Obamacare 2016 Rates and Health Insurance Providers for Vernon County,Viroqua,WI

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 Vernon County, Wisconsin.

Obamacare Providers, Plans and 2016 Rates for Vernon County

Vernon County is in “Rating Area 7” of Wisconsin.

Currently, there are 5 providers offering 100 plans to Rating Area 7. †

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 Viroqua, WI area accept this insurance coverage as within the plan's "network".

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Unity Health Plans Insurance Corporation Local: 1-608-643-2491 \| Toll Free: 1-800-362-3310 TTY: 1-608-643-1421
Plan: (HMO) Unity Elite Platinum 30/60 with Dental Summary 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 Out of Pocket Maximum per year: Individual: $1,500 : Family: $3,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Platinum	21 30 40 50 60	$371.89 $422.09 $475.27 $664.19 $1009.30	$743.78 $844.18 $950.54 $1328.38 $2018.60	$979.93 $1080.33 $1186.69 $1564.53	$1216.08 $1316.48 $1422.84 $1800.68	$1452.23 $1552.63 $1658.99 $2036.83	$608.04 $658.24 $711.42 $900.34	$844.19 $894.39 $947.57 $1136.49	$1080.34 $1130.54 $1183.72 $1372.64	$236.15
Plan: (HMO) Unity Elite Platinum 25/50 with Dental Summary 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 Out of Pocket Maximum per year: Individual: $2,000 : Family: $4,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Platinum	21 30 40 50 60	$416.20 $472.38 $531.89 $743.32 $1129.55	$832.40 $944.76 $1063.78 $1486.64 $2259.10	$1096.68 $1209.04 $1328.06 $1750.92	$1360.96 $1473.32 $1592.34 $2015.20	$1625.24 $1737.60 $1856.62 $2279.48	$680.48 $736.66 $796.17 $1007.60	$944.76 $1000.94 $1060.45 $1271.88	$1209.04 $1265.22 $1324.73 $1536.16	$264.28
Plan: (HMO) Unity Elite Gold 30/60 with Dental Summary 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 Out of Pocket Maximum per year: Individual: $5,800 : Family: $11,600 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$317.82 $360.72 $406.17 $567.62 $862.55	$635.64 $721.44 $812.34 $1135.24 $1725.10	$837.45 $923.25 $1014.15 $1337.05	$1039.26 $1125.06 $1215.96 $1538.86	$1241.07 $1326.87 $1417.77 $1740.67	$519.63 $562.53 $607.98 $769.43	$721.44 $764.34 $809.79 $971.24	$923.25 $966.15 $1011.60 $1173.05	$201.81
Plan: (HMO) Unity Elite Gold 20/40 with Dental Summary 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 Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$335.26 $380.52 $428.46 $598.77 $909.89	$670.52 $761.04 $856.92 $1197.54 $1819.78	$883.41 $973.93 $1069.81 $1410.43	$1096.30 $1186.82 $1282.70 $1623.32	$1309.19 $1399.71 $1495.59 $1836.21	$548.15 $593.41 $641.35 $811.66	$761.04 $806.30 $854.24 $1024.55	$973.93 $1019.19 $1067.13 $1237.44	$212.89
Plan: (HMO) Unity Elite Silver Plus with Dental Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$265.01 $300.78 $338.68 $473.31 $719.23	$530.02 $601.56 $677.36 $946.62 $1438.46	$698.30 $769.84 $845.64 $1114.90	$866.58 $938.12 $1013.92 $1283.18	$1034.86 $1106.40 $1182.20 $1451.46	$433.29 $469.06 $506.96 $641.59	$601.57 $637.34 $675.24 $809.87	$769.85 $805.62 $843.52 $978.15	$168.28
Plan: (HMO) Unity Elite Silver Choice Value with Dental Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$281.14 $319.09 $359.29 $502.11 $763.01	$562.28 $638.18 $718.58 $1004.22 $1526.02	$740.80 $816.70 $897.10 $1182.74	$919.32 $995.22 $1075.62 $1361.26	$1097.84 $1173.74 $1254.14 $1539.78	$459.66 $497.61 $537.81 $680.63	$638.18 $676.13 $716.33 $859.15	$816.70 $854.65 $894.85 $1037.67	$178.52
Plan: (HMO) Unity Elite Silver Exclusive Value with Dental Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$260.06 $295.16 $332.35 $464.46 $705.78	$520.12 $590.32 $664.70 $928.92 $1411.56	$685.25 $755.45 $829.83 $1094.05	$850.38 $920.58 $994.96 $1259.18	$1015.51 $1085.71 $1160.09 $1424.31	$425.19 $460.29 $497.48 $629.59	$590.32 $625.42 $662.61 $794.72	$755.45 $790.55 $827.74 $959.85	$165.13
Plan: (HMO) Unity Elite Bronze 55/150 with Dental Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$246.12 $279.34 $314.53 $439.55 $667.94	$492.24 $558.68 $629.06 $879.10 $1335.88	$648.52 $714.96 $785.34 $1035.38	$804.80 $871.24 $941.62 $1191.66	$961.08 $1027.52 $1097.90 $1347.94	$402.40 $435.62 $470.81 $595.83	$558.68 $591.90 $627.09 $752.11	$714.96 $748.18 $783.37 $908.39	$156.28
Plan: (HMO) Unity Elite Silver Maintenance with Dental Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$287.31 $326.09 $367.18 $513.13 $779.75	$574.62 $652.18 $734.36 $1026.26 $1559.50	$757.06 $834.62 $916.80 $1208.70	$939.50 $1017.06 $1099.24 $1391.14	$1121.94 $1199.50 $1281.68 $1573.58	$469.75 $508.53 $549.62 $695.57	$652.19 $690.97 $732.06 $878.01	$834.63 $873.41 $914.50 $1060.45	$182.44
Plan: (HMO) Unity Elite Platinum 20/40 with Dental Summary 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 Out of Pocket Maximum per year: Individual: $1,500 : Family: $3,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Platinum	21 30 40 50 60	$391.23 $444.04 $499.98 $698.72 $1061.78	$782.46 $888.08 $999.96 $1397.44 $2123.56	$1030.89 $1136.51 $1248.39 $1645.87	$1279.32 $1384.94 $1496.82 $1894.30	$1527.75 $1633.37 $1745.25 $2142.73	$639.66 $692.47 $748.41 $947.15	$888.09 $940.90 $996.84 $1195.58	$1136.52 $1189.33 $1245.27 $1444.01	$248.43
Plan: (HMO) Unity Elite Bronze 45/125 Value with Dental Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$243.93 $276.85 $311.74 $435.65 $662.01	$487.86 $553.70 $623.48 $871.30 $1324.02	$642.75 $708.59 $778.37 $1026.19	$797.64 $863.48 $933.26 $1181.08	$952.53 $1018.37 $1088.15 $1335.97	$398.82 $431.74 $466.63 $590.54	$553.71 $586.63 $621.52 $745.43	$708.60 $741.52 $776.41 $900.32	$154.89
Plan: (HMO) Unity Elite Platinum 30/60 Summary 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 Out of Pocket Maximum per year: Individual: $1,500 : Family: $3,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Platinum	21 30 40 50 60	$347.45 $394.35 $444.03 $620.53 $942.96	$694.90 $788.70 $888.06 $1241.06 $1885.92	$915.53 $1009.33 $1108.69 $1461.69	$1136.16 $1229.96 $1329.32 $1682.32	$1356.79 $1450.59 $1549.95 $1902.95	$568.08 $614.98 $664.66 $841.16	$788.71 $835.61 $885.29 $1061.79	$1009.34 $1056.24 $1105.92 $1282.42	$220.63
Plan: (HMO) Unity Elite Platinum 25/50 Summary 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 Out of Pocket Maximum per year: Individual: $2,000 : Family: $4,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Platinum	21 30 40 50 60	$388.84 $441.33 $496.93 $694.46 $1055.30	$777.68 $882.66 $993.86 $1388.92 $2110.60	$1024.59 $1129.57 $1240.77 $1635.83	$1271.50 $1376.48 $1487.68 $1882.74	$1518.41 $1623.39 $1734.59 $2129.65	$635.75 $688.24 $743.84 $941.37	$882.66 $935.15 $990.75 $1188.28	$1129.57 $1182.06 $1237.66 $1435.19	$246.91
Plan: (HMO) Unity Elite Gold 30/60 Summary 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 Out of Pocket Maximum per year: Individual: $5,800 : Family: $11,600 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$296.93 $337.01 $379.47 $530.31 $805.86	$593.86 $674.02 $758.94 $1060.62 $1611.72	$782.41 $862.57 $947.49 $1249.17	$970.96 $1051.12 $1136.04 $1437.72	$1159.51 $1239.67 $1324.59 $1626.27	$485.48 $525.56 $568.02 $718.86	$674.03 $714.11 $756.57 $907.41	$862.58 $902.66 $945.12 $1095.96	$188.55
Plan: (HMO) Unity Elite Gold 20/40 Summary 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 Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$313.22 $355.50 $400.29 $559.41 $850.08	$626.44 $711.00 $800.58 $1118.82 $1700.16	$825.33 $909.89 $999.47 $1317.71	$1024.22 $1108.78 $1198.36 $1516.60	$1223.11 $1307.67 $1397.25 $1715.49	$512.11 $554.39 $599.18 $758.30	$711.00 $753.28 $798.07 $957.19	$909.89 $952.17 $996.96 $1156.08	$198.89
Plan: (HMO) Unity Elite Silver Plus Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$247.59 $281.01 $316.42 $442.19 $671.96	$495.18 $562.02 $632.84 $884.38 $1343.92	$652.40 $719.24 $790.06 $1041.60	$809.62 $876.46 $947.28 $1198.82	$966.84 $1033.68 $1104.50 $1356.04	$404.81 $438.23 $473.64 $599.41	$562.03 $595.45 $630.86 $756.63	$719.25 $752.67 $788.08 $913.85	$157.22
Plan: (HMO) Unity Elite Silver Choice Value Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$262.66 $298.12 $335.68 $469.11 $712.85	$525.32 $596.24 $671.36 $938.22 $1425.70	$692.11 $763.03 $838.15 $1105.01	$858.90 $929.82 $1004.94 $1271.80	$1025.69 $1096.61 $1171.73 $1438.59	$429.45 $464.91 $502.47 $635.90	$596.24 $631.70 $669.26 $802.69	$763.03 $798.49 $836.05 $969.48	$166.79
Plan: (HMO) Unity Elite Silver Exclusive Value Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$242.96 $275.76 $310.50 $433.93 $659.39	$485.92 $551.52 $621.00 $867.86 $1318.78	$640.20 $705.80 $775.28 $1022.14	$794.48 $860.08 $929.56 $1176.42	$948.76 $1014.36 $1083.84 $1330.70	$397.24 $430.04 $464.78 $588.21	$551.52 $584.32 $619.06 $742.49	$705.80 $738.60 $773.34 $896.77	$154.28
Plan: (HMO) Unity Elite Bronze 55/150 Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$229.94 $260.97 $293.85 $410.66 $624.04	$459.88 $521.94 $587.70 $821.32 $1248.08	$605.89 $667.95 $733.71 $967.33	$751.90 $813.96 $879.72 $1113.34	$897.91 $959.97 $1025.73 $1259.35	$375.95 $406.98 $439.86 $556.67	$521.96 $552.99 $585.87 $702.68	$667.97 $699.00 $731.88 $848.69	$146.01
Plan: (HMO) Unity Elite Silver Maintenance Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$268.43 $304.66 $343.04 $479.40 $728.50	$536.86 $609.32 $686.08 $958.80 $1457.00	$707.31 $779.77 $856.53 $1129.25	$877.76 $950.22 $1026.98 $1299.70	$1048.21 $1120.67 $1197.43 $1470.15	$438.88 $475.11 $513.49 $649.85	$609.33 $645.56 $683.94 $820.30	$779.78 $816.01 $854.39 $990.75	$170.45
Plan: (HMO) Unity Elite Platinum 20/40 Summary 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 Out of Pocket Maximum per year: Individual: $1,500 : Family: $3,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Platinum	21 30 40 50 60	$365.51 $414.85 $467.12 $652.79 $991.98	$731.02 $829.70 $934.24 $1305.58 $1983.96	$963.12 $1061.80 $1166.34 $1537.68	$1195.22 $1293.90 $1398.44 $1769.78	$1427.32 $1526.00 $1630.54 $2001.88	$597.61 $646.95 $699.22 $884.89	$829.71 $879.05 $931.32 $1116.99	$1061.81 $1111.15 $1163.42 $1349.09	$232.10
Plan: (HMO) Unity Elite Bronze 45/125 Value Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$227.90 $258.66 $291.24 $407.01 $618.50	$455.80 $517.32 $582.48 $814.02 $1237.00	$600.51 $662.03 $727.19 $958.73	$745.22 $806.74 $871.90 $1103.44	$889.93 $951.45 $1016.61 $1248.15	$372.61 $403.37 $435.95 $551.72	$517.32 $548.08 $580.66 $696.43	$662.03 $692.79 $725.37 $841.14	$144.71
Plan: (HMO) Unity Elite Gold Deductible Summary 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 Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$306.10 $347.42 $391.19 $546.68 $830.74	$612.20 $694.84 $782.38 $1093.36 $1661.48	$806.57 $889.21 $976.75 $1287.73	$1000.94 $1083.58 $1171.12 $1482.10	$1195.31 $1277.95 $1365.49 $1676.47	$500.47 $541.79 $585.56 $741.05	$694.84 $736.16 $779.93 $935.42	$889.21 $930.53 $974.30 $1129.79	$194.37
Plan: (HMO) Unity Elite Silver Deductible Summary 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 Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$255.85 $290.39 $326.98 $456.95 $694.38	$511.70 $580.78 $653.96 $913.90 $1388.76	$674.16 $743.24 $816.42 $1076.36	$836.62 $905.70 $978.88 $1238.82	$999.08 $1068.16 $1141.34 $1401.28	$418.31 $452.85 $489.44 $619.41	$580.77 $615.31 $651.90 $781.87	$743.23 $777.77 $814.36 $944.33	$162.46
Plan: (HMO) Unity Elite Bronze HSA Summary 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 Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$194.08 $220.28 $248.03 $346.62 $526.73	$388.16 $440.56 $496.06 $693.24 $1053.46	$511.40 $563.80 $619.30 $816.48	$634.64 $687.04 $742.54 $939.72	$757.88 $810.28 $865.78 $1062.96	$317.32 $343.52 $371.27 $469.86	$440.56 $466.76 $494.51 $593.10	$563.80 $590.00 $617.75 $716.34	$123.24
Plan: (HMO) Unity Elite Catastrophic Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Catastrophic	21 30 40 50 60	$156.14 $177.21 $199.54 $278.85 $423.75	$312.28 $354.42 $399.08 $557.70 $847.50	$411.42 $453.56 $498.22 $656.84	$510.56 $552.70 $597.36 $755.98	$609.70 $651.84 $696.50 $855.12	$255.28 $276.35 $298.68 $377.99	$354.42 $375.49 $397.82 $477.13	$453.56 $474.63 $496.96 $576.27	++
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Dean Health Plan Local: 1-608-828-1301 \| Toll Free: 1-800-279-1301 TTY: 1-608-827-4086
Plan: (HMO) Dean Catastrophic Safety Net Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Catastrophic	21 30 40 50 60	$128.24 $145.55 $163.89 $229.04 $348.05	$256.48 $291.10 $327.78 $458.08 $696.10	$337.91 $372.53 $409.21 $539.51	$419.34 $453.96 $490.64 $620.94	$500.77 $535.39 $572.07 $702.37	$209.67 $226.98 $245.32 $310.47	$291.10 $308.41 $326.75 $391.90	$372.53 $389.84 $408.18 $473.33	$81.43
Plan: (HMO) Dean Silver Copay Plus 2000X Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$260.19 $295.31 $332.52 $464.70 $706.16	$520.38 $590.62 $665.04 $929.40 $1412.32	$685.60 $755.84 $830.26 $1094.62	$850.82 $921.06 $995.48 $1259.84	$1016.04 $1086.28 $1160.70 $1425.06	$425.41 $460.53 $497.74 $629.92	$590.63 $625.75 $662.96 $795.14	$755.85 $790.97 $828.18 $960.36	$165.22
Plan: (HMO) Dean Silver Classic 2500X Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$249.10 $282.73 $318.36 $444.90 $676.08	$498.20 $565.46 $636.72 $889.80 $1352.16	$656.38 $723.64 $794.90 $1047.98	$814.56 $881.82 $953.08 $1206.16	$972.74 $1040.00 $1111.26 $1364.34	$407.28 $440.91 $476.54 $603.08	$565.46 $599.09 $634.72 $761.26	$723.64 $757.27 $792.90 $919.44	$158.18
Plan: (HMO) Dean Silver Classic 4500X Summary 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 Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$225.56 $256.01 $288.27 $402.85 $612.17	$451.12 $512.02 $576.54 $805.70 $1224.34	$594.35 $655.25 $719.77 $948.93	$737.58 $798.48 $863.00 $1092.16	$880.81 $941.71 $1006.23 $1235.39	$368.79 $399.24 $431.50 $546.08	$512.02 $542.47 $574.73 $689.31	$655.25 $685.70 $717.96 $832.54	$143.23
Plan: (HMO) Dean Silver Value Copay 5150X Summary 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 Out of Pocket Maximum per year: 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	$216.70 $245.95 $276.94 $387.03 $588.13	$433.40 $491.90 $553.88 $774.06 $1176.26	$571.00 $629.50 $691.48 $911.66	$708.60 $767.10 $829.08 $1049.26	$846.20 $904.70 $966.68 $1186.86	$354.30 $383.55 $414.54 $524.63	$491.90 $521.15 $552.14 $662.23	$629.50 $658.75 $689.74 $799.83	$137.60
Plan: (HMO) Dean Bronze Value Copay 5500X Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$198.41 $225.20 $253.57 $354.37 $538.50	$396.82 $450.40 $507.14 $708.74 $1077.00	$522.81 $576.39 $633.13 $834.73	$648.80 $702.38 $759.12 $960.72	$774.79 $828.37 $885.11 $1086.71	$324.40 $351.19 $379.56 $480.36	$450.39 $477.18 $505.55 $606.35	$576.38 $603.17 $631.54 $732.34	$125.99
Plan: (HMO) Dean Gold Classic 1500X Summary 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 Out of Pocket Maximum per year: 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
Gold	21 30 40 50 60	$282.86 $321.05 $361.49 $505.19 $767.69	$565.72 $642.10 $722.98 $1010.38 $1535.38	$745.33 $821.71 $902.59 $1189.99	$924.94 $1001.32 $1082.20 $1369.60	$1104.55 $1180.93 $1261.81 $1549.21	$462.47 $500.66 $541.10 $684.80	$642.08 $680.27 $720.71 $864.41	$821.69 $859.88 $900.32 $1044.02	$179.61
Plan: (HMO) Dean Gold Value Copay 2250X Summary 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 Out of Pocket Maximum per year: 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	$268.64 $304.90 $343.32 $479.79 $729.08	$537.28 $609.80 $686.64 $959.58 $1458.16	$707.86 $780.38 $857.22 $1130.16	$878.44 $950.96 $1027.80 $1300.74	$1049.02 $1121.54 $1198.38 $1471.32	$439.22 $475.48 $513.90 $650.37	$609.80 $646.06 $684.48 $820.95	$780.38 $816.64 $855.06 $991.53	$170.58
Plan: (HMO) Dean Gold HSA 2000X Summary 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 Out of Pocket Maximum per year: Individual: $2,000 : Family: $4,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$276.15 $313.43 $352.92 $493.21 $749.48	$552.30 $626.86 $705.84 $986.42 $1498.96	$727.65 $802.21 $881.19 $1161.77	$903.00 $977.56 $1056.54 $1337.12	$1078.35 $1152.91 $1231.89 $1512.47	$451.50 $488.78 $528.27 $668.56	$626.85 $664.13 $703.62 $843.91	$802.20 $839.48 $878.97 $1019.26	$175.35
Plan: (HMO) Dean Bronze Value Copay 6750X Summary 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 Out of Pocket Maximum per year: Individual: $6,750 : Family: $13,500 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$192.02 $217.95 $245.41 $342.96 $521.16	$384.04 $435.90 $490.82 $685.92 $1042.32	$505.97 $557.83 $612.75 $807.85	$627.90 $679.76 $734.68 $929.78	$749.83 $801.69 $856.61 $1051.71	$313.95 $339.88 $367.34 $464.89	$435.88 $461.81 $489.27 $586.82	$557.81 $583.74 $611.20 $708.75	$121.93
Plan: (HMO) Dean Bronze HSA-E 6000X Summary 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 Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$192.67 $218.69 $246.24 $344.12 $522.93	$385.34 $437.38 $492.48 $688.24 $1045.86	$507.69 $559.73 $614.83 $810.59	$630.04 $682.08 $737.18 $932.94	$752.39 $804.43 $859.53 $1055.29	$315.02 $341.04 $368.59 $466.47	$437.37 $463.39 $490.94 $588.82	$559.72 $585.74 $613.29 $711.17	$122.35
Plan: (HMO) Dean Bronze HSA-E 6450X Summary 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 Out of Pocket Maximum per year: Individual: $6,450 : Family: $12,900 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$184.26 $209.14 $235.49 $329.10 $500.10	$368.52 $418.28 $470.98 $658.20 $1000.20	$485.53 $535.29 $587.99 $775.21	$602.54 $652.30 $705.00 $892.22	$719.55 $769.31 $822.01 $1009.23	$301.27 $326.15 $352.50 $446.11	$418.28 $443.16 $469.51 $563.12	$535.29 $560.17 $586.52 $680.13	$117.01
Plan: (HMO) Dean Silver HSA-E 3400X Summary 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 Out of Pocket Maximum per year: Individual: $3,400 : Family: $6,800 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$243.77 $276.68 $311.54 $435.38 $661.61	$487.54 $553.36 $623.08 $870.76 $1323.22	$642.33 $708.15 $777.87 $1025.55	$797.12 $862.94 $932.66 $1180.34	$951.91 $1017.73 $1087.45 $1335.13	$398.56 $431.47 $466.33 $590.17	$553.35 $586.26 $621.12 $744.96	$708.14 $741.05 $775.91 $899.75	$154.79
Plan: (HMO) Dean Platinum Copay Plus 500X Summary 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 Out of Pocket Maximum per year: 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	$331.88 $376.68 $424.14 $592.74 $900.73	$663.76 $753.36 $848.28 $1185.48 $1801.46	$874.50 $964.10 $1059.02 $1396.22	$1085.24 $1174.84 $1269.76 $1606.96	$1295.98 $1385.58 $1480.50 $1817.70	$542.62 $587.42 $634.88 $803.48	$753.36 $798.16 $845.62 $1014.22	$964.10 $1008.90 $1056.36 $1224.96	$210.74
Plan: (HMO) Dean Gold Copay Plus 1000X Summary 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 Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$297.12 $337.23 $379.72 $530.66 $806.38	$594.24 $674.46 $759.44 $1061.32 $1612.76	$782.91 $863.13 $948.11 $1249.99	$971.58 $1051.80 $1136.78 $1438.66	$1160.25 $1240.47 $1325.45 $1627.33	$485.79 $525.90 $568.39 $719.33	$674.46 $714.57 $757.06 $908.00	$863.13 $903.24 $945.73 $1096.67	$188.67
Plan: (HMO) Dean Silver Copay Plus 3500X Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$262.06 $297.44 $334.91 $468.04 $711.24	$524.12 $594.88 $669.82 $936.08 $1422.48	$690.53 $761.29 $836.23 $1102.49	$856.94 $927.70 $1002.64 $1268.90	$1023.35 $1094.11 $1169.05 $1435.31	$428.47 $463.85 $501.32 $634.45	$594.88 $630.26 $667.73 $800.86	$761.29 $796.67 $834.14 $967.27	$166.41
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All Savers Insurance Company Local: 1-877-887-0450 \| Toll Free: 1-877-887-0450
Plan: (EPO) Gold Compass 1000 Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$313.13 $355.39 $400.17 $559.23 $849.81	$626.26 $710.78 $800.34 $1118.46 $1699.62	$825.09 $909.61 $999.17 $1317.29	$1023.92 $1108.44 $1198.00 $1516.12	$1222.75 $1307.27 $1396.83 $1714.95	$511.96 $554.22 $599.00 $758.06	$710.79 $753.05 $797.83 $956.89	$909.62 $951.88 $996.66 $1155.72	$198.83
Plan: (EPO) Gold Compass 500 Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$311.79 $353.87 $398.45 $556.84 $846.17	$623.58 $707.74 $796.90 $1113.68 $1692.34	$821.56 $905.72 $994.88 $1311.66	$1019.54 $1103.70 $1192.86 $1509.64	$1217.52 $1301.68 $1390.84 $1707.62	$509.77 $551.85 $596.43 $754.82	$707.75 $749.83 $794.41 $952.80	$905.73 $947.81 $992.39 $1150.78	$197.98
Plan: (EPO) Silver Compass HSA 3000 Summary 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 Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$260.05 $295.15 $332.33 $464.43 $705.75	$520.10 $590.30 $664.66 $928.86 $1411.50	$685.23 $755.43 $829.79 $1093.99	$850.36 $920.56 $994.92 $1259.12	$1015.49 $1085.69 $1160.05 $1424.25	$425.18 $460.28 $497.46 $629.56	$590.31 $625.41 $662.59 $794.69	$755.44 $790.54 $827.72 $959.82	$165.13
Plan: (EPO) Silver Compass 2000 1 Summary 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 Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$270.77 $307.32 $346.04 $483.58 $734.85	$541.54 $614.64 $692.08 $967.16 $1469.70	$713.47 $786.57 $864.01 $1139.09	$885.40 $958.50 $1035.94 $1311.02	$1057.33 $1130.43 $1207.87 $1482.95	$442.70 $479.25 $517.97 $655.51	$614.63 $651.18 $689.90 $827.44	$786.56 $823.11 $861.83 $999.37	$171.93
Plan: (EPO) Silver Compass 2000 Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$272.92 $309.75 $348.78 $487.41 $740.67	$545.84 $619.50 $697.56 $974.82 $1481.34	$719.14 $792.80 $870.86 $1148.12	$892.44 $966.10 $1044.16 $1321.42	$1065.74 $1139.40 $1217.46 $1494.72	$446.22 $483.05 $522.08 $660.71	$619.52 $656.35 $695.38 $834.01	$792.82 $829.65 $868.68 $1007.31	$173.30
Plan: (EPO) Silver Compass 3500 Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$274.79 $311.88 $351.17 $490.77 $745.77	$549.58 $623.76 $702.34 $981.54 $1491.54	$724.07 $798.25 $876.83 $1156.03	$898.56 $972.74 $1051.32 $1330.52	$1073.05 $1147.23 $1225.81 $1505.01	$449.28 $486.37 $525.66 $665.26	$623.77 $660.86 $700.15 $839.75	$798.26 $835.35 $874.64 $1014.24	$174.49
Plan: (EPO) Silver Compass 4500 Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$280.96 $318.88 $359.05 $501.78 $762.50	$561.92 $637.76 $718.10 $1003.56 $1525.00	$740.32 $816.16 $896.50 $1181.96	$918.72 $994.56 $1074.90 $1360.36	$1097.12 $1172.96 $1253.30 $1538.76	$459.36 $497.28 $537.45 $680.18	$637.76 $675.68 $715.85 $858.58	$816.16 $854.08 $894.25 $1036.98	$178.40
Plan: (EPO) Bronze Compass HSA 5500 Summary 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 Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$226.81 $257.42 $289.85 $405.06 $615.53	$453.62 $514.84 $579.70 $810.12 $1231.06	$597.64 $658.86 $723.72 $954.14	$741.66 $802.88 $867.74 $1098.16	$885.68 $946.90 $1011.76 $1242.18	$370.83 $401.44 $433.87 $549.08	$514.85 $545.46 $577.89 $693.10	$658.87 $689.48 $721.91 $837.12	$144.02
Plan: (EPO) Bronze Compass 6500 Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$239.14 $271.41 $305.61 $427.09 $649.00	$478.28 $542.82 $611.22 $854.18 $1298.00	$630.13 $694.67 $763.07 $1006.03	$781.98 $846.52 $914.92 $1157.88	$933.83 $998.37 $1066.77 $1309.73	$390.99 $423.26 $457.46 $578.94	$542.84 $575.11 $609.31 $730.79	$694.69 $726.96 $761.16 $882.64	$151.85
Plan: (EPO) Gold Compass 0 Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$308.30 $349.91 $394.00 $550.61 $836.71	$616.60 $699.82 $788.00 $1101.22 $1673.42	$812.37 $895.59 $983.77 $1296.99	$1008.14 $1091.36 $1179.54 $1492.76	$1203.91 $1287.13 $1375.31 $1688.53	$504.07 $545.68 $589.77 $746.38	$699.84 $741.45 $785.54 $942.15	$895.61 $937.22 $981.31 $1137.92	$195.77
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Health Tradition Health Plan Local: 1-608-781-9692 \| Toll Free: 1-888-459-3020
Plan: (HMO) Gold 1000/80 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan) Deductible: Individual: $1,000 : Family: $2,000 Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$354.65 $402.53 $453.25 $633.41 $962.52	$709.30 $805.06 $906.50 $1266.82 $1925.04	$934.51 $1030.27 $1131.71 $1492.03	$1159.72 $1255.48 $1356.92 $1717.24	$1384.93 $1480.69 $1582.13 $1942.45	$579.86 $627.74 $678.46 $858.62	$805.07 $852.95 $903.67 $1083.83	$1030.28 $1078.16 $1128.88 $1309.04	$225.21
Plan: (HMO) Gold 2000/80 w/copay Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan) Deductible: Individual: $2,000 : Family: $4,000 Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$357.14 $405.35 $456.42 $637.85 $969.27	$714.28 $810.70 $912.84 $1275.70 $1938.54	$941.07 $1037.49 $1139.63 $1502.49	$1167.86 $1264.28 $1366.42 $1729.28	$1394.65 $1491.07 $1593.21 $1956.07	$583.93 $632.14 $683.21 $864.64	$810.72 $858.93 $910.00 $1091.43	$1037.51 $1085.72 $1136.79 $1318.22	$226.79
Plan: (HMO) Bronze HDHP 100 Low Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan) Deductible: Individual: $6,250 : Family: $12,500 Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$221.74 $251.67 $283.38 $396.02 $601.79	$443.48 $503.34 $566.76 $792.04 $1203.58	$584.29 $644.15 $707.57 $932.85	$725.10 $784.96 $848.38 $1073.66	$865.91 $925.77 $989.19 $1214.47	$362.55 $392.48 $424.19 $536.83	$503.36 $533.29 $565.00 $677.64	$644.17 $674.10 $705.81 $818.45	$140.81
Plan: (HMO) Bronze 6000/80 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan) Deductible: Individual: $6,000 : Family: $12,000 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$245.90 $279.10 $314.26 $439.17 $667.36	$491.80 $558.20 $628.52 $878.34 $1334.72	$647.95 $714.35 $784.67 $1034.49	$804.10 $870.50 $940.82 $1190.64	$960.25 $1026.65 $1096.97 $1346.79	$402.05 $435.25 $470.41 $595.32	$558.20 $591.40 $626.56 $751.47	$714.35 $747.55 $782.71 $907.62	$156.15
Plan: (HMO) Bronze HDHP 100 High Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan) Deductible: Individual: $6,450 : Family: $12,900 Out of Pocket Maximum per year: Individual: $6,450 : Family: $12,900 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$218.90 $248.45 $279.75 $390.95 $594.08	$437.80 $496.90 $559.50 $781.90 $1188.16	$576.80 $635.90 $698.50 $920.90	$715.80 $774.90 $837.50 $1059.90	$854.80 $913.90 $976.50 $1198.90	$357.90 $387.45 $418.75 $529.95	$496.90 $526.45 $557.75 $668.95	$635.90 $665.45 $696.75 $807.95	$139.00
Plan: (HMO) Essential HDHP Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan) Deductible: Individual: $6,850 : Family: $13,700 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Catastrophic	21 30 40 50 60	$195.27 $221.63 $249.56 $348.75 $529.96	$390.54 $443.26 $499.12 $697.50 $1059.92	$514.54 $567.26 $623.12 $821.50	$638.54 $691.26 $747.12 $945.50	$762.54 $815.26 $871.12 $1069.50	$319.27 $345.63 $373.56 $472.75	$443.27 $469.63 $497.56 $596.75	$567.27 $593.63 $621.56 $720.75	$124.00
Plan: (HMO) Silver 2000/80 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan) Deductible: Individual: $2,000 : Family: $4,000 Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$309.67 $351.48 $395.76 $553.07 $840.45	$619.34 $702.96 $791.52 $1106.14 $1680.90	$815.98 $899.60 $988.16 $1302.78	$1012.62 $1096.24 $1184.80 $1499.42	$1209.26 $1292.88 $1381.44 $1696.06	$506.31 $548.12 $592.40 $749.71	$702.95 $744.76 $789.04 $946.35	$899.59 $941.40 $985.68 $1142.99	$196.64
Plan: (HMO) Silver 4000/80 w/copay Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan) Deductible: Individual: $4,000 : Family: $8,000 Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$306.83 $348.25 $392.13 $548.00 $832.73	$613.66 $696.50 $784.26 $1096.00 $1665.46	$808.50 $891.34 $979.10 $1290.84	$1003.34 $1086.18 $1173.94 $1485.68	$1198.18 $1281.02 $1368.78 $1680.52	$501.67 $543.09 $586.97 $742.84	$696.51 $737.93 $781.81 $937.68	$891.35 $932.77 $976.65 $1132.52	$194.84
Plan: (HMO) Silver HDHP 85 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan) Deductible: Individual: $3,000 : Family: $6,000 Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$291.70 $331.07 $372.79 $520.97 $791.66	$583.40 $662.14 $745.58 $1041.94 $1583.32	$768.63 $847.37 $930.81 $1227.17	$953.86 $1032.60 $1116.04 $1412.40	$1139.09 $1217.83 $1301.27 $1597.63	$476.93 $516.30 $558.02 $706.20	$662.16 $701.53 $743.25 $891.43	$847.39 $886.76 $928.48 $1076.66	$185.23
Plan: (HMO) Gold 2375/100 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan) Deductible: Individual: $2,375 : Family: $4,750 Out of Pocket Maximum per year: Individual: $2,375 : Family: $4,750 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple 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	$342.40 $388.62 $437.58 $611.52 $929.25	$684.80 $777.24 $875.16 $1223.04 $1858.50	$902.22 $994.66 $1092.58 $1440.46	$1119.64 $1212.08 $1310.00 $1657.88	$1337.06 $1429.50 $1527.42 $1875.30	$559.82 $606.04 $655.00 $828.94	$777.24 $823.46 $872.42 $1046.36	$994.66 $1040.88 $1089.84 $1263.78	$217.42
Plan: (HMO) Silver 3000/70 w/copay Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan) Deductible: Individual: $3,000 : Family: $6,000 Out of Pocket Maximum per year: Individual: $5,400 : Family: $10,800 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	$305.20 $346.40 $390.04 $545.08 $828.30	$610.40 $692.80 $780.08 $1090.16 $1656.60	$804.20 $886.60 $973.88 $1283.96	$998.00 $1080.40 $1167.68 $1477.76	$1191.80 $1274.20 $1361.48 $1671.56	$499.00 $540.20 $583.84 $738.88	$692.80 $734.00 $777.64 $932.68	$886.60 $927.80 $971.44 $1126.48	$193.80
Plan: (HMO) Silver HDHP 100 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan) Deductible: Individual: $4,125 : Family: $8,250 Out of Pocket Maximum per year: Individual: $4,125 : Family: $8,250 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$281.46 $319.46 $359.71 $502.69 $763.88	$562.92 $638.92 $719.42 $1005.38 $1527.76	$741.65 $817.65 $898.15 $1184.11	$920.38 $996.38 $1076.88 $1362.84	$1099.11 $1175.11 $1255.61 $1541.57	$460.19 $498.19 $538.44 $681.42	$638.92 $676.92 $717.17 $860.15	$817.65 $855.65 $895.90 $1038.88	$178.73
Plan: (HMO) Silver 3500 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan) Deductible: Individual: $3,500 : Family: $7,000 Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$281.46 $319.46 $359.71 $502.69 $763.88	$562.92 $638.92 $719.42 $1005.38 $1527.76	$741.65 $817.65 $898.15 $1184.11	$920.38 $996.38 $1076.88 $1362.84	$1099.11 $1175.11 $1255.61 $1541.57	$460.19 $498.19 $538.44 $681.42	$638.92 $676.92 $717.17 $860.15	$817.65 $855.65 $895.90 $1038.88	$178.73
Plan: (HMO) Bronze HDHP 80 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan) Deductible: Individual: $5,000 : Family: $10,000 Out of Pocket Maximum per year: Individual: $6,450 : Family: $12,900 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$230.34 $261.43 $294.37 $411.38 $625.13	$460.68 $522.86 $588.74 $822.76 $1250.26	$606.95 $669.13 $735.01 $969.03	$753.22 $815.40 $881.28 $1115.30	$899.49 $961.67 $1027.55 $1261.57	$376.61 $407.70 $440.64 $557.65	$522.88 $553.97 $586.91 $703.92	$669.15 $700.24 $733.18 $850.19	$146.27
Plan: (HMO) Bronze HDHP 50 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan) Deductible: Individual: $3,500 : Family: $7,000 Out of Pocket Maximum per year: Individual: $6,450 : Family: $12,900 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$232.40 $263.77 $297.00 $415.06 $630.72	$464.80 $527.54 $594.00 $830.12 $1261.44	$612.38 $675.12 $741.58 $977.70	$759.96 $822.70 $889.16 $1125.28	$907.54 $970.28 $1036.74 $1272.86	$379.98 $411.35 $444.58 $562.64	$527.56 $558.93 $592.16 $710.22	$675.14 $706.51 $739.74 $857.80	$147.58
Plan: (HMO) Bronze 6850/100 Rx Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan) Deductible: Individual: $6,850 : Family: $13,700 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$240.14 $272.56 $306.90 $428.89 $651.74	$480.28 $545.12 $613.80 $857.78 $1303.48	$632.77 $697.61 $766.29 $1010.27	$785.26 $850.10 $918.78 $1162.76	$937.75 $1002.59 $1071.27 $1315.25	$392.63 $425.05 $459.39 $581.38	$545.12 $577.54 $611.88 $733.87	$697.61 $730.03 $764.37 $886.36	$152.49
Plan: (HMO) Bronze 6850/100 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan) Deductible: Individual: $6,850 : Family: $13,700 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$213.57 $242.40 $272.94 $381.43 $579.62	$427.14 $484.80 $545.88 $762.86 $1159.24	$562.76 $620.42 $681.50 $898.48	$698.38 $756.04 $817.12 $1034.10	$834.00 $891.66 $952.74 $1169.72	$349.19 $378.02 $408.56 $517.05	$484.81 $513.64 $544.18 $652.67	$620.43 $649.26 $679.80 $788.29	$135.62
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Physicians Plus Insurance Corporation Local: 1-608-282-8900 \| Toll Free: 1-800-545-5015 TTY: 1-608-260-7998
Plan: (HMO) 6850D Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Catastrophic	21 30 40 50 60	$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 LTD Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$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) 6550D Summary 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 Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$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 LTD Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$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 COINS Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$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) 4000D Summary 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 Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$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 40 Summary 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 Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$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 40 Summary 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 Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$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 40 Summary 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 Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$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 40 Summary 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 Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$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 35 Summary 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 Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$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) 2250D Summary 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 Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$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 35 Summary 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 Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$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 25 Summary 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 Out of Pocket Maximum per year: 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 25 Summary 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 Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$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
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Compcare Health Serv Ins Co(Anthem BCBS) Local: 1-855-748-1813 \| Toll Free: 1-855-748-1813
Plan: (POS) Anthem Catastrophic Blue Priority X WI 6850/0% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS)) Deductible: Individual: $6,850 : Family: $13,700 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Catastrophic	21 30 40 50 60	$285.16 $323.66 $364.43 $509.30 $773.92	$570.32 $647.32 $728.86 $1018.60 $1547.84	$751.40 $828.40 $909.94 $1199.68	$932.48 $1009.48 $1091.02 $1380.76	$1113.56 $1190.56 $1272.10 $1561.84	$466.24 $504.74 $545.51 $690.38	$647.32 $685.82 $726.59 $871.46	$828.40 $866.90 $907.67 $1052.54	$181.08
Plan: (POS) Anthem Bronze Blue Priority X WI 5850 20 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS)) Deductible: Individual: $5,850 : Family: $11,700 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$368.89 $418.69 $471.44 $658.84 $1001.17	$737.78 $837.38 $942.88 $1317.68 $2002.34	$972.03 $1071.63 $1177.13 $1551.93	$1206.28 $1305.88 $1411.38 $1786.18	$1440.53 $1540.13 $1645.63 $2020.43	$603.14 $652.94 $705.69 $893.09	$837.39 $887.19 $939.94 $1127.34	$1071.64 $1121.44 $1174.19 $1361.59	$234.25
Plan: (POS) Anthem Bronze Blue Priority X WI 6050 25 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS)) Deductible: Individual: $6,050 : Family: $12,100 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$364.08 $413.23 $465.29 $650.25 $988.11	$728.16 $826.46 $930.58 $1300.50 $1976.22	$959.35 $1057.65 $1161.77 $1531.69	$1190.54 $1288.84 $1392.96 $1762.88	$1421.73 $1520.03 $1624.15 $1994.07	$595.27 $644.42 $696.48 $881.44	$826.46 $875.61 $927.67 $1112.63	$1057.65 $1106.80 $1158.86 $1343.82	$231.19
Plan: (POS) Anthem Bronze Blue Priority X WI 0 for HSA Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS)) Deductible: Individual: $6,550 : Family: $13,100 Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$363.55 $412.63 $464.62 $649.30 $986.67	$727.10 $825.26 $929.24 $1298.60 $1973.34	$957.95 $1056.11 $1160.09 $1529.45	$1188.80 $1286.96 $1390.94 $1760.30	$1419.65 $1517.81 $1621.79 $1991.15	$594.40 $643.48 $695.47 $880.15	$825.25 $874.33 $926.32 $1111.00	$1056.10 $1105.18 $1157.17 $1341.85	$230.85
Plan: (POS) Anthem Bronze Blue Priority X WI 30 for HSA Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS)) Deductible: Individual: $4,650 : Family: $9,300 Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$356.45 $404.57 $455.54 $636.62 $967.41	$712.90 $809.14 $911.08 $1273.24 $1934.82	$939.25 $1035.49 $1137.43 $1499.59	$1165.60 $1261.84 $1363.78 $1725.94	$1391.95 $1488.19 $1590.13 $1952.29	$582.80 $630.92 $681.89 $862.97	$809.15 $857.27 $908.24 $1089.32	$1035.50 $1083.62 $1134.59 $1315.67	$226.35
Plan: (POS) Anthem Silver Blue Priority X WI 3750 10 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS)) Deductible: Individual: $3,750 : Family: $7,500 Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$392.19 $445.14 $501.22 $700.45 $1064.40	$784.38 $890.28 $1002.44 $1400.90 $2128.80	$1033.42 $1139.32 $1251.48 $1649.94	$1282.46 $1388.36 $1500.52 $1898.98	$1531.50 $1637.40 $1749.56 $2148.02	$641.23 $694.18 $750.26 $949.49	$890.27 $943.22 $999.30 $1198.53	$1139.31 $1192.26 $1248.34 $1447.57	$249.04
Plan: (POS) Anthem Silver Blue Priority X WI 2500/10% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS)) Deductible: Individual: $2,500 : Family: $5,000 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$411.91 $467.52 $526.42 $735.67 $1117.92	$823.82 $935.04 $1052.84 $1471.34 $2235.84	$1085.38 $1196.60 $1314.40 $1732.90	$1346.94 $1458.16 $1575.96 $1994.46	$1608.50 $1719.72 $1837.52 $2256.02	$673.47 $729.08 $787.98 $997.23	$935.03 $990.64 $1049.54 $1258.79	$1196.59 $1252.20 $1311.10 $1520.35	$261.56
Plan: (POS) Anthem Silver Blue Priority X WI 10 for HSA Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS)) Deductible: Individual: $3,000 : Family: $6,000 Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$396.28 $449.78 $506.45 $707.76 $1075.50	$792.56 $899.56 $1012.90 $1415.52 $2151.00	$1044.20 $1151.20 $1264.54 $1667.16	$1295.84 $1402.84 $1516.18 $1918.80	$1547.48 $1654.48 $1767.82 $2170.44	$647.92 $701.42 $758.09 $959.40	$899.56 $953.06 $1009.73 $1211.04	$1151.20 $1204.70 $1261.37 $1462.68	$251.64
Plan: (POS) Anthem Silver Blue Priority X WI 1850/20% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS)) Deductible: Individual: $1,850 : Family: $3,700 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$410.81 $466.27 $525.02 $733.71 $1114.94	$821.62 $932.54 $1050.04 $1467.42 $2229.88	$1082.48 $1193.40 $1310.90 $1728.28	$1343.34 $1454.26 $1571.76 $1989.14	$1604.20 $1715.12 $1832.62 $2250.00	$671.67 $727.13 $785.88 $994.57	$932.53 $987.99 $1046.74 $1255.43	$1193.39 $1248.85 $1307.60 $1516.29	$260.86
Plan: (POS) Anthem Bronze Blue Priority X WI 40 for HSA Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS)) Deductible: Individual: $5,500 : Family: $11,000 Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$345.12 $391.71 $441.06 $616.38 $936.66	$690.24 $783.42 $882.12 $1232.76 $1873.32	$909.39 $1002.57 $1101.27 $1451.91	$1128.54 $1221.72 $1320.42 $1671.06	$1347.69 $1440.87 $1539.57 $1890.21	$564.27 $610.86 $660.21 $835.53	$783.42 $830.01 $879.36 $1054.68	$1002.57 $1049.16 $1098.51 $1273.83	$219.15
Plan: (POS) Anthem Bronze Blue Priority X WI 5450 30 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS)) Deductible: Individual: $5,450 : Family: $10,900 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$348.98 $396.09 $446.00 $623.28 $947.13	$697.96 $792.18 $892.00 $1246.56 $1894.26	$919.56 $1013.78 $1113.60 $1468.16	$1141.16 $1235.38 $1335.20 $1689.76	$1362.76 $1456.98 $1556.80 $1911.36	$570.58 $617.69 $667.60 $844.88	$792.18 $839.29 $889.20 $1066.48	$1013.78 $1060.89 $1110.80 $1288.08	$221.60
Plan: (POS) Anthem Silver Blue Priority X WI 4000 25 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS)) Deductible: Individual: $4,000 : Family: $8,000 Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$379.76 $431.03 $485.33 $678.25 $1030.67	$759.52 $862.06 $970.66 $1356.50 $2061.34	$1000.67 $1103.21 $1211.81 $1597.65	$1241.82 $1344.36 $1452.96 $1838.80	$1482.97 $1585.51 $1694.11 $2079.95	$620.91 $672.18 $726.48 $919.40	$862.06 $913.33 $967.63 $1160.55	$1103.21 $1154.48 $1208.78 $1401.70	$241.15
Plan: (POS) Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS)) Deductible: Individual: $1,750 : Family: $3,500 Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$415.35 $471.42 $530.82 $741.82 $1127.26	$830.70 $942.84 $1061.64 $1483.64 $2254.52	$1094.45 $1206.59 $1325.39 $1747.39	$1358.20 $1470.34 $1589.14 $2011.14	$1621.95 $1734.09 $1852.89 $2274.89	$679.10 $735.17 $794.57 $1005.57	$942.85 $998.92 $1058.32 $1269.32	$1206.60 $1262.67 $1322.07 $1533.07	$263.75
Plan: (POS) Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS)) Deductible: Individual: $1,000 : Family: $2,000 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$561.63 $637.45 $717.76 $1003.07 $1524.26	$1123.26 $1274.90 $1435.52 $2006.14 $3048.52	$1479.90 $1631.54 $1792.16 $2362.78	$1836.54 $1988.18 $2148.80 $2719.42	$2193.18 $2344.82 $2505.44 $3076.06	$918.27 $994.09 $1074.40 $1359.71	$1274.91 $1350.73 $1431.04 $1716.35	$1631.55 $1707.37 $1787.68 $2072.99	$356.64
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Gundersen Health Plan, Inc. Local: 1-608-775-8092 \| Toll Free: 1-855-685-6404
Plan: (POS) Platinum $1000 - 0% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.) Deductible: Individual: $1,000 : Family: $2,000 Out of Pocket Maximum per year: 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	$450.34 $511.13 $575.53 $804.30 $1222.22	$900.68 $1022.26 $1151.06 $1608.60 $2444.44	$1186.64 $1308.22 $1437.02 $1894.56	$1472.60 $1594.18 $1722.98 $2180.52	$1758.56 $1880.14 $2008.94 $2466.48	$736.30 $797.09 $861.49 $1090.26	$1022.26 $1083.05 $1147.45 $1376.22	$1308.22 $1369.01 $1433.41 $1662.18	$285.96
Plan: (POS) Platinum $500 - 20% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.) Deductible: Individual: $500 : Family: $1,000 Out of Pocket Maximum per year: 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	$447.86 $508.32 $572.36 $799.87 $1215.49	$895.72 $1016.64 $1144.72 $1599.74 $2430.98	$1180.11 $1301.03 $1429.11 $1884.13	$1464.50 $1585.42 $1713.50 $2168.52	$1748.89 $1869.81 $1997.89 $2452.91	$732.25 $792.71 $856.75 $1084.26	$1016.64 $1077.10 $1141.14 $1368.65	$1301.03 $1361.49 $1425.53 $1653.04	$284.39
Plan: (POS) Gold $1500 - 30% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.) Deductible: Individual: $1,500 : Family: $3,000 Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$395.96 $449.41 $506.03 $707.18 $1074.63	$791.92 $898.82 $1012.06 $1414.36 $2149.26	$1043.35 $1150.25 $1263.49 $1665.79	$1294.78 $1401.68 $1514.92 $1917.22	$1546.21 $1653.11 $1766.35 $2168.65	$647.39 $700.84 $757.46 $958.61	$898.82 $952.27 $1008.89 $1210.04	$1150.25 $1203.70 $1260.32 $1461.47	$251.43
Plan: (POS) Gold $3500 - 0% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.) Deductible: Individual: $3,500 : Family: $7,000 Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$379.22 $430.41 $484.64 $677.28 $1029.20	$758.44 $860.82 $969.28 $1354.56 $2058.40	$999.24 $1101.62 $1210.08 $1595.36	$1240.04 $1342.42 $1450.88 $1836.16	$1480.84 $1583.22 $1691.68 $2076.96	$620.02 $671.21 $725.44 $918.08	$860.82 $912.01 $966.24 $1158.88	$1101.62 $1152.81 $1207.04 $1399.68	$240.80
Plan: (POS) Silver $3500 - 20% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.) Deductible: Individual: $3,500 : Family: $7,000 Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$355.24 $403.19 $453.99 $634.45 $964.12	$710.48 $806.38 $907.98 $1268.90 $1928.24	$936.05 $1031.95 $1133.55 $1494.47	$1161.62 $1257.52 $1359.12 $1720.04	$1387.19 $1483.09 $1584.69 $1945.61	$580.81 $628.76 $679.56 $860.02	$806.38 $854.33 $905.13 $1085.59	$1031.95 $1079.90 $1130.70 $1311.16	$225.57
Plan: (POS) Silver $2500 - 50% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.) Deductible: Individual: $2,500 : Family: $5,000 Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$355.50 $403.49 $454.32 $634.92 $964.82	$711.00 $806.98 $908.64 $1269.84 $1929.64	$936.74 $1032.72 $1134.38 $1495.58	$1162.48 $1258.46 $1360.12 $1721.32	$1388.22 $1484.20 $1585.86 $1947.06	$581.24 $629.23 $680.06 $860.66	$806.98 $854.97 $905.80 $1086.40	$1032.72 $1080.71 $1131.54 $1312.14	$225.74
Plan: (POS) Silver $2500 - 20% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.) Deductible: Individual: $2,500 : Family: $5,000 Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$366.60 $416.09 $468.51 $654.74 $994.95	$733.20 $832.18 $937.02 $1309.48 $1989.90	$965.99 $1064.97 $1169.81 $1542.27	$1198.78 $1297.76 $1402.60 $1775.06	$1431.57 $1530.55 $1635.39 $2007.85	$599.39 $648.88 $701.30 $887.53	$832.18 $881.67 $934.09 $1120.32	$1064.97 $1114.46 $1166.88 $1353.11	$232.79
Plan: (POS) Bronze $3000 - 50% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.) Deductible: Individual: $3,000 : Family: $6,000 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$291.89 $331.29 $373.03 $521.31 $792.18	$583.78 $662.58 $746.06 $1042.62 $1584.36	$769.13 $847.93 $931.41 $1227.97	$954.48 $1033.28 $1116.76 $1413.32	$1139.83 $1218.63 $1302.11 $1598.67	$477.24 $516.64 $558.38 $706.66	$662.59 $701.99 $743.73 $892.01	$847.94 $887.34 $929.08 $1077.36	$185.35
Plan: (POS) Bronze $4000 - 30% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.) Deductible: Individual: $4,000 : Family: $8,000 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$297.97 $338.19 $380.80 $532.17 $808.69	$595.94 $676.38 $761.60 $1064.34 $1617.38	$785.15 $865.59 $950.81 $1253.55	$974.36 $1054.80 $1140.02 $1442.76	$1163.57 $1244.01 $1329.23 $1631.97	$487.18 $527.40 $570.01 $721.38	$676.39 $716.61 $759.22 $910.59	$865.60 $905.82 $948.43 $1099.80	$189.21
Plan: (POS) Bronze $6250 - 30% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.) Deductible: Individual: $6,250 : Family: $12,500 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$313.45 $355.76 $400.58 $559.82 $850.70	$626.90 $711.52 $801.16 $1119.64 $1701.40	$825.94 $910.56 $1000.20 $1318.68	$1024.98 $1109.60 $1199.24 $1517.72	$1224.02 $1308.64 $1398.28 $1716.76	$512.49 $554.80 $599.62 $758.86	$711.53 $753.84 $798.66 $957.90	$910.57 $952.88 $997.70 $1156.94	$199.04
Plan: (POS) Catastrophic $6,850 - 0% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.) Deductible: Individual: $6,850 : Family: $13,700 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Catastrophic	21 30 40 50 60	$221.92 $251.87 $283.61 $396.34 $602.29	$443.84 $503.74 $567.22 $792.68 $1204.58	$584.75 $644.65 $708.13 $933.59	$725.66 $785.56 $849.04 $1074.50	$866.57 $926.47 $989.95 $1215.41	$362.83 $392.78 $424.52 $537.25	$503.74 $533.69 $565.43 $678.16	$644.65 $674.60 $706.34 $819.07	$140.91
Plan: (POS) Silver HSA $3500 - 0% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.) Deductible: Individual: $3,500 : Family: $7,000 Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$334.80 $379.99 $427.87 $597.95 $908.64	$669.60 $759.98 $855.74 $1195.90 $1817.28	$882.19 $972.57 $1068.33 $1408.49	$1094.78 $1185.16 $1280.92 $1621.08	$1307.37 $1397.75 $1493.51 $1833.67	$547.39 $592.58 $640.46 $810.54	$759.98 $805.17 $853.05 $1023.13	$972.57 $1017.76 $1065.64 $1235.72	$212.59
Plan: (POS) Silver HSA $2000 - 50% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.) Deductible: Individual: $2,000 : Family: $4,000 Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$323.99 $367.72 $414.05 $578.64 $879.30	$647.98 $735.44 $828.10 $1157.28 $1758.60	$853.71 $941.17 $1033.83 $1363.01	$1059.44 $1146.90 $1239.56 $1568.74	$1265.17 $1352.63 $1445.29 $1774.47	$529.72 $573.45 $619.78 $784.37	$735.45 $779.18 $825.51 $990.10	$941.18 $984.91 $1031.24 $1195.83	$205.73
Plan: (POS) Bronze HSA $3250 - 50% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.) Deductible: Individual: $3,250 : Family: $6,500 Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$287.34 $326.13 $367.22 $513.18 $779.84	$574.68 $652.26 $734.44 $1026.36 $1559.68	$757.14 $834.72 $916.90 $1208.82	$939.60 $1017.18 $1099.36 $1391.28	$1122.06 $1199.64 $1281.82 $1573.74	$469.80 $508.59 $549.68 $695.64	$652.26 $691.05 $732.14 $878.10	$834.72 $873.51 $914.60 $1060.56	$182.46
Plan: (POS) Bronze HSA $6000 - 0% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.) Deductible: Individual: $6,000 : Family: $12,000 Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$276.28 $313.57 $353.08 $493.43 $749.82	$552.56 $627.14 $706.16 $986.86 $1499.64	$727.99 $802.57 $881.59 $1162.29	$903.42 $978.00 $1057.02 $1337.72	$1078.85 $1153.43 $1232.45 $1513.15	$451.71 $489.00 $528.51 $668.86	$627.14 $664.43 $703.94 $844.29	$802.57 $839.86 $879.37 $1019.72	$175.43
Plan: (POS) Bronze HSA $5000 - 20% Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.) Deductible: Individual: $5,000 : Family: $10,000 Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$267.52 $303.63 $341.89 $477.79 $726.04	$535.04 $607.26 $683.78 $955.58 $1452.08	$704.91 $777.13 $853.65 $1125.45	$874.78 $947.00 $1023.52 $1295.32	$1044.65 $1116.87 $1193.39 $1465.19	$437.39 $473.50 $511.76 $647.66	$607.26 $643.37 $681.63 $817.53	$777.13 $813.24 $851.50 $987.40	$169.87
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Group Health Cooperative- SCW Local: 1-608-442-7290 \| Toll Free: 1-855-344-2729 TTY: 1-608-828-4815
Plan: (HMO) Platinum 500 Deductible Summary 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 Out of Pocket Maximum per year: 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	$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 Arch Summary 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 Out of Pocket Maximum per year: Individual: $2,000 : Family: $4,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
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 Deductible Summary 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 Out of Pocket Maximum per year: Individual: $3,000 : Family: $6,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$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 Arch Summary 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 Out of Pocket Maximum per year: Individual: $4,000 : Family: $8,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$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 HSA Summary 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 Out of Pocket Maximum per year: Individual: $2,000 : Family: $4,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$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 Copay Summary 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 Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$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 Deductible Summary 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 Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$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 HSA Summary 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 Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$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 Deductible Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$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 HSA Summary 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 Out of Pocket Maximum per year: Individual: $6,450 : Family: $12,900 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$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) Silver 3,500 Deductible Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$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 Deductible Summary 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 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Catastrophic	21 30 40 50 60	$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

†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 Vernon County here.

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Obamacare 2016 Marketplace Rates For Vernon County, Wisconsin

2016 Rates and Providers

Obamacare Providers, Plans and 2016 Rates for Vernon County

Unity Health Plans Insurance Corporation

Plan: (HMO) Unity Elite Platinum 30/60 with Dental

Plan: (HMO) Unity Elite Platinum 25/50 with Dental

Plan: (HMO) Unity Elite Gold 30/60 with Dental

Plan: (HMO) Unity Elite Gold 20/40 with Dental

Plan: (HMO) Unity Elite Silver Plus with Dental

Plan: (HMO) Unity Elite Silver Choice Value with Dental

Plan: (HMO) Unity Elite Silver Exclusive Value with Dental

Plan: (HMO) Unity Elite Bronze 55/150 with Dental

Plan: (HMO) Unity Elite Silver Maintenance with Dental

Plan: (HMO) Unity Elite Platinum 20/40 with Dental

Plan: (HMO) Unity Elite Bronze 45/125 Value with Dental

Plan: (HMO) Unity Elite Platinum 30/60

Plan: (HMO) Unity Elite Platinum 25/50

Plan: (HMO) Unity Elite Gold 30/60

Plan: (HMO) Unity Elite Gold 20/40

Plan: (HMO) Unity Elite Silver Plus

Plan: (HMO) Unity Elite Silver Choice Value

Plan: (HMO) Unity Elite Silver Exclusive Value

Plan: (HMO) Unity Elite Bronze 55/150

Plan: (HMO) Unity Elite Silver Maintenance

Plan: (HMO) Unity Elite Platinum 20/40

Plan: (HMO) Unity Elite Bronze 45/125 Value

Plan: (HMO) Unity Elite Gold Deductible

Plan: (HMO) Unity Elite Silver Deductible

Plan: (HMO) Unity Elite Bronze HSA

Plan: (HMO) Unity Elite Catastrophic

Dean Health Plan

Plan: (HMO) Dean Catastrophic Safety Net

Plan: (HMO) Dean Silver Copay Plus 2000X

Plan: (HMO) Dean Silver Classic 2500X

Plan: (HMO) Dean Silver Classic 4500X

Plan: (HMO) Dean Silver Value Copay 5150X

Plan: (HMO) Dean Bronze Value Copay 5500X

Plan: (HMO) Dean Gold Classic 1500X

Plan: (HMO) Dean Gold Value Copay 2250X

Plan: (HMO) Dean Gold HSA 2000X

Plan: (HMO) Dean Bronze Value Copay 6750X

Plan: (HMO) Dean Bronze HSA-E 6000X

Plan: (HMO) Dean Bronze HSA-E 6450X

Plan: (HMO) Dean Silver HSA-E 3400X

Plan: (HMO) Dean Platinum Copay Plus 500X

Plan: (HMO) Dean Gold Copay Plus 1000X

Plan: (HMO) Dean Silver Copay Plus 3500X

All Savers Insurance Company

Plan: (EPO) Gold Compass 1000

Plan: (EPO) Gold Compass 500

Plan: (EPO) Silver Compass HSA 3000

Plan: (EPO) Silver Compass 2000 1

Plan: (EPO) Silver Compass 2000

Plan: (EPO) Silver Compass 3500

Plan: (EPO) Silver Compass 4500

Plan: (EPO) Bronze Compass HSA 5500

Plan: (EPO) Bronze Compass 6500

Plan: (EPO) Gold Compass 0

Health Tradition Health Plan

Plan: (HMO) Gold 1000/80

Plan: (HMO) Gold 2000/80 w/copay

Plan: (HMO) Bronze HDHP 100 Low

Plan: (HMO) Bronze 6000/80

Plan: (HMO) Bronze HDHP 100 High

Plan: (HMO) Essential HDHP

Plan: (HMO) Silver 2000/80

Plan: (HMO) Silver 4000/80 w/copay

Plan: (HMO) Silver HDHP 85

Plan: (HMO) Gold 2375/100

Plan: (HMO) Silver 3000/70 w/copay

Plan: (HMO) Silver HDHP 100

Plan: (HMO) Silver 3500

Plan: (HMO) Bronze HDHP 80

Plan: (HMO) Bronze HDHP 50

Plan: (HMO) Bronze 6850/100 Rx

Plan: (HMO) Bronze 6850/100

Physicians Plus Insurance Corporation

Plan: (HMO) 6850D