |
$462.39 $500.56 $541.01 $684.67 |
$641.97 $680.14 $720.59 $864.25 |
$821.55 $859.72 $900.17 $1043.83 |
$179.58 |
Plan: (HMO) 3000D 20 COINS OV 40Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-545-5015 - Provider Directory for This Plan: (Physicians Plus 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 |
$291.22 $330.53 $372.17 $520.11 $790.37 |
$582.44 $661.06 $744.34 $1040.22 $1580.74 |
$767.36 $845.98 $929.26 $1225.14 |
$952.28 $1030.90 $1114.18 $1410.06 |
$1137.20 $1215.82 $1299.10 $1594.98 |
$476.14 $515.45 $557.09 $705.03 |
$661.06 $700.37 $742.01 $889.95 |
$845.98 $885.29 $926.93 $1074.87 |
$184.92 |
Plan: (HMO) 2500D 30 COINS OV 40Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-545-5015 - Provider Directory for This Plan: (Physicians Plus 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 |
$288.34 $327.26 $368.49 $514.97 $782.55 |
$576.68 $654.52 $736.98 $1029.94 $1565.10 |
$759.77 $837.61 $920.07 $1213.03 |
$942.86 $1020.70 $1103.16 $1396.12 |
$1125.95 $1203.79 $1286.25 $1579.21 |
$471.43 $510.35 $551.58 $698.06 |
$654.52 $693.44 $734.67 $881.15 |
$837.61 $876.53 $917.76 $1064.24 |
$183.09 |
Plan: (HMO) 2500D 20 COINS OV 40Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-545-5015 - Provider Directory for This Plan: (Physicians Plus 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 |
$298.18 $338.43 $381.07 $532.54 $809.26 |
$596.36 $676.86 $762.14 $1065.08 $1618.52 |
$785.70 $866.20 $951.48 $1254.42 |
$975.04 $1055.54 $1140.82 $1443.76 |
$1164.38 $1244.88 $1330.16 $1633.10 |
$487.52 $527.77 $570.41 $721.88 |
$676.86 $717.11 $759.75 $911.22 |
$866.20 $906.45 $949.09 $1100.56 |
$189.34 |
Plan: (HMO) 1500D 20 COINS OV 35Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-545-5015 - Provider Directory for This Plan: (Physicians Plus 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 |
Gold | 21 30 40 50 60 |
$347.43 $394.33 $444.01 $620.50 $942.92 |
$694.86 $788.66 $888.02 $1241.00 $1885.84 |
$915.47 $1009.27 $1108.63 $1461.61 |
$1136.08 $1229.88 $1329.24 $1682.22 |
$1356.69 $1450.49 $1549.85 $1902.83 |
$568.04 $614.94 $664.62 $841.11 |
$788.65 $835.55 $885.23 $1061.72 |
$1009.26 $1056.16 $1105.84 $1282.33 |
$220.61 |
Plan: (HMO) 2250DSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-545-5015 - Provider Directory for This Plan: (Physicians Plus Insurance Corporation)
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 |
$374.09 $424.59 $478.08 $668.12 $1015.28 |
$748.18 $849.18 $956.16 $1336.24 $2030.56 |
$985.72 $1086.72 $1193.70 $1573.78 |
$1223.26 $1324.26 $1431.24 $1811.32 |
$1460.80 $1561.80 $1668.78 $2048.86 |
$611.63 $662.13 $715.62 $905.66 |
$849.17 $899.67 $953.16 $1143.20 |
$1086.71 $1137.21 $1190.70 $1380.74 |
$237.54 |
Plan: (HMO) 2000D 20 COINS OV 35Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-545-5015 - Provider Directory for This Plan: (Physicians Plus Insurance Corporation)
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 |
$341.19 $387.25 $436.04 $609.36 $925.98 |
$682.38 $774.50 $872.08 $1218.72 $1851.96 |
$899.03 $991.15 $1088.73 $1435.37 |
$1115.68 $1207.80 $1305.38 $1652.02 |
$1332.33 $1424.45 $1522.03 $1868.67 |
$557.84 $603.90 $652.69 $826.01 |
$774.49 $820.55 $869.34 $1042.66 |
$991.14 $1037.20 $1085.99 $1259.31 |
$216.65 |
Plan: (HMO) 5250D OV 25Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-545-5015 - Provider Directory for This Plan: (Physicians Plus Insurance Corporation)
Deductible: Individual:
$5,250
: 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 |
$269.36 $305.72 $344.24 $481.07 $731.04 |
$538.72 $611.44 $688.48 $962.14 $1462.08 |
$709.76 $782.48 $859.52 $1133.18 |
$880.80 $953.52 $1030.56 $1304.22 |
$1051.84 $1124.56 $1201.60 $1475.26 |
$440.40 $476.76 $515.28 $652.11 |
$611.44 $647.80 $686.32 $823.15 |
$782.48 $818.84 $857.36 $994.19 |
$171.04 |
Plan: (HMO) 5500D OV 25Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-545-5015 - Provider Directory for This Plan: (Physicians Plus Insurance Corporation)
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 |
Silver | 21 30 40 50 60 |
$265.04 $300.82 $338.72 $473.36 $719.31 |
$530.08 $601.64 $677.44 $946.72 $1438.62 |
$698.38 $769.94 $845.74 $1115.02 |
$866.68 $938.24 $1014.04 $1283.32 |
$1034.98 $1106.54 $1182.34 $1451.62 |
$433.34 $469.12 $507.02 $641.66 |
$601.64 $637.42 $675.32 $809.96 |
$769.94 $805.72 $843.62 $978.26 |
$168.30 |
ADVERTISEMENT
|
||||||||||
Group Health Cooperative- SCWLocal: 1-608-442-7290 | Toll Free: 1-855-344-2729 TTY: 1-608-828-4815 |
||||||||||
Plan: (HMO) Platinum 500 DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$387.09 $439.34 $494.70 $691.34 $1050.55 |
$774.18 $878.68 $989.40 $1382.68 $2101.10 |
$1019.98 $1124.48 $1235.20 $1628.48 |
$1265.78 $1370.28 $1481.00 $1874.28 |
$1511.58 $1616.08 $1726.80 $2120.08 |
$632.89 $685.14 $740.50 $937.14 |
$878.69 $930.94 $986.30 $1182.94 |
$1124.49 $1176.74 $1232.10 $1428.74 |
$245.80 |
Plan: (HMO) Platinum Benefit ArchSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
Platinum | 21 30 40 50 60 |
$374.01 $424.51 $477.99 $667.99 $1015.07 |
$748.02 $849.02 $955.98 $1335.98 $2030.14 |
$985.52 $1086.52 $1193.48 $1573.48 |
$1223.02 $1324.02 $1430.98 $1810.98 |
$1460.52 $1561.52 $1668.48 $2048.48 |
$611.51 $662.01 $715.49 $905.49 |
$849.01 $899.51 $952.99 $1142.99 |
$1086.51 $1137.01 $1190.49 $1380.49 |
$237.50 |
Plan: (HMO) Gold 1,000 DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$345.87 $392.56 $442.02 $617.72 $938.68 |
$691.74 $785.12 $884.04 $1235.44 $1877.36 |
$911.37 $1004.75 $1103.67 $1455.07 |
$1131.00 $1224.38 $1323.30 $1674.70 |
$1350.63 $1444.01 $1542.93 $1894.33 |
$565.50 $612.19 $661.65 $837.35 |
$785.13 $831.82 $881.28 $1056.98 |
$1004.76 $1051.45 $1100.91 $1276.61 |
$219.63 |
Plan: (HMO) Gold Benefit ArchSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$342.18 $388.37 $437.31 $611.13 $928.68 |
$684.36 $776.74 $874.62 $1222.26 $1857.36 |
$901.64 $994.02 $1091.90 $1439.54 |
$1118.92 $1211.30 $1309.18 $1656.82 |
$1336.20 $1428.58 $1526.46 $1874.10 |
$559.46 $605.65 $654.59 $828.41 |
$776.74 $822.93 $871.87 $1045.69 |
$994.02 $1040.21 $1089.15 $1262.97 |
$217.28 |
Plan: (HMO) Gold 2000 Deductible HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$341.84 $387.99 $436.87 $610.53 $927.75 |
$683.68 $775.98 $873.74 $1221.06 $1855.50 |
$900.75 $993.05 $1090.81 $1438.13 |
$1117.82 $1210.12 $1307.88 $1655.20 |
$1334.89 $1427.19 $1524.95 $1872.27 |
$558.91 $605.06 $653.94 $827.60 |
$775.98 $822.13 $871.01 $1044.67 |
$993.05 $1039.20 $1088.08 $1261.74 |
$217.07 |
Plan: (HMO) Silver 30 CopaySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$304.98 $346.15 $389.76 $544.69 $827.72 |
$609.96 $692.30 $779.52 $1089.38 $1655.44 |
$803.62 $885.96 $973.18 $1283.04 |
$997.28 $1079.62 $1166.84 $1476.70 |
$1190.94 $1273.28 $1360.50 $1670.36 |
$498.64 $539.81 $583.42 $738.35 |
$692.30 $733.47 $777.08 $932.01 |
$885.96 $927.13 $970.74 $1125.67 |
$193.66 |
Plan: (HMO) Silver 2000 DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$291.23 $330.55 $372.20 $520.14 $790.41 |
$582.46 $661.10 $744.40 $1040.28 $1580.82 |
$767.39 $846.03 $929.33 $1225.21 |
$952.32 $1030.96 $1114.26 $1410.14 |
$1137.25 $1215.89 $1299.19 $1595.07 |
$476.16 $515.48 $557.13 $705.07 |
$661.09 $700.41 $742.06 $890.00 |
$846.02 $885.34 $926.99 $1074.93 |
$184.93 |
Plan: (HMO) Silver 3500 Deductible HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$301.96 $342.72 $385.90 $539.30 $819.52 |
$603.92 $685.44 $771.80 $1078.60 $1639.04 |
$795.66 $877.18 $963.54 $1270.34 |
$987.40 $1068.92 $1155.28 $1462.08 |
$1179.14 $1260.66 $1347.02 $1653.82 |
$493.70 $534.46 $577.64 $731.04 |
$685.44 $726.20 $769.38 $922.78 |
$877.18 $917.94 $961.12 $1114.52 |
$191.74 |
Plan: (HMO) Bronze 4,000 DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
Bronze | 21 30 40 50 60 |
$260.41 $295.56 $332.80 $465.09 $706.74 |
$520.82 $591.12 $665.60 $930.18 $1413.48 |
$686.18 $756.48 $830.96 $1095.54 |
$851.54 $921.84 $996.32 $1260.90 |
$1016.90 $1087.20 $1161.68 $1426.26 |
$425.77 $460.92 $498.16 $630.45 |
$591.13 $626.28 $663.52 $795.81 |
$756.49 $791.64 $828.88 $961.17 |
$165.36 |
Plan: (HMO) Bronze 5000 Deductible HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$261.07 $296.32 $333.65 $466.28 $708.55 |
$522.14 $592.64 $667.30 $932.56 $1417.10 |
$687.92 $758.42 $833.08 $1098.34 |
$853.70 $924.20 $998.86 $1264.12 |
$1019.48 $1089.98 $1164.64 $1429.90 |
$426.85 $462.10 $499.43 $632.06 |
$592.63 $627.88 $665.21 $797.84 |
$758.41 $793.66 $830.99 $963.62 |
$165.78 |
Plan: (HMO) Select Platinum 500 DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$351.90 $399.41 $449.73 $628.49 $955.06 |
$703.80 $798.82 $899.46 $1256.98 $1910.12 |
$927.26 $1022.28 $1122.92 $1480.44 |
$1150.72 $1245.74 $1346.38 $1703.90 |
$1374.18 $1469.20 $1569.84 $1927.36 |
$575.36 $622.87 $673.19 $851.95 |
$798.82 $846.33 $896.65 $1075.41 |
$1022.28 $1069.79 $1120.11 $1298.87 |
$223.46 |
Plan: (HMO) Select Platinum Benefit ArchSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
Platinum | 21 30 40 50 60 |
$339.83 $385.71 $434.31 $606.94 $922.31 |
$679.66 $771.42 $868.62 $1213.88 $1844.62 |
$895.45 $987.21 $1084.41 $1429.67 |
$1111.24 $1203.00 $1300.20 $1645.46 |
$1327.03 $1418.79 $1515.99 $1861.25 |
$555.62 $601.50 $650.10 $822.73 |
$771.41 $817.29 $865.89 $1038.52 |
$987.20 $1033.08 $1081.68 $1254.31 |
$215.79 |
Plan: (HMO) Select Gold 1,000 DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$314.36 $356.80 $401.75 $561.45 $853.17 |
$628.72 $713.60 $803.50 $1122.90 $1706.34 |
$828.34 $913.22 $1003.12 $1322.52 |
$1027.96 $1112.84 $1202.74 $1522.14 |
$1227.58 $1312.46 $1402.36 $1721.76 |
$513.98 $556.42 $601.37 $761.07 |
$713.60 $756.04 $800.99 $960.69 |
$913.22 $955.66 $1000.61 $1160.31 |
$199.62 |
Plan: (HMO) Select Gold Benefit ArchSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$311.01 $352.99 $397.47 $555.46 $844.07 |
$622.02 $705.98 $794.94 $1110.92 $1688.14 |
$819.51 $903.47 $992.43 $1308.41 |
$1017.00 $1100.96 $1189.92 $1505.90 |
$1214.49 $1298.45 $1387.41 $1703.39 |
$508.50 $550.48 $594.96 $752.95 |
$705.99 $747.97 $792.45 $950.44 |
$903.48 $945.46 $989.94 $1147.93 |
$197.49 |
Plan: (HMO) Select Gold 2000 Deductible HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$310.67 $352.61 $397.04 $554.86 $843.17 |
$621.34 $705.22 $794.08 $1109.72 $1686.34 |
$818.62 $902.50 $991.36 $1307.00 |
$1015.90 $1099.78 $1188.64 $1504.28 |
$1213.18 $1297.06 $1385.92 $1701.56 |
$507.95 $549.89 $594.32 $752.14 |
$705.23 $747.17 $791.60 $949.42 |
$902.51 $944.45 $988.88 $1146.70 |
$197.28 |
Plan: (HMO) Select Silver 30 CopaySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$277.16 $314.58 $354.21 $495.01 $752.21 |
$554.32 $629.16 $708.42 $990.02 $1504.42 |
$730.32 $805.16 $884.42 $1166.02 |
$906.32 $981.16 $1060.42 $1342.02 |
$1082.32 $1157.16 $1236.42 $1518.02 |
$453.16 $490.58 $530.21 $671.01 |
$629.16 $666.58 $706.21 $847.01 |
$805.16 $842.58 $882.21 $1023.01 |
$176.00 |
Plan: (HMO) Select Silver 2000 DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$264.76 $300.50 $338.36 $472.86 $718.56 |
$529.52 $601.00 $676.72 $945.72 $1437.12 |
$697.64 $769.12 $844.84 $1113.84 |
$865.76 $937.24 $1012.96 $1281.96 |
$1033.88 $1105.36 $1181.08 $1450.08 |
$432.88 $468.62 $506.48 $640.98 |
$601.00 $636.74 $674.60 $809.10 |
$769.12 $804.86 $842.72 $977.22 |
$168.12 |
Plan: (HMO) Select Silver 3500 Deductible HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$274.48 $311.53 $350.79 $490.22 $744.94 |
$548.96 $623.06 $701.58 $980.44 $1489.88 |
$723.25 $797.35 $875.87 $1154.73 |
$897.54 $971.64 $1050.16 $1329.02 |
$1071.83 $1145.93 $1224.45 $1503.31 |
$448.77 $485.82 $525.08 $664.51 |
$623.06 $660.11 $699.37 $838.80 |
$797.35 $834.40 $873.66 $1013.09 |
$174.29 |
Plan: (HMO) Select Bronze 4,000 DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
Bronze | 21 30 40 50 60 |
$236.61 $268.55 $302.38 $422.58 $642.15 |
$473.22 $537.10 $604.76 $845.16 $1284.30 |
$623.47 $687.35 $755.01 $995.41 |
$773.72 $837.60 $905.26 $1145.66 |
$923.97 $987.85 $1055.51 $1295.91 |
$386.86 $418.80 $452.63 $572.83 |
$537.11 $569.05 $602.88 $723.08 |
$687.36 $719.30 $753.13 $873.33 |
$150.25 |
Plan: (HMO) Select Bronze 5000 Deductible HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$237.28 $269.31 $303.24 $423.78 $643.98 |
$474.56 $538.62 $606.48 $847.56 $1287.96 |
$625.23 $689.29 $757.15 $998.23 |
$775.90 $839.96 $907.82 $1148.90 |
$926.57 $990.63 $1058.49 $1299.57 |
$387.95 $419.98 $453.91 $574.45 |
$538.62 $570.65 $604.58 $725.12 |
$689.29 $721.32 $755.25 $875.79 |
$150.67 |
Plan: (HMO) Silver 3,500 DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$292.58 $332.08 $373.92 $522.55 $794.06 |
$585.16 $664.16 $747.84 $1045.10 $1588.12 |
$770.95 $849.95 $933.63 $1230.89 |
$956.74 $1035.74 $1119.42 $1416.68 |
$1142.53 $1221.53 $1305.21 $1602.47 |
$478.37 $517.87 $559.71 $708.34 |
$664.16 $703.66 $745.50 $894.13 |
$849.95 $889.45 $931.29 $1079.92 |
$185.79 |
Plan: (HMO) Catastrophic 6,850 DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$181.31 $205.79 $231.72 $323.83 $492.08 |
$362.62 $411.58 $463.44 $647.66 $984.16 |
$477.75 $526.71 $578.57 $762.79 |
$592.88 $641.84 $693.70 $877.92 |
$708.01 $756.97 $808.83 $993.05 |
$296.44 $320.92 $346.85 $438.96 |
$411.57 $436.05 $461.98 $554.09 |
$526.70 $551.18 $577.11 $669.22 |
$115.13 |
Plan: (HMO) Select Silver 3,500 DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$266.10 $302.02 $340.08 $475.25 $722.20 |
$532.20 $604.04 $680.16 $950.50 $1444.40 |
$701.17 $773.01 $849.13 $1119.47 |
$870.14 $941.98 $1018.10 $1288.44 |
$1039.11 $1110.95 $1187.07 $1457.41 |
$435.07 $470.99 $509.05 $644.22 |
$604.04 $639.96 $678.02 $813.19 |
$773.01 $808.93 $846.99 $982.16 |
$168.97 |
Plan: (HMO) Select Catastrophic 6,850 DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative- SCW)
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 |
$164.89 $187.15 $210.73 $294.49 $447.50 |
$329.78 $374.30 $421.46 $588.98 $895.00 |
$434.48 $479.00 $526.16 $693.68 |
$539.18 $583.70 $630.86 $798.38 |
$643.88 $688.40 $735.56 $903.08 |
$269.59 $291.85 $315.43 $399.19 |
$374.29 $396.55 $420.13 $503.89 |
$478.99 $501.25 $524.83 $608.59 |
$104.70 |
†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 Rock County here.