Obamacare Providers, Plans and 2017 Rates for Walworth County
The health insurance rates listed below are for calendar year 2017.
2017 Rates and Providers
(click here for 2014)
(click here for 2015)
(click here for 2016)
This page gives you an overview of the rates for individual and family health insurance plans available from HealthCare.gov, the marketplace for Elkhorn, WI.
Currently, there are 70 plans offered in Walworth County.
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:
- 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 Elkhorn, WI area accept this insurance coverage as within the plan's "network".
‡Source: HealthCare.gov has released sample rates for all counties in those states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Walworth County here.
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MercyCare HMO, Inc.Local: 1-800-895-2421 | Toll Free: 1-800-895-2421 |
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Plan: (HMO) MercyCare HMO Bronze Option ASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$179.75 $204.00 $229.71 $321.02 $487.81 |
$359.50 $408.00 $459.42 $642.04 $975.62 |
$473.63 $522.13 $573.55 $756.17 |
$587.76 $636.26 $687.68 $870.30 |
$701.89 $750.39 $801.81 $984.43 |
$293.88 $318.13 $343.84 $435.15 |
$408.01 $432.26 $457.97 $549.28 |
$522.14 $546.39 $572.10 $663.41 |
$114.13 |
Plan: (HMO) MercyCare HMO Gold Option B StandardSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
Deductible: Individual:
$1,250
: Family:
$2,500 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$258.42 $293.30 $330.25 $461.52 $701.32 |
$516.84 $586.60 $660.50 $923.04 $1402.64 |
$680.93 $750.69 $824.59 $1087.13 |
$845.02 $914.78 $988.68 $1251.22 |
$1009.11 $1078.87 $1152.77 $1415.31 |
$422.51 $457.39 $494.34 $625.61 |
$586.60 $621.48 $658.43 $789.70 |
$750.69 $785.57 $822.52 $953.79 |
$164.09 |
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Unity Health Plans Insurance CorporationLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 TTY: 1-608-643-1421 |
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Plan: (HMO) Elite Gold 30/60 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,200
: Family:
$2,400 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$424.21 $481.48 $542.14 $757.64 $1151.30 |
$848.42 $962.96 $1084.28 $1515.28 $2302.60 |
$1117.79 $1232.33 $1353.65 $1784.65 |
$1387.16 $1501.70 $1623.02 $2054.02 |
$1656.53 $1771.07 $1892.39 $2323.39 |
$693.58 $750.85 $811.51 $1027.01 |
$962.95 $1020.22 $1080.88 $1296.38 |
$1232.32 $1289.59 $1350.25 $1565.75 |
$269.37 |
Plan: (HMO) Elite Silver 30/60 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$5,250
: Family:
$10,500 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$357.23 $405.45 $456.53 $638.00 $969.51 |
$714.46 $810.90 $913.06 $1276.00 $1939.02 |
$941.30 $1037.74 $1139.90 $1502.84 |
$1168.14 $1264.58 $1366.74 $1729.68 |
$1394.98 $1491.42 $1593.58 $1956.52 |
$584.07 $632.29 $683.37 $864.84 |
$810.91 $859.13 $910.21 $1091.68 |
$1037.75 $1085.97 $1137.05 $1318.52 |
$226.84 |
Plan: (HMO) Elite Silver 25/50 Value with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$3,200
: Family:
$6,400 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$360.45 $409.11 $460.65 $643.76 $978.26 |
$720.90 $818.22 $921.30 $1287.52 $1956.52 |
$949.78 $1047.10 $1150.18 $1516.40 |
$1178.66 $1275.98 $1379.06 $1745.28 |
$1407.54 $1504.86 $1607.94 $1974.16 |
$589.33 $637.99 $689.53 $872.64 |
$818.21 $866.87 $918.41 $1101.52 |
$1047.09 $1095.75 $1147.29 $1330.40 |
$228.88 |
Plan: (HMO) Elite Silver 40/90 Value with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$4,350
: Family:
$8,700 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$346.17 $392.90 $442.40 $618.25 $939.50 |
$692.34 $785.80 $884.80 $1236.50 $1879.00 |
$912.16 $1005.62 $1104.62 $1456.32 |
$1131.98 $1225.44 $1324.44 $1676.14 |
$1351.80 $1445.26 $1544.26 $1895.96 |
$565.99 $612.72 $662.22 $838.07 |
$785.81 $832.54 $882.04 $1057.89 |
$1005.63 $1052.36 $1101.86 $1277.71 |
$219.82 |
Plan: (HMO) Elite Silver Maintenance with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,750
: Family:
$3,500 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$370.75 $420.80 $473.82 $662.16 $1006.21 |
$741.50 $841.60 $947.64 $1324.32 $2012.42 |
$976.93 $1077.03 $1183.07 $1559.75 |
$1212.36 $1312.46 $1418.50 $1795.18 |
$1447.79 $1547.89 $1653.93 $2030.61 |
$606.18 $656.23 $709.25 $897.59 |
$841.61 $891.66 $944.68 $1133.02 |
$1077.04 $1127.09 $1180.11 $1368.45 |
$235.43 |
Plan: (HMO) Elite Bronze 55/125 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$6,900
: Family:
$13,800 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$307.37 $348.86 $392.81 $548.96 $834.19 |
$614.74 $697.72 $785.62 $1097.92 $1668.38 |
$809.92 $892.90 $980.80 $1293.10 |
$1005.10 $1088.08 $1175.98 $1488.28 |
$1200.28 $1283.26 $1371.16 $1683.46 |
$502.55 $544.04 $587.99 $744.14 |
$697.73 $739.22 $783.17 $939.32 |
$892.91 $934.40 $978.35 $1134.50 |
$195.18 |
Plan: (HMO) Elite Gold Wise Savings with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$430.09 $488.15 $549.65 $768.13 $1167.25 |
$860.18 $976.30 $1099.30 $1536.26 $2334.50 |
$1133.28 $1249.40 $1372.40 $1809.36 |
$1406.38 $1522.50 $1645.50 $2082.46 |
$1679.48 $1795.60 $1918.60 $2355.56 |
$703.19 $761.25 $822.75 $1041.23 |
$976.29 $1034.35 $1095.85 $1314.33 |
$1249.39 $1307.45 $1368.95 $1587.43 |
$273.10 |
Plan: (HMO) Elite Gold 30/60Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,200
: Family:
$2,400 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$400.32 $454.36 $511.61 $714.97 $1086.46 |
$800.64 $908.72 $1023.22 $1429.94 $2172.92 |
$1054.84 $1162.92 $1277.42 $1684.14 |
$1309.04 $1417.12 $1531.62 $1938.34 |
$1563.24 $1671.32 $1785.82 $2192.54 |
$654.52 $708.56 $765.81 $969.17 |
$908.72 $962.76 $1020.01 $1223.37 |
$1162.92 $1216.96 $1274.21 $1477.57 |
$254.20 |
Plan: (HMO) Elite Silver 30/60Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$5,250
: Family:
$10,500 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$337.11 $382.62 $430.82 $602.07 $914.91 |
$674.22 $765.24 $861.64 $1204.14 $1829.82 |
$888.28 $979.30 $1075.70 $1418.20 |
$1102.34 $1193.36 $1289.76 $1632.26 |
$1316.40 $1407.42 $1503.82 $1846.32 |
$551.17 $596.68 $644.88 $816.13 |
$765.23 $810.74 $858.94 $1030.19 |
$979.29 $1024.80 $1073.00 $1244.25 |
$214.06 |
Plan: (HMO) Elite Silver 25/50 ValueSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$3,200
: Family:
$6,400 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$340.15 $386.07 $434.71 $607.50 $923.16 |
$680.30 $772.14 $869.42 $1215.00 $1846.32 |
$896.29 $988.13 $1085.41 $1430.99 |
$1112.28 $1204.12 $1301.40 $1646.98 |
$1328.27 $1420.11 $1517.39 $1862.97 |
$556.14 $602.06 $650.70 $823.49 |
$772.13 $818.05 $866.69 $1039.48 |
$988.12 $1034.04 $1082.68 $1255.47 |
$215.99 |
Plan: (HMO) Elite Silver 40/90 ValueSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$4,350
: Family:
$8,700 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$326.68 $370.77 $417.49 $583.43 $886.58 |
$653.36 $741.54 $834.98 $1166.86 $1773.16 |
$860.80 $948.98 $1042.42 $1374.30 |
$1068.24 $1156.42 $1249.86 $1581.74 |
$1275.68 $1363.86 $1457.30 $1789.18 |
$534.12 $578.21 $624.93 $790.87 |
$741.56 $785.65 $832.37 $998.31 |
$949.00 $993.09 $1039.81 $1205.75 |
$207.44 |
Plan: (HMO) Elite Silver MaintenanceSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,750
: Family:
$3,500 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$349.87 $397.10 $447.13 $624.86 $949.54 |
$699.74 $794.20 $894.26 $1249.72 $1899.08 |
$921.91 $1016.37 $1116.43 $1471.89 |
$1144.08 $1238.54 $1338.60 $1694.06 |
$1366.25 $1460.71 $1560.77 $1916.23 |
$572.04 $619.27 $669.30 $847.03 |
$794.21 $841.44 $891.47 $1069.20 |
$1016.38 $1063.61 $1113.64 $1291.37 |
$222.17 |
Plan: (HMO) Elite Bronze 55/125Summary 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:
$6,900
: Family:
$13,800 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$290.06 $329.21 $370.69 $518.04 $787.21 |
$580.12 $658.42 $741.38 $1036.08 $1574.42 |
$764.31 $842.61 $925.57 $1220.27 |
$948.50 $1026.80 $1109.76 $1404.46 |
$1132.69 $1210.99 $1293.95 $1588.65 |
$474.25 $513.40 $554.88 $702.23 |
$658.44 $697.59 $739.07 $886.42 |
$842.63 $881.78 $923.26 $1070.61 |
$184.19 |
Plan: (HMO) Elite Gold Wise SavingsSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$405.87 $460.66 $518.69 $724.87 $1101.51 |
$811.74 $921.32 $1037.38 $1449.74 $2203.02 |
$1069.46 $1179.04 $1295.10 $1707.46 |
$1327.18 $1436.76 $1552.82 $1965.18 |
$1584.90 $1694.48 $1810.54 $2222.90 |
$663.59 $718.38 $776.41 $982.59 |
$921.31 $976.10 $1034.13 $1240.31 |
$1179.03 $1233.82 $1291.85 $1498.03 |
$257.72 |
Plan: (HMO) Elite Gold StandardSummary 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:
$1,250
: Family:
$2,500 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$415.59 $471.69 $531.12 $742.23 $1127.89 |
$831.18 $943.38 $1062.24 $1484.46 $2255.78 |
$1095.08 $1207.28 $1326.14 $1748.36 |
$1358.98 $1471.18 $1590.04 $2012.26 |
$1622.88 $1735.08 $1853.94 $2276.16 |
$679.49 $735.59 $795.02 $1006.13 |
$943.39 $999.49 $1058.92 $1270.03 |
$1207.29 $1263.39 $1322.82 $1533.93 |
$263.90 |
Plan: (HMO) Elite Silver StandardSummary 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:
$3,500
: Family:
$7,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$349.34 $396.49 $446.45 $623.91 $948.08 |
$698.68 $792.98 $892.90 $1247.82 $1896.16 |
$920.51 $1014.81 $1114.73 $1469.65 |
$1142.34 $1236.64 $1336.56 $1691.48 |
$1364.17 $1458.47 $1558.39 $1913.31 |
$571.17 $618.32 $668.28 $845.74 |
$793.00 $840.15 $890.11 $1067.57 |
$1014.83 $1061.98 $1111.94 $1289.40 |
$221.83 |
Plan: (HMO) Elite Bronze StandardSummary 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:
$6,650
: Family:
$13,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$289.52 $328.60 $370.01 $517.08 $785.75 |
$579.04 $657.20 $740.02 $1034.16 $1571.50 |
$762.88 $841.04 $923.86 $1218.00 |
$946.72 $1024.88 $1107.70 $1401.84 |
$1130.56 $1208.72 $1291.54 $1585.68 |
$473.36 $512.44 $553.85 $700.92 |
$657.20 $696.28 $737.69 $884.76 |
$841.04 $880.12 $921.53 $1068.60 |
$183.84 |
Plan: (HMO) Elite Gold DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,500
: Family:
$3,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$384.34 $436.22 $491.18 $686.42 $1043.09 |
$768.68 $872.44 $982.36 $1372.84 $2086.18 |
$1012.73 $1116.49 $1226.41 $1616.89 |
$1256.78 $1360.54 $1470.46 $1860.94 |
$1500.83 $1604.59 $1714.51 $2104.99 |
$628.39 $680.27 $735.23 $930.47 |
$872.44 $924.32 $979.28 $1174.52 |
$1116.49 $1168.37 $1223.33 $1418.57 |
$244.05 |
Plan: (HMO) Elite Silver DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$2,650
: Family:
$5,300 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 |
$333.95 $379.03 $426.78 $596.43 $906.33 |
$667.90 $758.06 $853.56 $1192.86 $1812.66 |
$879.96 $970.12 $1065.62 $1404.92 |
$1092.02 $1182.18 $1277.68 $1616.98 |
$1304.08 $1394.24 $1489.74 $1829.04 |
$546.01 $591.09 $638.84 $808.49 |
$758.07 $803.15 $850.90 $1020.55 |
$970.13 $1015.21 $1062.96 $1232.61 |
$212.06 |
Plan: (HMO) Elite Bronze HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$286.84 $325.56 $366.58 $512.29 $778.47 |
$573.68 $651.12 $733.16 $1024.58 $1556.94 |
$755.82 $833.26 $915.30 $1206.72 |
$937.96 $1015.40 $1097.44 $1388.86 |
$1120.10 $1197.54 $1279.58 $1571.00 |
$468.98 $507.70 $548.72 $694.43 |
$651.12 $689.84 $730.86 $876.57 |
$833.26 $871.98 $913.00 $1058.71 |
$182.14 |
Plan: (HMO) Elite CatastrophicSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$7,150
: Family:
$14,300 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 |
Catastrophic | 21 30 40 50 60 |
$211.11 $239.60 $269.79 $377.03 $572.93 |
$422.22 $479.20 $539.58 $754.06 $1145.86 |
$556.27 $613.25 $673.63 $888.11 |
$690.32 $747.30 $807.68 $1022.16 |
$824.37 $881.35 $941.73 $1156.21 |
$345.16 $373.65 $403.84 $511.08 |
$479.21 $507.70 $537.89 $645.13 |
$613.26 $641.75 $671.94 $779.18 |
|
ADVERTISEMENT
|
||||||||||
Dean Health PlanLocal: 1-608-828-1302 | Toll Free: 1-800-279-1302 TTY: 1-608-827-4086 |
||||||||||
Plan: (HMO) Dean Catastrophic Safety NetSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$7,150
: Family:
$14,300 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 |
Catastrophic | 21 30 40 50 60 |
$139.59 $158.43 $178.39 $249.30 $378.84 |
$279.18 $316.86 $356.78 $498.60 $757.68 |
$367.82 $405.50 $445.42 $587.24 |
$456.46 $494.14 $534.06 $675.88 |
$545.10 $582.78 $622.70 $764.52 |
$228.23 $247.07 $267.03 $337.94 |
$316.87 $335.71 $355.67 $426.58 |
$405.51 $424.35 $444.31 $515.22 |
$88.64 |
Plan: (HMO) Dean Silver Copay Plus 2750XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$2,750
: Family:
$5,500 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 |
$268.97 $305.29 $343.75 $480.39 $730.00 |
$537.94 $610.58 $687.50 $960.78 $1460.00 |
$708.74 $781.38 $858.30 $1131.58 |
$879.54 $952.18 $1029.10 $1302.38 |
$1050.34 $1122.98 $1199.90 $1473.18 |
$439.77 $476.09 $514.55 $651.19 |
$610.57 $646.89 $685.35 $821.99 |
$781.37 $817.69 $856.15 $992.79 |
$170.80 |
Plan: (HMO) Dean Silver Classic 2500XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$267.06 $303.11 $341.30 $476.96 $724.79 |
$534.12 $606.22 $682.60 $953.92 $1449.58 |
$703.70 $775.80 $852.18 $1123.50 |
$873.28 $945.38 $1021.76 $1293.08 |
$1042.86 $1114.96 $1191.34 $1462.66 |
$436.64 $472.69 $510.88 $646.54 |
$606.22 $642.27 $680.46 $816.12 |
$775.80 $811.85 $850.04 $985.70 |
$169.58 |
ADVERTISEMENT
|
||||||||||
MercyCare HMO, Inc.Local: 1-800-895-2421 | Toll Free: 1-800-895-2421 |
||||||||||
Plan: (HMO) MercyCare HMO Gold Option CSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
Deductible: Individual:
$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 |
$260.32 $295.45 $332.68 $464.91 $706.48 |
$520.64 $590.90 $665.36 $929.82 $1412.96 |
$685.94 $756.20 $830.66 $1095.12 |
$851.24 $921.50 $995.96 $1260.42 |
$1016.54 $1086.80 $1161.26 $1425.72 |
$425.62 $460.75 $497.98 $630.21 |
$590.92 $626.05 $663.28 $795.51 |
$756.22 $791.35 $828.58 $960.81 |
$165.30 |
ADVERTISEMENT
|
||||||||||
Dean Health PlanLocal: 1-608-828-1302 | Toll Free: 1-800-279-1302 TTY: 1-608-827-4086 |
||||||||||
Plan: (HMO) Dean Silver Classic 3750XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$3,750
: Family:
$7,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$255.84 $290.37 $326.96 $456.92 $694.34 |
$511.68 $580.74 $653.92 $913.84 $1388.68 |
$674.14 $743.20 $816.38 $1076.30 |
$836.60 $905.66 $978.84 $1238.76 |
$999.06 $1068.12 $1141.30 $1401.22 |
$418.30 $452.83 $489.42 $619.38 |
$580.76 $615.29 $651.88 $781.84 |
$743.22 $777.75 $814.34 $944.30 |
$162.46 |
Plan: (HMO) Dean Silver Value Copay 5000XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$252.02 $286.05 $322.09 $450.11 $683.99 |
$504.04 $572.10 $644.18 $900.22 $1367.98 |
$664.08 $732.14 $804.22 $1060.26 |
$824.12 $892.18 $964.26 $1220.30 |
$984.16 $1052.22 $1124.30 $1380.34 |
$412.06 $446.09 $482.13 $610.15 |
$572.10 $606.13 $642.17 $770.19 |
$732.14 $766.17 $802.21 $930.23 |
$160.04 |
Plan: (HMO) Dean Gold Value Copay 2650XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$2,650
: Family:
$5,300 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 |
Gold | 21 30 40 50 60 |
$292.31 $331.77 $373.57 $522.07 $793.33 |
$584.62 $663.54 $747.14 $1044.14 $1586.66 |
$770.24 $849.16 $932.76 $1229.76 |
$955.86 $1034.78 $1118.38 $1415.38 |
$1141.48 $1220.40 $1304.00 $1601.00 |
$477.93 $517.39 $559.19 $707.69 |
$663.55 $703.01 $744.81 $893.31 |
$849.17 $888.63 $930.43 $1078.93 |
$185.62 |
Plan: (HMO) Dean Bronze Value Copay 7150XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$7,150
: Family:
$14,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$206.61 $234.50 $264.05 $369.01 $560.74 |
$413.22 $469.00 $528.10 $738.02 $1121.48 |
$544.42 $600.20 $659.30 $869.22 |
$675.62 $731.40 $790.50 $1000.42 |
$806.82 $862.60 $921.70 $1131.62 |
$337.81 $365.70 $395.25 $500.21 |
$469.01 $496.90 $526.45 $631.41 |
$600.21 $628.10 $657.65 $762.61 |
$131.20 |
ADVERTISEMENT
|
||||||||||
MercyCare HMO, Inc.Local: 1-800-895-2421 | Toll Free: 1-800-895-2421 |
||||||||||
Plan: (HMO) MercyCare HMO Silver Option ASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$211.31 $239.83 $270.04 $377.38 $573.47 |
$422.62 $479.66 $540.08 $754.76 $1146.94 |
$556.80 $613.84 $674.26 $888.94 |
$690.98 $748.02 $808.44 $1023.12 |
$825.16 $882.20 $942.62 $1157.30 |
$345.49 $374.01 $404.22 $511.56 |
$479.67 $508.19 $538.40 $645.74 |
$613.85 $642.37 $672.58 $779.92 |
$134.18 |
ADVERTISEMENT
|
||||||||||
Dean Health PlanLocal: 1-608-828-1302 | Toll Free: 1-800-279-1302 TTY: 1-608-827-4086 |
||||||||||
Plan: (HMO) Dean Silver HSA-E 3000XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$254.31 $288.64 $325.00 $454.19 $690.19 |
$508.62 $577.28 $650.00 $908.38 $1380.38 |
$670.10 $738.76 $811.48 $1069.86 |
$831.58 $900.24 $972.96 $1231.34 |
$993.06 $1061.72 $1134.44 $1392.82 |
$415.79 $450.12 $486.48 $615.67 |
$577.27 $611.60 $647.96 $777.15 |
$738.75 $773.08 $809.44 $938.63 |
$161.48 |
Plan: (HMO) Dean Gold Copay Plus 1500XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$1,500
: Family:
$3,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$293.48 $333.10 $375.06 $524.15 $796.50 |
$586.96 $666.20 $750.12 $1048.30 $1593.00 |
$773.32 $852.56 $936.48 $1234.66 |
$959.68 $1038.92 $1122.84 $1421.02 |
$1146.04 $1225.28 $1309.20 $1607.38 |
$479.84 $519.46 $561.42 $710.51 |
$666.20 $705.82 $747.78 $896.87 |
$852.56 $892.18 $934.14 $1083.23 |
$186.36 |
Plan: (HMO) Dean Silver Copay Plus 3500XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$270.50 $307.02 $345.70 $483.12 $734.15 |
$541.00 $614.04 $691.40 $966.24 $1468.30 |
$712.77 $785.81 $863.17 $1138.01 |
$884.54 $957.58 $1034.94 $1309.78 |
$1056.31 $1129.35 $1206.71 $1481.55 |
$442.27 $478.79 $517.47 $654.89 |
$614.04 $650.56 $689.24 $826.66 |
$785.81 $822.33 $861.01 $998.43 |
$171.77 |
Plan: (HMO) Dean Bronze HSA-E 6550XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$205.08 $232.77 $262.09 $366.28 $556.59 |
$410.16 $465.54 $524.18 $732.56 $1113.18 |
$540.39 $595.77 $654.41 $862.79 |
$670.62 $726.00 $784.64 $993.02 |
$800.85 $856.23 $914.87 $1123.25 |
$335.31 $363.00 $392.32 $496.51 |
$465.54 $493.23 $522.55 $626.74 |
$595.77 $623.46 $652.78 $756.97 |
$130.23 |
ADVERTISEMENT
|
||||||||||
Molina Healthcare of Wisconsin, Inc.Local: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
||||||||||
Plan: (HMO) Molina Marketplace GoldSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-2043 - Provider Directory for This Plan: (Molina Healthcare of Wisconsin, Inc.)
Deductible: Individual:
$1,025
: Family:
$2,050 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$392.88 $445.92 $502.10 $701.69 $1066.28 |
$785.76 $891.84 $1004.20 $1403.38 $2132.56 |
$1035.24 $1141.32 $1253.68 $1652.86 |
$1284.72 $1390.80 $1503.16 $1902.34 |
$1534.20 $1640.28 $1752.64 $2151.82 |
$642.36 $695.40 $751.58 $951.17 |
$891.84 $944.88 $1001.06 $1200.65 |
$1141.32 $1194.36 $1250.54 $1450.13 |
$249.48 |
Plan: (HMO) Molina Marketplace SilverSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-2043 - Provider Directory for This Plan: (Molina Healthcare of Wisconsin, Inc.)
Deductible: Individual:
$2,400
: Family:
$4,800 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$307.98 $349.56 $393.60 $550.05 $835.86 |
$615.96 $699.12 $787.20 $1100.10 $1671.72 |
$811.53 $894.69 $982.77 $1295.67 |
$1007.10 $1090.26 $1178.34 $1491.24 |
$1202.67 $1285.83 $1373.91 $1686.81 |
$503.55 $545.13 $589.17 $745.62 |
$699.12 $740.70 $784.74 $941.19 |
$894.69 $936.27 $980.31 $1136.76 |
$195.57 |
Plan: (HMO) Molina Marketplace BronzeSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-2043 - Provider Directory for This Plan: (Molina Healthcare of Wisconsin, Inc.)
Deductible: Individual:
$6,650
: Family:
$13,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$263.40 $298.95 $336.62 $470.42 $714.86 |
$526.80 $597.90 $673.24 $940.84 $1429.72 |
$694.06 $765.16 $840.50 $1108.10 |
$861.32 $932.42 $1007.76 $1275.36 |
$1028.58 $1099.68 $1175.02 $1442.62 |
$430.66 $466.21 $503.88 $637.68 |
$597.92 $633.47 $671.14 $804.94 |
$765.18 $800.73 $838.40 $972.20 |
$167.26 |
Plan: (HMO) Molina Marketplace Options SilverSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-2043 - Provider Directory for This Plan: (Molina Healthcare of Wisconsin, Inc.)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$310.86 $352.82 $397.27 $555.19 $843.66 |
$621.72 $705.64 $794.54 $1110.38 $1687.32 |
$819.11 $903.03 $991.93 $1307.77 |
$1016.50 $1100.42 $1189.32 $1505.16 |
$1213.89 $1297.81 $1386.71 $1702.55 |
$508.25 $550.21 $594.66 $752.58 |
$705.64 $747.60 $792.05 $949.97 |
$903.03 $944.99 $989.44 $1147.36 |
$197.39 |
Plan: (HMO) Molina Marketplace Options BronzeSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-560-2043 - Provider Directory for This Plan: (Molina Healthcare of Wisconsin, Inc.)
Deductible: Individual:
$6,650
: Family:
$13,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$271.01 $307.60 $346.35 $484.03 $735.53 |
$542.02 $615.20 $692.70 $968.06 $1471.06 |
$714.11 $787.29 $864.79 $1140.15 |
$886.20 $959.38 $1036.88 $1312.24 |
$1058.29 $1131.47 $1208.97 $1484.33 |
$443.10 $479.69 $518.44 $656.12 |
$615.19 $651.78 $690.53 $828.21 |
$787.28 $823.87 $862.62 $1000.30 |
$172.09 |
ADVERTISEMENT
|
||||||||||
MercyCare HMO, Inc.Local: 1-800-895-2421 | Toll Free: 1-800-895-2421 |
||||||||||
Plan: (HMO) MercyCare HMO Gold Option ASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
Deductible: Individual:
$1,500
: Family:
$3,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$256.49 $291.10 $327.78 $458.07 $696.09 |
$512.98 $582.20 $655.56 $916.14 $1392.18 |
$675.84 $745.06 $818.42 $1079.00 |
$838.70 $907.92 $981.28 $1241.86 |
$1001.56 $1070.78 $1144.14 $1404.72 |
$419.35 $453.96 $490.64 $620.93 |
$582.21 $616.82 $653.50 $783.79 |
$745.07 $779.68 $816.36 $946.65 |
$162.86 |
Plan: (HMO) MercyCare HMO Silver Option B StandardSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$213.28 $242.06 $272.56 $380.90 $578.81 |
$426.56 $484.12 $545.12 $761.80 $1157.62 |
$561.99 $619.55 $680.55 $897.23 |
$697.42 $754.98 $815.98 $1032.66 |
$832.85 $890.41 $951.41 $1168.09 |
$348.71 $377.49 $407.99 $516.33 |
$484.14 $512.92 $543.42 $651.76 |
$619.57 $648.35 $678.85 $787.19 |
$135.43 |
Plan: (HMO) MercyCare HMO Silver Option CSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
Deductible: Individual:
$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 |
$203.96 $231.48 $260.65 $364.25 $553.52 |
$407.92 $462.96 $521.30 $728.50 $1107.04 |
$537.43 $592.47 $650.81 $858.01 |
$666.94 $721.98 $780.32 $987.52 |
$796.45 $851.49 $909.83 $1117.03 |
$333.47 $360.99 $390.16 $493.76 |
$462.98 $490.50 $519.67 $623.27 |
$592.49 $620.01 $649.18 $752.78 |
$129.51 |
Plan: (HMO) MercyCare HMO Bronze Option B StandardSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
Deductible: Individual:
$6,650
: Family:
$13,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$176.75 $200.60 $225.87 $315.66 $479.67 |
$353.50 $401.20 $451.74 $631.32 $959.34 |
$465.73 $513.43 $563.97 $743.55 |
$577.96 $625.66 $676.20 $855.78 |
$690.19 $737.89 $788.43 $968.01 |
$288.98 $312.83 $338.10 $427.89 |
$401.21 $425.06 $450.33 $540.12 |
$513.44 $537.29 $562.56 $652.35 |
$112.23 |
Plan: (HMO) MercyCare HMO Bronze Option CSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$167.74 $190.37 $214.36 $299.57 $455.22 |
$335.48 $380.74 $428.72 $599.14 $910.44 |
$441.99 $487.25 $535.23 $705.65 |
$548.50 $593.76 $641.74 $812.16 |
$655.01 $700.27 $748.25 $918.67 |
$274.25 $296.88 $320.87 $406.08 |
$380.76 $403.39 $427.38 $512.59 |
$487.27 $509.90 $533.89 $619.10 |
$106.51 |
ADVERTISEMENT
|
||||||||||
Compcare Health Serv Ins Co(Anthem BCBS)Local: 1-855-748-1813 | Toll Free: 1-855-748-1813 |
||||||||||
Plan: (HMO) Anthem Catastrophic Blue Priority WI 7150Summary 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:
$7,150
: Family:
$14,300 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 |
Catastrophic | 21 30 40 50 60 |
$243.29 $276.13 $310.92 $434.52 $660.29 |
$486.58 $552.26 $621.84 $869.04 $1320.58 |
$641.07 $706.75 $776.33 $1023.53 |
$795.56 $861.24 $930.82 $1178.02 |
$950.05 $1015.73 $1085.31 $1332.51 |
$397.78 $430.62 $465.41 $589.01 |
$552.27 $585.11 $619.90 $743.50 |
$706.76 $739.60 $774.39 $897.99 |
$154.49 |
Plan: (HMO) Anthem Bronze Blue Priority WI 0 for HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$307.39 $348.89 $392.84 $549.00 $834.26 |
$614.78 $697.78 $785.68 $1098.00 $1668.52 |
$809.97 $892.97 $980.87 $1293.19 |
$1005.16 $1088.16 $1176.06 $1488.38 |
$1200.35 $1283.35 $1371.25 $1683.57 |
$502.58 $544.08 $588.03 $744.19 |
$697.77 $739.27 $783.22 $939.38 |
$892.96 $934.46 $978.41 $1134.57 |
$195.19 |
Plan: (HMO) Anthem Bronze Blue Priority WI 30 for HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$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 |
Bronze | 21 30 40 50 60 |
$311.55 $353.61 $398.16 $556.43 $845.55 |
$623.10 $707.22 $796.32 $1112.86 $1691.10 |
$820.93 $905.05 $994.15 $1310.69 |
$1018.76 $1102.88 $1191.98 $1508.52 |
$1216.59 $1300.71 $1389.81 $1706.35 |
$509.38 $551.44 $595.99 $754.26 |
$707.21 $749.27 $793.82 $952.09 |
$905.04 $947.10 $991.65 $1149.92 |
$197.83 |
Plan: (HMO) Anthem Silver Blue Priority WI 3750Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$3,750
: Family:
$7,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$347.68 $394.62 $444.34 $620.96 $943.60 |
$695.36 $789.24 $888.68 $1241.92 $1887.20 |
$916.14 $1010.02 $1109.46 $1462.70 |
$1136.92 $1230.80 $1330.24 $1683.48 |
$1357.70 $1451.58 $1551.02 $1904.26 |
$568.46 $615.40 $665.12 $841.74 |
$789.24 $836.18 $885.90 $1062.52 |
$1010.02 $1056.96 $1106.68 $1283.30 |
$220.78 |
Plan: (HMO) Anthem Silver Blue Priority WI 2500Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$355.48 $403.47 $454.30 $634.89 $964.77 |
$710.96 $806.94 $908.60 $1269.78 $1929.54 |
$936.69 $1032.67 $1134.33 $1495.51 |
$1162.42 $1258.40 $1360.06 $1721.24 |
$1388.15 $1484.13 $1585.79 $1946.97 |
$581.21 $629.20 $680.03 $860.62 |
$806.94 $854.93 $905.76 $1086.35 |
$1032.67 $1080.66 $1131.49 $1312.08 |
$225.73 |
ADVERTISEMENT
|
||||||||||
Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 TTY: 1-855-643-5001 |
||||||||||
Plan: (PPO) Envision Aurora Bellin PPO - Gold 1000/90Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$1,000
: Family:
$2,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$444.51 $504.50 $568.07 $793.87 $1206.36 |
$889.02 $1009.00 $1136.14 $1587.74 $2412.72 |
$1171.27 $1291.25 $1418.39 $1869.99 |
$1453.52 $1573.50 $1700.64 $2152.24 |
$1735.77 $1855.75 $1982.89 $2434.49 |
$726.76 $786.75 $850.32 $1076.12 |
$1009.01 $1069.00 $1132.57 $1358.37 |
$1291.26 $1351.25 $1414.82 $1640.62 |
$282.25 |
ADVERTISEMENT
|
||||||||||
Compcare Health Serv Ins Co(Anthem BCBS)Local: 1-855-748-1813 | Toll Free: 1-855-748-1813 |
||||||||||
Plan: (HMO) Anthem Silver Blue Priority WI for HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$351.81 $399.30 $449.61 $628.33 $954.81 |
$703.62 $798.60 $899.22 $1256.66 $1909.62 |
$927.02 $1022.00 $1122.62 $1480.06 |
$1150.42 $1245.40 $1346.02 $1703.46 |
$1373.82 $1468.80 $1569.42 $1926.86 |
$575.21 $622.70 $673.01 $851.73 |
$798.61 $846.10 $896.41 $1075.13 |
$1022.01 $1069.50 $1119.81 $1298.53 |
$223.40 |
Plan: (HMO) Anthem Bronze Blue Priority WI 40 for HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$5,500
: Family:
$11,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$309.02 $350.74 $394.93 $551.91 $838.68 |
$618.04 $701.48 $789.86 $1103.82 $1677.36 |
$814.27 $897.71 $986.09 $1300.05 |
$1010.50 $1093.94 $1182.32 $1496.28 |
$1206.73 $1290.17 $1378.55 $1692.51 |
$505.25 $546.97 $591.16 $748.14 |
$701.48 $743.20 $787.39 $944.37 |
$897.71 $939.43 $983.62 $1140.60 |
$196.23 |
Plan: (HMO) Anthem Bronze Blue Priority WI 5450Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$5,450
: Family:
$10,900 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$303.70 $344.70 $388.13 $542.41 $824.24 |
$607.40 $689.40 $776.26 $1084.82 $1648.48 |
$800.25 $882.25 $969.11 $1277.67 |
$993.10 $1075.10 $1161.96 $1470.52 |
$1185.95 $1267.95 $1354.81 $1663.37 |
$496.55 $537.55 $580.98 $735.26 |
$689.40 $730.40 $773.83 $928.11 |
$882.25 $923.25 $966.68 $1120.96 |
$192.85 |
Plan: (HMO) Anthem Silver Blue Priority WI 4000Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$4,000
: Family:
$8,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$339.76 $385.63 $434.21 $606.81 $922.11 |
$679.52 $771.26 $868.42 $1213.62 $1844.22 |
$895.27 $987.01 $1084.17 $1429.37 |
$1111.02 $1202.76 $1299.92 $1645.12 |
$1326.77 $1418.51 $1515.67 $1860.87 |
$555.51 $601.38 $649.96 $822.56 |
$771.26 $817.13 $865.71 $1038.31 |
$987.01 $1032.88 $1081.46 $1254.06 |
$215.75 |
ADVERTISEMENT
|
||||||||||
Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 TTY: 1-855-643-5001 |
||||||||||
Plan: (PPO) Envision Aurora Bellin PPO - Catastrophic 7150/100Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$7,150
: Family:
$14,300 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 |
Catastrophic | 21 30 40 50 60 |
$238.06 $270.18 $304.22 $425.15 $646.06 |
$476.12 $540.36 $608.44 $850.30 $1292.12 |
$627.28 $691.52 $759.60 $1001.46 |
$778.44 $842.68 $910.76 $1152.62 |
$929.60 $993.84 $1061.92 $1303.78 |
$389.22 $421.34 $455.38 $576.31 |
$540.38 $572.50 $606.54 $727.47 |
$691.54 $723.66 $757.70 $878.63 |
$151.16 |
ADVERTISEMENT
|
||||||||||
Compcare Health Serv Ins Co(Anthem BCBS)Local: 1-855-748-1813 | Toll Free: 1-855-748-1813 |
||||||||||
Plan: (HMO) Anthem Silver Blue Priority WI 5300Summary 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:
$5,300
: Family:
$10,600 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$322.01 $365.48 $411.53 $575.11 $873.94 |
$644.02 $730.96 $823.06 $1150.22 $1747.88 |
$848.50 $935.44 $1027.54 $1354.70 |
$1052.98 $1139.92 $1232.02 $1559.18 |
$1257.46 $1344.40 $1436.50 $1763.66 |
$526.49 $569.96 $616.01 $779.59 |
$730.97 $774.44 $820.49 $984.07 |
$935.45 $978.92 $1024.97 $1188.55 |
$204.48 |
Plan: (HMO) Anthem Silver Blue Priority WI 3200Summary 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:
$3,200
: Family:
$6,400 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$335.33 $380.60 $428.55 $598.90 $910.09 |
$670.66 $761.20 $857.10 $1197.80 $1820.18 |
$883.59 $974.13 $1070.03 $1410.73 |
$1096.52 $1187.06 $1282.96 $1623.66 |
$1309.45 $1399.99 $1495.89 $1836.59 |
$548.26 $593.53 $641.48 $811.83 |
$761.19 $806.46 $854.41 $1024.76 |
$974.12 $1019.39 $1067.34 $1237.69 |
$212.93 |
Plan: (HMO) Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$1,850
: Family:
$3,700 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$362.07 $410.95 $462.73 $646.66 $982.66 |
$724.14 $821.90 $925.46 $1293.32 $1965.32 |
$954.05 $1051.81 $1155.37 $1523.23 |
$1183.96 $1281.72 $1385.28 $1753.14 |
$1413.87 $1511.63 $1615.19 $1983.05 |
$591.98 $640.86 $692.64 $876.57 |
$821.89 $870.77 $922.55 $1106.48 |
$1051.80 $1100.68 $1152.46 $1336.39 |
$229.91 |
Plan: (HMO) Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1813 - Provider Directory for This Plan: (Compcare Health Serv Ins Co(Anthem BCBS))
Deductible: Individual:
$1,000
: Family:
$3,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$501.66 $569.38 $641.12 $895.96 $1361.51 |
$1003.32 $1138.76 $1282.24 $1791.92 $2723.02 |
$1321.87 $1457.31 $1600.79 $2110.47 |
$1640.42 $1775.86 $1919.34 $2429.02 |
$1958.97 $2094.41 $2237.89 $2747.57 |
$820.21 $887.93 $959.67 $1214.51 |
$1138.76 $1206.48 $1278.22 $1533.06 |
$1457.31 $1525.03 $1596.77 $1851.61 |
$318.55 |
ADVERTISEMENT
|
||||||||||
Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 TTY: 1-855-643-5001 |
||||||||||
Plan: (PPO) Envision Aurora Bellin PPO - Silver 3800/80Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$3,800
: Family:
$7,600 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$354.74 $402.62 $453.35 $633.56 $962.75 |
$709.48 $805.24 $906.70 $1267.12 $1925.50 |
$934.74 $1030.50 $1131.96 $1492.38 |
$1160.00 $1255.76 $1357.22 $1717.64 |
$1385.26 $1481.02 $1582.48 $1942.90 |
$580.00 $627.88 $678.61 $858.82 |
$805.26 $853.14 $903.87 $1084.08 |
$1030.52 $1078.40 $1129.13 $1309.34 |
$225.26 |
Plan: (PPO) Envision Aurora Bellin PPO - Silver 2500/80/Copy35Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$368.13 $417.82 $470.46 $657.47 $999.09 |
$736.26 $835.64 $940.92 $1314.94 $1998.18 |
$970.02 $1069.40 $1174.68 $1548.70 |
$1203.78 $1303.16 $1408.44 $1782.46 |
$1437.54 $1536.92 $1642.20 $2016.22 |
$601.89 $651.58 $704.22 $891.23 |
$835.65 $885.34 $937.98 $1124.99 |
$1069.41 $1119.10 $1171.74 $1358.75 |
$233.76 |
Plan: (PPO) Envision Aurora Bellin PPO - Silver 2400/80Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$2,400
: Family:
$4,800 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$367.58 $417.19 $469.75 $656.47 $997.57 |
$735.16 $834.38 $939.50 $1312.94 $1995.14 |
$968.56 $1067.78 $1172.90 $1546.34 |
$1201.96 $1301.18 $1406.30 $1779.74 |
$1435.36 $1534.58 $1639.70 $2013.14 |
$600.98 $650.59 $703.15 $889.87 |
$834.38 $883.99 $936.55 $1123.27 |
$1067.78 $1117.39 $1169.95 $1356.67 |
$233.40 |
Plan: (PPO) Envision Aurora Bellin PPO - Silver 2000/70Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$2,000
: Family:
$4,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$356.97 $405.15 $456.19 $637.53 $968.78 |
$713.94 $810.30 $912.38 $1275.06 $1937.56 |
$940.61 $1036.97 $1139.05 $1501.73 |
$1167.28 $1263.64 $1365.72 $1728.40 |
$1393.95 $1490.31 $1592.39 $1955.07 |
$583.64 $631.82 $682.86 $864.20 |
$810.31 $858.49 $909.53 $1090.87 |
$1036.98 $1085.16 $1136.20 $1317.54 |
$226.67 |
Plan: (PPO) Envision Aurora Bellin PPO - Bronze 7150/100Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$7,150
: Family:
$14,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$291.06 $330.34 $371.96 $519.82 $789.91 |
$582.12 $660.68 $743.92 $1039.64 $1579.82 |
$766.94 $845.50 $928.74 $1224.46 |
$951.76 $1030.32 $1113.56 $1409.28 |
$1136.58 $1215.14 $1298.38 $1594.10 |
$475.88 $515.16 $556.78 $704.64 |
$660.70 $699.98 $741.60 $889.46 |
$845.52 $884.80 $926.42 $1074.28 |
$184.82 |
Plan: (PPO) Envision Aurora Bellin PPO - HSA Silver 3000/80Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$366.91 $416.44 $468.90 $655.29 $995.78 |
$733.82 $832.88 $937.80 $1310.58 $1991.56 |
$966.80 $1065.86 $1170.78 $1543.56 |
$1199.78 $1298.84 $1403.76 $1776.54 |
$1432.76 $1531.82 $1636.74 $2009.52 |
$599.89 $649.42 $701.88 $888.27 |
$832.87 $882.40 $934.86 $1121.25 |
$1065.85 $1115.38 $1167.84 $1354.23 |
$232.98 |
Plan: (PPO) Envision Aurora Bellin PPO - HSA Bronze 6500/100Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$6,500
: 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 |
$295.14 $334.98 $377.18 $527.11 $801.00 |
$590.28 $669.96 $754.36 $1054.22 $1602.00 |
$777.69 $857.37 $941.77 $1241.63 |
$965.10 $1044.78 $1129.18 $1429.04 |
$1152.51 $1232.19 $1316.59 $1616.45 |
$482.55 $522.39 $564.59 $714.52 |
$669.96 $709.80 $752.00 $901.93 |
$857.37 $897.21 $939.41 $1089.34 |
$187.41 |
Plan: (PPO) Envision Aurora Bellin PPO - Silver 3500/80Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$3,500
: 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 |
$363.57 $412.65 $464.64 $649.33 $986.71 |
$727.14 $825.30 $929.28 $1298.66 $1973.42 |
$958.00 $1056.16 $1160.14 $1529.52 |
$1188.86 $1287.02 $1391.00 $1760.38 |
$1419.72 $1517.88 $1621.86 $1991.24 |
$594.43 $643.51 $695.50 $880.19 |
$825.29 $874.37 $926.36 $1111.05 |
$1056.15 $1105.23 $1157.22 $1341.91 |
$230.86 |
Plan: (PPO) Envision Aurora Bellin PPO - Silver 5200/80Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)
Deductible: Individual:
$5,200
: Family:
$10,400 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$292.82 $332.34 $374.21 $522.96 $794.68 |
$585.64 $664.68 $748.42 $1045.92 $1589.36 |
$771.57 $850.61 $934.35 $1231.85 |
$957.50 $1036.54 $1120.28 $1417.78 |
$1143.43 $1222.47 $1306.21 $1603.71 |
$478.75 $518.27 $560.14 $708.89 |
$664.68 $704.20 $746.07 $894.82 |
$850.61 $890.13 $932.00 $1080.75 |
$185.93 |