Obamacare Providers, Plans and 2017 Rates for Grant 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 Lancaster, WI.
Currently, there are 83 plans offered in Grant 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 Lancaster, 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 Grant County here.
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Gundersen Health Plan, Inc.Local: 1-608-775-8092 | Toll Free: 1-855-685-6404 |
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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 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Platinum | 21 30 40 50 60 |
$530.87 $602.54 $678.45 $948.13 $1440.78 |
$1061.74 $1205.08 $1356.90 $1896.26 $2881.56 |
$1398.84 $1542.18 $1694.00 $2233.36 |
$1735.94 $1879.28 $2031.10 $2570.46 |
$2073.04 $2216.38 $2368.20 $2907.56 |
$867.97 $939.64 $1015.55 $1285.23 |
$1205.07 $1276.74 $1352.65 $1622.33 |
$1542.17 $1613.84 $1689.75 $1959.43 |
$337.10 |
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 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Platinum | 21 30 40 50 60 |
$535.75 $608.08 $684.69 $956.85 $1454.03 |
$1071.50 $1216.16 $1369.38 $1913.70 $2908.06 |
$1411.70 $1556.36 $1709.58 $2253.90 |
$1751.90 $1896.56 $2049.78 $2594.10 |
$2092.10 $2236.76 $2389.98 $2934.30 |
$875.95 $948.28 $1024.89 $1297.05 |
$1216.15 $1288.48 $1365.09 $1637.25 |
$1556.35 $1628.68 $1705.29 $1977.45 |
$340.20 |
Plan: (POS) Gold $1750 - 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:
$1,750
: 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 |
Gold | 21 30 40 50 60 |
$474.11 $538.11 $605.91 $846.76 $1286.73 |
$948.22 $1076.22 $1211.82 $1693.52 $2573.46 |
$1249.28 $1377.28 $1512.88 $1994.58 |
$1550.34 $1678.34 $1813.94 $2295.64 |
$1851.40 $1979.40 $2115.00 $2596.70 |
$775.17 $839.17 $906.97 $1147.82 |
$1076.23 $1140.23 $1208.03 $1448.88 |
$1377.29 $1441.29 $1509.09 $1749.94 |
$301.06 |
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 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 |
$449.25 $509.90 $574.14 $802.36 $1219.26 |
$898.50 $1019.80 $1148.28 $1604.72 $2438.52 |
$1183.77 $1305.07 $1433.55 $1889.99 |
$1469.04 $1590.34 $1718.82 $2175.26 |
$1754.31 $1875.61 $2004.09 $2460.53 |
$734.52 $795.17 $859.41 $1087.63 |
$1019.79 $1080.44 $1144.68 $1372.90 |
$1305.06 $1365.71 $1429.95 $1658.17 |
$285.27 |
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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) Pioneer One 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 |
$370.48 $420.49 $473.46 $661.67 $1005.46 |
$740.96 $840.98 $946.92 $1323.34 $2010.92 |
$976.21 $1076.23 $1182.17 $1558.59 |
$1211.46 $1311.48 $1417.42 $1793.84 |
$1446.71 $1546.73 $1652.67 $2029.09 |
$605.73 $655.74 $708.71 $896.92 |
$840.98 $890.99 $943.96 $1132.17 |
$1076.23 $1126.24 $1179.21 $1367.42 |
$235.25 |
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 |
$367.65 $417.27 $469.85 $656.61 $997.78 |
$735.30 $834.54 $939.70 $1313.22 $1995.56 |
$968.75 $1067.99 $1173.15 $1546.67 |
$1202.20 $1301.44 $1406.60 $1780.12 |
$1435.65 $1534.89 $1640.05 $2013.57 |
$601.10 $650.72 $703.30 $890.06 |
$834.55 $884.17 $936.75 $1123.51 |
$1068.00 $1117.62 $1170.20 $1356.96 |
$233.45 |
Plan: (HMO) Pioneer One Gold 30/60Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,200
: 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 |
$344.84 $391.38 $440.69 $615.87 $935.87 |
$689.68 $782.76 $881.38 $1231.74 $1871.74 |
$908.65 $1001.73 $1100.35 $1450.71 |
$1127.62 $1220.70 $1319.32 $1669.68 |
$1346.59 $1439.67 $1538.29 $1888.65 |
$563.81 $610.35 $659.66 $834.84 |
$782.78 $829.32 $878.63 $1053.81 |
$1001.75 $1048.29 $1097.60 $1272.78 |
$218.97 |
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 |
$372.74 $423.05 $476.35 $665.70 $1011.60 |
$745.48 $846.10 $952.70 $1331.40 $2023.20 |
$982.17 $1082.79 $1189.39 $1568.09 |
$1218.86 $1319.48 $1426.08 $1804.78 |
$1455.55 $1556.17 $1662.77 $2041.47 |
$609.43 $659.74 $713.04 $902.39 |
$846.12 $896.43 $949.73 $1139.08 |
$1082.81 $1133.12 $1186.42 $1375.77 |
$236.69 |
Plan: (HMO) Pioneer One 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 |
$349.61 $396.81 $446.80 $624.40 $948.84 |
$699.22 $793.62 $893.60 $1248.80 $1897.68 |
$921.22 $1015.62 $1115.60 $1470.80 |
$1143.22 $1237.62 $1337.60 $1692.80 |
$1365.22 $1459.62 $1559.60 $1914.80 |
$571.61 $618.81 $668.80 $846.40 |
$793.61 $840.81 $890.80 $1068.40 |
$1015.61 $1062.81 $1112.80 $1290.40 |
$222.00 |
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 |
$381.67 $433.19 $487.76 $681.65 $1035.83 |
$763.34 $866.38 $975.52 $1363.30 $2071.66 |
$1005.69 $1108.73 $1217.87 $1605.65 |
$1248.04 $1351.08 $1460.22 $1848.00 |
$1490.39 $1593.43 $1702.57 $2090.35 |
$624.02 $675.54 $730.11 $924.00 |
$866.37 $917.89 $972.46 $1166.35 |
$1108.72 $1160.24 $1214.81 $1408.70 |
$242.35 |
Plan: (HMO) Pioneer One 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 |
$357.99 $406.31 $457.50 $639.35 $971.56 |
$715.98 $812.62 $915.00 $1278.70 $1943.12 |
$943.30 $1039.94 $1142.32 $1506.02 |
$1170.62 $1267.26 $1369.64 $1733.34 |
$1397.94 $1494.58 $1596.96 $1960.66 |
$585.31 $633.63 $684.82 $866.67 |
$812.63 $860.95 $912.14 $1093.99 |
$1039.95 $1088.27 $1139.46 $1321.31 |
$227.32 |
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Health Tradition Health PlanLocal: 1-608-781-9692 | Toll Free: 1-888-459-3020 |
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Plan: (HMO) Gold 2000/80 w/copaySummary 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 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 |
$443.51 $503.38 $566.80 $792.10 $1203.67 |
$887.02 $1006.76 $1133.60 $1584.20 $2407.34 |
$1168.65 $1288.39 $1415.23 $1865.83 |
$1450.28 $1570.02 $1696.86 $2147.46 |
$1731.91 $1851.65 $1978.49 $2429.09 |
$725.14 $785.01 $848.43 $1073.73 |
$1006.77 $1066.64 $1130.06 $1355.36 |
$1288.40 $1348.27 $1411.69 $1636.99 |
$281.63 |
Plan: (HMO) Bronze 6000/80Summary 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 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 |
$311.39 $353.43 $397.96 $556.14 $845.11 |
$622.78 $706.86 $795.92 $1112.28 $1690.22 |
$820.52 $904.60 $993.66 $1310.02 |
$1018.26 $1102.34 $1191.40 $1507.76 |
$1216.00 $1300.08 $1389.14 $1705.50 |
$509.13 $551.17 $595.70 $753.88 |
$706.87 $748.91 $793.44 $951.62 |
$904.61 $946.65 $991.18 $1149.36 |
$197.74 |
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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 |
$389.59 $442.18 $497.89 $695.79 $1057.33 |
$779.18 $884.36 $995.78 $1391.58 $2114.66 |
$1026.56 $1131.74 $1243.16 $1638.96 |
$1273.94 $1379.12 $1490.54 $1886.34 |
$1521.32 $1626.50 $1737.92 $2133.72 |
$636.97 $689.56 $745.27 $943.17 |
$884.35 $936.94 $992.65 $1190.55 |
$1131.73 $1184.32 $1240.03 $1437.93 |
$247.38 |
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 |
$328.07 $372.36 $419.27 $585.93 $890.37 |
$656.14 $744.72 $838.54 $1171.86 $1780.74 |
$864.46 $953.04 $1046.86 $1380.18 |
$1072.78 $1161.36 $1255.18 $1588.50 |
$1281.10 $1369.68 $1463.50 $1796.82 |
$536.39 $580.68 $627.59 $794.25 |
$744.71 $789.00 $835.91 $1002.57 |
$953.03 $997.32 $1044.23 $1210.89 |
$208.32 |
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 |
$331.03 $375.71 $423.05 $591.21 $898.40 |
$662.06 $751.42 $846.10 $1182.42 $1796.80 |
$872.26 $961.62 $1056.30 $1392.62 |
$1082.46 $1171.82 $1266.50 $1602.82 |
$1292.66 $1382.02 $1476.70 $1813.02 |
$541.23 $585.91 $633.25 $801.41 |
$751.43 $796.11 $843.45 $1011.61 |
$961.63 $1006.31 $1053.65 $1221.81 |
$210.20 |
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 |
$317.92 $360.83 $406.29 $567.79 $862.81 |
$635.84 $721.66 $812.58 $1135.58 $1725.62 |
$837.71 $923.53 $1014.45 $1337.45 |
$1039.58 $1125.40 $1216.32 $1539.32 |
$1241.45 $1327.27 $1418.19 $1741.19 |
$519.79 $562.70 $608.16 $769.66 |
$721.66 $764.57 $810.03 $971.53 |
$923.53 $966.44 $1011.90 $1173.40 |
$201.87 |
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 |
$340.49 $386.45 $435.14 $608.11 $924.08 |
$680.98 $772.90 $870.28 $1216.22 $1848.16 |
$897.19 $989.11 $1086.49 $1432.43 |
$1113.40 $1205.32 $1302.70 $1648.64 |
$1329.61 $1421.53 $1518.91 $1864.85 |
$556.70 $602.66 $651.35 $824.32 |
$772.91 $818.87 $867.56 $1040.53 |
$989.12 $1035.08 $1083.77 $1256.74 |
$216.21 |
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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$282.28 $320.38 $360.75 $504.15 $766.10 |
$564.56 $640.76 $721.50 $1008.30 $1532.20 |
$743.81 $820.01 $900.75 $1187.55 |
$923.06 $999.26 $1080.00 $1366.80 |
$1102.31 $1178.51 $1259.25 $1546.05 |
$461.53 $499.63 $540.00 $683.40 |
$640.78 $678.88 $719.25 $862.65 |
$820.03 $858.13 $898.50 $1041.90 |
$179.25 |
Plan: (HMO) Pioneer One Gold 30/60 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,200
: Family:
$2,400 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 |
Gold | 21 30 40 50 60 |
$365.42 $414.74 $467.00 $652.62 $991.73 |
$730.84 $829.48 $934.00 $1305.24 $1983.46 |
$962.88 $1061.52 $1166.04 $1537.28 |
$1194.92 $1293.56 $1398.08 $1769.32 |
$1426.96 $1525.60 $1630.12 $2001.36 |
$597.46 $646.78 $699.04 $884.66 |
$829.50 $878.82 $931.08 $1116.70 |
$1061.54 $1110.86 $1163.12 $1348.74 |
$232.04 |
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 |
$394.98 $448.30 $504.78 $705.43 $1071.97 |
$789.96 $896.60 $1009.56 $1410.86 $2143.94 |
$1040.77 $1147.41 $1260.37 $1661.67 |
$1291.58 $1398.22 $1511.18 $1912.48 |
$1542.39 $1649.03 $1761.99 $2163.29 |
$645.79 $699.11 $755.59 $956.24 |
$896.60 $949.92 $1006.40 $1207.05 |
$1147.41 $1200.73 $1257.21 $1457.86 |
$250.81 |
Plan: (HMO) Pioneer One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$307.72 $349.25 $393.26 $549.57 $835.13 |
$615.44 $698.50 $786.52 $1099.14 $1670.26 |
$810.84 $893.90 $981.92 $1294.54 |
$1006.24 $1089.30 $1177.32 $1489.94 |
$1201.64 $1284.70 $1372.72 $1685.34 |
$503.12 $544.65 $588.66 $744.97 |
$698.52 $740.05 $784.06 $940.37 |
$893.92 $935.45 $979.46 $1135.77 |
$195.40 |
Plan: (HMO) Pioneer One Silver Maintenance with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,750
: Family:
$3,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$319.37 $362.47 $408.14 $570.38 $866.74 |
$638.74 $724.94 $816.28 $1140.76 $1733.48 |
$841.53 $927.73 $1019.07 $1343.55 |
$1044.32 $1130.52 $1221.86 $1546.34 |
$1247.11 $1333.31 $1424.65 $1749.13 |
$522.16 $565.26 $610.93 $773.17 |
$724.95 $768.05 $813.72 $975.96 |
$927.74 $970.84 $1016.51 $1178.75 |
$202.79 |
Plan: (HMO) Pioneer One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$310.49 $352.40 $396.80 $554.53 $842.66 |
$620.98 $704.80 $793.60 $1109.06 $1685.32 |
$818.14 $901.96 $990.76 $1306.22 |
$1015.30 $1099.12 $1187.92 $1503.38 |
$1212.46 $1296.28 $1385.08 $1700.54 |
$507.65 $549.56 $593.96 $751.69 |
$704.81 $746.72 $791.12 $948.85 |
$901.97 $943.88 $988.28 $1146.01 |
$197.16 |
Plan: (HMO) Pioneer One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$298.19 $338.44 $381.08 $532.56 $809.28 |
$596.38 $676.88 $762.16 $1065.12 $1618.56 |
$785.73 $866.23 $951.51 $1254.47 |
$975.08 $1055.58 $1140.86 $1443.82 |
$1164.43 $1244.93 $1330.21 $1633.17 |
$487.54 $527.79 $570.43 $721.91 |
$676.89 $717.14 $759.78 $911.26 |
$866.24 $906.49 $949.13 $1100.61 |
$189.35 |
Plan: (HMO) Pioneer One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$264.77 $300.51 $338.37 $472.87 $718.57 |
$529.54 $601.02 $676.74 $945.74 $1437.14 |
$697.66 $769.14 $844.86 $1113.86 |
$865.78 $937.26 $1012.98 $1281.98 |
$1033.90 $1105.38 $1181.10 $1450.10 |
$432.89 $468.63 $506.49 $640.99 |
$601.01 $636.75 $674.61 $809.11 |
$769.13 $804.87 $842.73 $977.23 |
$168.12 |
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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$309.59 $351.38 $395.66 $552.93 $840.23 |
$619.18 $702.76 $791.32 $1105.86 $1680.46 |
$815.77 $899.35 $987.91 $1302.45 |
$1012.36 $1095.94 $1184.50 $1499.04 |
$1208.95 $1292.53 $1381.09 $1695.63 |
$506.18 $547.97 $592.25 $749.52 |
$702.77 $744.56 $788.84 $946.11 |
$899.36 $941.15 $985.43 $1142.70 |
$196.59 |
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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$312.39 $354.55 $399.23 $557.92 $847.81 |
$624.78 $709.10 $798.46 $1115.84 $1695.62 |
$823.14 $907.46 $996.82 $1314.20 |
$1021.50 $1105.82 $1195.18 $1512.56 |
$1219.86 $1304.18 $1393.54 $1710.92 |
$510.75 $552.91 $597.59 $756.28 |
$709.11 $751.27 $795.95 $954.64 |
$907.47 $949.63 $994.31 $1153.00 |
$198.36 |
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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$300.01 $340.51 $383.41 $535.81 $814.22 |
$600.02 $681.02 $766.82 $1071.62 $1628.44 |
$790.52 $871.52 $957.32 $1262.12 |
$981.02 $1062.02 $1147.82 $1452.62 |
$1171.52 $1252.52 $1338.32 $1643.12 |
$490.51 $531.01 $573.91 $726.31 |
$681.01 $721.51 $764.41 $916.81 |
$871.51 $912.01 $954.91 $1107.31 |
$190.50 |
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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$321.31 $364.69 $410.63 $573.86 $872.03 |
$642.62 $729.38 $821.26 $1147.72 $1744.06 |
$846.65 $933.41 $1025.29 $1351.75 |
$1050.68 $1137.44 $1229.32 $1555.78 |
$1254.71 $1341.47 $1433.35 $1759.81 |
$525.34 $568.72 $614.66 $777.89 |
$729.37 $772.75 $818.69 $981.92 |
$933.40 $976.78 $1022.72 $1185.95 |
$204.03 |
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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$266.38 $302.34 $340.43 $475.75 $722.95 |
$532.76 $604.68 $680.86 $951.50 $1445.90 |
$701.91 $773.83 $850.01 $1120.65 |
$871.06 $942.98 $1019.16 $1289.80 |
$1040.21 $1112.13 $1188.31 $1458.95 |
$435.53 $471.49 $509.58 $644.90 |
$604.68 $640.64 $678.73 $814.05 |
$773.83 $809.79 $847.88 $983.20 |
$169.15 |
Plan: (HMO) Pioneer One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$290.39 $329.58 $371.11 $518.62 $788.10 |
$580.78 $659.16 $742.22 $1037.24 $1576.20 |
$765.17 $843.55 $926.61 $1221.63 |
$949.56 $1027.94 $1111.00 $1406.02 |
$1133.95 $1212.33 $1295.39 $1590.41 |
$474.78 $513.97 $555.50 $703.01 |
$659.17 $698.36 $739.89 $887.40 |
$843.56 $882.75 $924.28 $1071.79 |
$184.39 |
Plan: (HMO) Pioneer One Silver MaintenanceSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,750
: Family:
$3,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$301.38 $342.06 $385.16 $538.25 $817.93 |
$602.76 $684.12 $770.32 $1076.50 $1635.86 |
$794.13 $875.49 $961.69 $1267.87 |
$985.50 $1066.86 $1153.06 $1459.24 |
$1176.87 $1258.23 $1344.43 $1650.61 |
$492.75 $533.43 $576.53 $729.62 |
$684.12 $724.80 $767.90 $920.99 |
$875.49 $916.17 $959.27 $1112.36 |
$191.37 |
Plan: (HMO) Pioneer One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$293.01 $332.56 $374.46 $523.30 $795.21 |
$586.02 $665.12 $748.92 $1046.60 $1590.42 |
$772.08 $851.18 $934.98 $1232.66 |
$958.14 $1037.24 $1121.04 $1418.72 |
$1144.20 $1223.30 $1307.10 $1604.78 |
$479.07 $518.62 $560.52 $709.36 |
$665.13 $704.68 $746.58 $895.42 |
$851.19 $890.74 $932.64 $1081.48 |
$186.06 |
Plan: (HMO) Pioneer One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$281.40 $319.38 $359.62 $502.57 $763.70 |
$562.80 $638.76 $719.24 $1005.14 $1527.40 |
$741.48 $817.44 $897.92 $1183.82 |
$920.16 $996.12 $1076.60 $1362.50 |
$1098.84 $1174.80 $1255.28 $1541.18 |
$460.08 $498.06 $538.30 $681.25 |
$638.76 $676.74 $716.98 $859.93 |
$817.44 $855.42 $895.66 $1038.61 |
$178.68 |
Plan: (HMO) Pioneer One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$249.86 $283.58 $319.31 $446.24 $678.10 |
$499.72 $567.16 $638.62 $892.48 $1356.20 |
$658.38 $725.82 $797.28 $1051.14 |
$817.04 $884.48 $955.94 $1209.80 |
$975.70 $1043.14 $1114.60 $1368.46 |
$408.52 $442.24 $477.97 $604.90 |
$567.18 $600.90 $636.63 $763.56 |
$725.84 $759.56 $795.29 $922.22 |
$158.66 |
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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$320.82 $364.13 $410.00 $572.98 $870.70 |
$641.64 $728.26 $820.00 $1145.96 $1741.40 |
$845.36 $931.98 $1023.72 $1349.68 |
$1049.08 $1135.70 $1227.44 $1553.40 |
$1252.80 $1339.42 $1431.16 $1757.12 |
$524.54 $567.85 $613.72 $776.70 |
$728.26 $771.57 $817.44 $980.42 |
$931.98 $975.29 $1021.16 $1184.14 |
$203.72 |
Plan: (HMO) Pioneer One 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$300.92 $341.53 $384.57 $537.43 $816.67 |
$601.84 $683.06 $769.14 $1074.86 $1633.34 |
$792.92 $874.14 $960.22 $1265.94 |
$984.00 $1065.22 $1151.30 $1457.02 |
$1175.08 $1256.30 $1342.38 $1648.10 |
$492.00 $532.61 $575.65 $728.51 |
$683.08 $723.69 $766.73 $919.59 |
$874.16 $914.77 $957.81 $1110.67 |
$191.08 |
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 |
$265.89 $301.78 $339.80 $474.87 $721.62 |
$531.78 $603.56 $679.60 $949.74 $1443.24 |
$700.62 $772.40 $848.44 $1118.58 |
$869.46 $941.24 $1017.28 $1287.42 |
$1038.30 $1110.08 $1186.12 $1456.26 |
$434.73 $470.62 $508.64 $643.71 |
$603.57 $639.46 $677.48 $812.55 |
$772.41 $808.30 $846.32 $981.39 |
$168.84 |
Plan: (HMO) Pioneer One 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 |
$249.40 $283.06 $318.72 $445.41 $676.84 |
$498.80 $566.12 $637.44 $890.82 $1353.68 |
$657.16 $724.48 $795.80 $1049.18 |
$815.52 $882.84 $954.16 $1207.54 |
$973.88 $1041.20 $1112.52 $1365.90 |
$407.76 $441.42 $477.08 $603.77 |
$566.12 $599.78 $635.44 $762.13 |
$724.48 $758.14 $793.80 $920.49 |
$158.36 |
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 |
$352.97 $400.61 $451.09 $630.39 $957.94 |
$705.94 $801.22 $902.18 $1260.78 $1915.88 |
$930.07 $1025.35 $1126.31 $1484.91 |
$1154.20 $1249.48 $1350.44 $1709.04 |
$1378.33 $1473.61 $1574.57 $1933.17 |
$577.10 $624.74 $675.22 $854.52 |
$801.23 $848.87 $899.35 $1078.65 |
$1025.36 $1073.00 $1123.48 $1302.78 |
$224.13 |
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 |
$306.69 $348.09 $391.95 $547.74 $832.35 |
$613.38 $696.18 $783.90 $1095.48 $1664.70 |
$808.13 $890.93 $978.65 $1290.23 |
$1002.88 $1085.68 $1173.40 $1484.98 |
$1197.63 $1280.43 $1368.15 $1679.73 |
$501.44 $542.84 $586.70 $742.49 |
$696.19 $737.59 $781.45 $937.24 |
$890.94 $932.34 $976.20 $1131.99 |
$194.75 |
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 |
$263.43 $298.98 $336.65 $470.47 $714.93 |
$526.86 $597.96 $673.30 $940.94 $1429.86 |
$694.13 $765.23 $840.57 $1108.21 |
$861.40 $932.50 $1007.84 $1275.48 |
$1028.67 $1099.77 $1175.11 $1442.75 |
$430.70 $466.25 $503.92 $637.74 |
$597.97 $633.52 $671.19 $805.01 |
$765.24 $800.79 $838.46 $972.28 |
$167.27 |
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 |
$193.88 $220.04 $247.77 $346.25 $526.16 |
$387.76 $440.08 $495.54 $692.50 $1052.32 |
$510.87 $563.19 $618.65 $815.61 |
$633.98 $686.30 $741.76 $938.72 |
$757.09 $809.41 $864.87 $1061.83 |
$316.99 $343.15 $370.88 $469.36 |
$440.10 $466.26 $493.99 $592.47 |
$563.21 $589.37 $617.10 $715.58 |
|
Plan: (HMO) Pioneer One Gold DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,500
: 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 |
$331.07 $375.76 $423.10 $591.28 $898.51 |
$662.14 $751.52 $846.20 $1182.56 $1797.02 |
$872.37 $961.75 $1056.43 $1392.79 |
$1082.60 $1171.98 $1266.66 $1603.02 |
$1292.83 $1382.21 $1476.89 $1813.25 |
$541.30 $585.99 $633.33 $801.51 |
$751.53 $796.22 $843.56 $1011.74 |
$961.76 $1006.45 $1053.79 $1221.97 |
$210.23 |
Plan: (HMO) Pioneer One Silver DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$2,650
: 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 |
$287.66 $326.49 $367.63 $513.76 $780.71 |
$575.32 $652.98 $735.26 $1027.52 $1561.42 |
$757.98 $835.64 $917.92 $1210.18 |
$940.64 $1018.30 $1100.58 $1392.84 |
$1123.30 $1200.96 $1283.24 $1575.50 |
$470.32 $509.15 $550.29 $696.42 |
$652.98 $691.81 $732.95 $879.08 |
$835.64 $874.47 $915.61 $1061.74 |
$182.66 |
Plan: (HMO) Pioneer One Bronze HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$247.08 $280.43 $315.77 $441.28 $670.57 |
$494.16 $560.86 $631.54 $882.56 $1341.14 |
$651.05 $717.75 $788.43 $1039.45 |
$807.94 $874.64 $945.32 $1196.34 |
$964.83 $1031.53 $1102.21 $1353.23 |
$403.97 $437.32 $472.66 $598.17 |
$560.86 $594.21 $629.55 $755.06 |
$717.75 $751.10 $786.44 $911.95 |
$156.89 |
Plan: (HMO) Pioneer One CatastrophicSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$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 |
$181.85 $206.39 $232.39 $324.77 $493.52 |
$363.70 $412.78 $464.78 $649.54 $987.04 |
$479.17 $528.25 $580.25 $765.01 |
$594.64 $643.72 $695.72 $880.48 |
$710.11 $759.19 $811.19 $995.95 |
$297.32 $321.86 $347.86 $440.24 |
$412.79 $437.33 $463.33 $555.71 |
$528.26 $552.80 $578.80 $671.18 |
|
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 |
$127.22 $144.40 $162.59 $227.22 $345.29 |
$254.44 $288.80 $325.18 $454.44 $690.58 |
$335.23 $369.59 $405.97 $535.23 |
$416.02 $450.38 $486.76 $616.02 |
$496.81 $531.17 $567.55 $696.81 |
$208.01 $225.19 $243.38 $308.01 |
$288.80 $305.98 $324.17 $388.80 |
$369.59 $386.77 $404.96 $469.59 |
$80.79 |
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 |
$245.15 $278.25 $313.30 $437.84 $665.34 |
$490.30 $556.50 $626.60 $875.68 $1330.68 |
$645.97 $712.17 $782.27 $1031.35 |
$801.64 $867.84 $937.94 $1187.02 |
$957.31 $1023.51 $1093.61 $1342.69 |
$400.82 $433.92 $468.97 $593.51 |
$556.49 $589.59 $624.64 $749.18 |
$712.16 $745.26 $780.31 $904.85 |
$155.67 |
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 |
$243.40 $276.26 $311.07 $434.72 $660.60 |
$486.80 $552.52 $622.14 $869.44 $1321.20 |
$641.36 $707.08 $776.70 $1024.00 |
$795.92 $861.64 $931.26 $1178.56 |
$950.48 $1016.20 $1085.82 $1333.12 |
$397.96 $430.82 $465.63 $589.28 |
$552.52 $585.38 $620.19 $743.84 |
$707.08 $739.94 $774.75 $898.40 |
$154.56 |
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 |
$233.18 $264.66 $298.00 $416.46 $632.84 |
$466.36 $529.32 $596.00 $832.92 $1265.68 |
$614.43 $677.39 $744.07 $980.99 |
$762.50 $825.46 $892.14 $1129.06 |
$910.57 $973.53 $1040.21 $1277.13 |
$381.25 $412.73 $446.07 $564.53 |
$529.32 $560.80 $594.14 $712.60 |
$677.39 $708.87 $742.21 $860.67 |
$148.07 |
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 |
$229.70 $260.71 $293.56 $410.25 $623.41 |
$459.40 $521.42 $587.12 $820.50 $1246.82 |
$605.26 $667.28 $732.98 $966.36 |
$751.12 $813.14 $878.84 $1112.22 |
$896.98 $959.00 $1024.70 $1258.08 |
$375.56 $406.57 $439.42 $556.11 |
$521.42 $552.43 $585.28 $701.97 |
$667.28 $698.29 $731.14 $847.83 |
$145.86 |
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 |
$266.42 $302.39 $340.49 $475.83 $723.07 |
$532.84 $604.78 $680.98 $951.66 $1446.14 |
$702.02 $773.96 $850.16 $1120.84 |
$871.20 $943.14 $1019.34 $1290.02 |
$1040.38 $1112.32 $1188.52 $1459.20 |
$435.60 $471.57 $509.67 $645.01 |
$604.78 $640.75 $678.85 $814.19 |
$773.96 $809.93 $848.03 $983.37 |
$169.18 |
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 |
$188.31 $213.74 $240.66 $336.33 $511.08 |
$376.62 $427.48 $481.32 $672.66 $1022.16 |
$496.20 $547.06 $600.90 $792.24 |
$615.78 $666.64 $720.48 $911.82 |
$735.36 $786.22 $840.06 $1031.40 |
$307.89 $333.32 $360.24 $455.91 |
$427.47 $452.90 $479.82 $575.49 |
$547.05 $572.48 $599.40 $695.07 |
$119.58 |
ADVERTISEMENT
|
||||||||||
Health Tradition Health PlanLocal: 1-608-781-9692 | Toll Free: 1-888-459-3020 |
||||||||||
Plan: (HMO) Bronze HDHP 100Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)
Deductible: Individual:
$6,550
: 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 |
$276.84 $314.21 $353.80 $494.43 $751.33 |
$553.68 $628.42 $707.60 $988.86 $1502.66 |
$729.47 $804.21 $883.39 $1164.65 |
$905.26 $980.00 $1059.18 $1340.44 |
$1081.05 $1155.79 $1234.97 $1516.23 |
$452.63 $490.00 $529.59 $670.22 |
$628.42 $665.79 $705.38 $846.01 |
$804.21 $841.58 $881.17 $1021.80 |
$175.79 |
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 |
$231.78 $263.07 $296.22 $413.97 $629.06 |
$463.56 $526.14 $592.44 $827.94 $1258.12 |
$610.74 $673.32 $739.62 $975.12 |
$757.92 $820.50 $886.80 $1122.30 |
$905.10 $967.68 $1033.98 $1269.48 |
$378.96 $410.25 $443.40 $561.15 |
$526.14 $557.43 $590.58 $708.33 |
$673.32 $704.61 $737.76 $855.51 |
$147.18 |
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 |
$267.49 $303.60 $341.85 $477.73 $725.95 |
$534.98 $607.20 $683.70 $955.46 $1451.90 |
$704.83 $777.05 $853.55 $1125.31 |
$874.68 $946.90 $1023.40 $1295.16 |
$1044.53 $1116.75 $1193.25 $1465.01 |
$437.34 $473.45 $511.70 $647.58 |
$607.19 $643.30 $681.55 $817.43 |
$777.04 $813.15 $851.40 $987.28 |
$169.85 |
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 |
$246.55 $279.83 $315.09 $440.33 $669.13 |
$493.10 $559.66 $630.18 $880.66 $1338.26 |
$649.66 $716.22 $786.74 $1037.22 |
$806.22 $872.78 $943.30 $1193.78 |
$962.78 $1029.34 $1099.86 $1350.34 |
$403.11 $436.39 $471.65 $596.89 |
$559.67 $592.95 $628.21 $753.45 |
$716.23 $749.51 $784.77 $910.01 |
$156.56 |
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 |
$186.92 $212.15 $238.88 $333.84 $507.30 |
$373.84 $424.30 $477.76 $667.68 $1014.60 |
$492.53 $542.99 $596.45 $786.37 |
$611.22 $661.68 $715.14 $905.06 |
$729.91 $780.37 $833.83 $1023.75 |
$305.61 $330.84 $357.57 $452.53 |
$424.30 $449.53 $476.26 $571.22 |
$542.99 $568.22 $594.95 $689.91 |
$118.69 |
ADVERTISEMENT
|
||||||||||
Health Tradition Health PlanLocal: 1-608-781-9692 | Toll Free: 1-888-459-3020 |
||||||||||
Plan: (HMO) Gold 1000/80Summary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$441.41 $501.00 $564.13 $788.36 $1197.99 |
$882.82 $1002.00 $1128.26 $1576.72 $2395.98 |
$1163.12 $1282.30 $1408.56 $1857.02 |
$1443.42 $1562.60 $1688.86 $2137.32 |
$1723.72 $1842.90 $1969.16 $2417.62 |
$721.71 $781.30 $844.43 $1068.66 |
$1002.01 $1061.60 $1124.73 $1348.96 |
$1282.31 $1341.90 $1405.03 $1629.26 |
$280.30 |
Plan: (HMO) EssentialSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition 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 |
$240.61 $273.10 $307.50 $429.73 $653.02 |
$481.22 $546.20 $615.00 $859.46 $1306.04 |
$634.01 $698.99 $767.79 $1012.25 |
$786.80 $851.78 $920.58 $1165.04 |
$939.59 $1004.57 $1073.37 $1317.83 |
$393.40 $425.89 $460.29 $582.52 |
$546.19 $578.68 $613.08 $735.31 |
$698.98 $731.47 $765.87 $888.10 |
$152.79 |
Plan: (HMO) Silver 2500/80Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)
Deductible: Individual:
$2,500
: 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 |
$384.54 $436.45 $491.44 $686.79 $1043.63 |
$769.08 $872.90 $982.88 $1373.58 $2087.26 |
$1013.27 $1117.09 $1227.07 $1617.77 |
$1257.46 $1361.28 $1471.26 $1861.96 |
$1501.65 $1605.47 $1715.45 $2106.15 |
$628.73 $680.64 $735.63 $930.98 |
$872.92 $924.83 $979.82 $1175.17 |
$1117.11 $1169.02 $1224.01 $1419.36 |
$244.19 |
Plan: (HMO) Silver 4000/80 w/copaySummary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$380.49 $431.86 $486.27 $679.56 $1032.65 |
$760.98 $863.72 $972.54 $1359.12 $2065.30 |
$1002.60 $1105.34 $1214.16 $1600.74 |
$1244.22 $1346.96 $1455.78 $1842.36 |
$1485.84 $1588.58 $1697.40 $2083.98 |
$622.11 $673.48 $727.89 $921.18 |
$863.73 $915.10 $969.51 $1162.80 |
$1105.35 $1156.72 $1211.13 $1404.42 |
$241.62 |
Plan: (HMO) Silver HDHP 85Summary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$360.82 $409.53 $461.13 $644.43 $979.27 |
$721.64 $819.06 $922.26 $1288.86 $1958.54 |
$950.77 $1048.19 $1151.39 $1517.99 |
$1179.90 $1277.32 $1380.52 $1747.12 |
$1409.03 $1506.45 $1609.65 $1976.25 |
$589.95 $638.66 $690.26 $873.56 |
$819.08 $867.79 $919.39 $1102.69 |
$1048.21 $1096.92 $1148.52 $1331.82 |
$229.13 |
Plan: (HMO) Bronze 7150/100Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition 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 |
$263.17 $298.69 $336.33 $470.01 $714.23 |
$526.34 $597.38 $672.66 $940.02 $1428.46 |
$693.45 $764.49 $839.77 $1107.13 |
$860.56 $931.60 $1006.88 $1274.24 |
$1027.67 $1098.71 $1173.99 $1441.35 |
$430.28 $465.80 $503.44 $637.12 |
$597.39 $632.91 $670.55 $804.23 |
$764.50 $800.02 $837.66 $971.34 |
$167.11 |
Plan: (HMO) Silver 3000/70 w/copaySummary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$384.49 $436.40 $491.38 $686.70 $1043.51 |
$768.98 $872.80 $982.76 $1373.40 $2087.02 |
$1013.14 $1116.96 $1226.92 $1617.56 |
$1257.30 $1361.12 $1471.08 $1861.72 |
$1501.46 $1605.28 $1715.24 $2105.88 |
$628.65 $680.56 $735.54 $930.86 |
$872.81 $924.72 $979.70 $1175.02 |
$1116.97 $1168.88 $1223.86 $1419.18 |
$244.16 |
Plan: (HMO) Silver HDHP 100Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)
Deductible: Individual:
$4,400
: Family:
$8,800 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 |
$342.87 $389.16 $438.19 $612.37 $930.55 |
$685.74 $778.32 $876.38 $1224.74 $1861.10 |
$903.47 $996.05 $1094.11 $1442.47 |
$1121.20 $1213.78 $1311.84 $1660.20 |
$1338.93 $1431.51 $1529.57 $1877.93 |
$560.60 $606.89 $655.92 $830.10 |
$778.33 $824.62 $873.65 $1047.83 |
$996.06 $1042.35 $1091.38 $1265.56 |
$217.73 |
Plan: (HMO) Silver 4000Summary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$354.55 $402.41 $453.11 $633.22 $962.23 |
$709.10 $804.82 $906.22 $1266.44 $1924.46 |
$934.24 $1029.96 $1131.36 $1491.58 |
$1159.38 $1255.10 $1356.50 $1716.72 |
$1384.52 $1480.24 $1581.64 $1941.86 |
$579.69 $627.55 $678.25 $858.36 |
$804.83 $852.69 $903.39 $1083.50 |
$1029.97 $1077.83 $1128.53 $1308.64 |
$225.14 |
Plan: (HMO) Bronze HDHP 50Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition Health Plan)
Deductible: Individual:
$4,500
: 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 |
Bronze | 21 30 40 50 60 |
$280.42 $318.28 $358.38 $500.83 $761.05 |
$560.84 $636.56 $716.76 $1001.66 $1522.10 |
$738.91 $814.63 $894.83 $1179.73 |
$916.98 $992.70 $1072.90 $1357.80 |
$1095.05 $1170.77 $1250.97 $1535.87 |
$458.49 $496.35 $536.45 $678.90 |
$636.56 $674.42 $714.52 $856.97 |
$814.63 $852.49 $892.59 $1035.04 |
$178.07 |
Plan: (HMO) Bronze 7150/100 RxSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-459-3020 - Provider Directory for This Plan: (Health Tradition 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 |
$296.14 $336.12 $378.46 $528.90 $803.71 |
$592.28 $672.24 $756.92 $1057.80 $1607.42 |
$780.33 $860.29 $944.97 $1245.85 |
$968.38 $1048.34 $1133.02 $1433.90 |
$1156.43 $1236.39 $1321.07 $1621.95 |
$484.19 $524.17 $566.51 $716.95 |
$672.24 $712.22 $754.56 $905.00 |
$860.29 $900.27 $942.61 $1093.05 |
$188.05 |
ADVERTISEMENT
|
||||||||||
Gundersen Health Plan, Inc.Local: 1-608-775-8092 | Toll Free: 1-855-685-6404 |
||||||||||
Plan: (POS) Silver $4000 - 10%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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$414.17 $470.08 $529.31 $739.71 $1124.06 |
$828.34 $940.16 $1058.62 $1479.42 $2248.12 |
$1091.34 $1203.16 $1321.62 $1742.42 |
$1354.34 $1466.16 $1584.62 $2005.42 |
$1617.34 $1729.16 $1847.62 $2268.42 |
$677.17 $733.08 $792.31 $1002.71 |
$940.17 $996.08 $1055.31 $1265.71 |
$1203.17 $1259.08 $1318.31 $1528.71 |
$263.00 |
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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$410.32 $465.71 $524.39 $732.83 $1113.61 |
$820.64 $931.42 $1048.78 $1465.66 $2227.22 |
$1081.19 $1191.97 $1309.33 $1726.21 |
$1341.74 $1452.52 $1569.88 $1986.76 |
$1602.29 $1713.07 $1830.43 $2247.31 |
$670.87 $726.26 $784.94 $993.38 |
$931.42 $986.81 $1045.49 $1253.93 |
$1191.97 $1247.36 $1306.04 $1514.48 |
$260.55 |
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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$432.56 $490.96 $552.81 $772.55 $1173.97 |
$865.12 $981.92 $1105.62 $1545.10 $2347.94 |
$1139.80 $1256.60 $1380.30 $1819.78 |
$1414.48 $1531.28 $1654.98 $2094.46 |
$1689.16 $1805.96 $1929.66 $2369.14 |
$707.24 $765.64 $827.49 $1047.23 |
$981.92 $1040.32 $1102.17 $1321.91 |
$1256.60 $1315.00 $1376.85 $1596.59 |
$274.68 |
Plan: (POS) Bronze $3750 - 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:
$3,750
: 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 |
Bronze | 21 30 40 50 60 |
$342.16 $388.35 $437.28 $611.10 $928.62 |
$684.32 $776.70 $874.56 $1222.20 $1857.24 |
$901.59 $993.97 $1091.83 $1439.47 |
$1118.86 $1211.24 $1309.10 $1656.74 |
$1336.13 $1428.51 $1526.37 $1874.01 |
$559.43 $605.62 $654.55 $828.37 |
$776.70 $822.89 $871.82 $1045.64 |
$993.97 $1040.16 $1089.09 $1262.91 |
$217.27 |
Plan: (POS) Bronze $5000 - 10%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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$357.07 $405.27 $456.34 $637.73 $969.09 |
$714.14 $810.54 $912.68 $1275.46 $1938.18 |
$940.88 $1037.28 $1139.42 $1502.20 |
$1167.62 $1264.02 $1366.16 $1728.94 |
$1394.36 $1490.76 $1592.90 $1955.68 |
$583.81 $632.01 $683.08 $864.47 |
$810.55 $858.75 $909.82 $1091.21 |
$1037.29 $1085.49 $1136.56 $1317.95 |
$226.74 |
Plan: (POS) Bronze $6500 - 10%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:
$6,500
: 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 |
$338.11 $383.75 $432.10 $603.86 $917.63 |
$676.22 $767.50 $864.20 $1207.72 $1835.26 |
$890.92 $982.20 $1078.90 $1422.42 |
$1105.62 $1196.90 $1293.60 $1637.12 |
$1320.32 $1411.60 $1508.30 $1851.82 |
$552.81 $598.45 $646.80 $818.56 |
$767.51 $813.15 $861.50 $1033.26 |
$982.21 $1027.85 $1076.20 $1247.96 |
$214.70 |
Plan: (POS) Catastrophic $7150 - 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:
$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 |
$316.61 $359.35 $404.63 $565.47 $859.28 |
$633.22 $718.70 $809.26 $1130.94 $1718.56 |
$834.27 $919.75 $1010.31 $1331.99 |
$1035.32 $1120.80 $1211.36 $1533.04 |
$1236.37 $1321.85 $1412.41 $1734.09 |
$517.66 $560.40 $605.68 $766.52 |
$718.71 $761.45 $806.73 $967.57 |
$919.76 $962.50 $1007.78 $1168.62 |
$201.05 |
Plan: (POS) Silver HSA $4400 - 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:
$4,400
: Family:
$8,800 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 |
$378.54 $429.64 $483.77 $676.07 $1027.36 |
$757.08 $859.28 $967.54 $1352.14 $2054.72 |
$997.45 $1099.65 $1207.91 $1592.51 |
$1237.82 $1340.02 $1448.28 $1832.88 |
$1478.19 $1580.39 $1688.65 $2073.25 |
$618.91 $670.01 $724.14 $916.44 |
$859.28 $910.38 $964.51 $1156.81 |
$1099.65 $1150.75 $1204.88 $1397.18 |
$240.37 |
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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$393.88 $447.05 $503.38 $703.47 $1068.99 |
$787.76 $894.10 $1006.76 $1406.94 $2137.98 |
$1037.87 $1144.21 $1256.87 $1657.05 |
$1287.98 $1394.32 $1506.98 $1907.16 |
$1538.09 $1644.43 $1757.09 $2157.27 |
$643.99 $697.16 $753.49 $953.58 |
$894.10 $947.27 $1003.60 $1203.69 |
$1144.21 $1197.38 $1253.71 $1453.80 |
$250.11 |
Plan: (POS) Bronze HSA $4400 - 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:
$4,400
: Family:
$8,800 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 |
Bronze | 21 30 40 50 60 |
$342.85 $389.13 $438.16 $612.33 $930.49 |
$685.70 $778.26 $876.32 $1224.66 $1860.98 |
$903.41 $995.97 $1094.03 $1442.37 |
$1121.12 $1213.68 $1311.74 $1660.08 |
$1338.83 $1431.39 $1529.45 $1877.79 |
$560.56 $606.84 $655.87 $830.04 |
$778.27 $824.55 $873.58 $1047.75 |
$995.98 $1042.26 $1091.29 $1265.46 |
$217.71 |
Plan: (POS) Bronze HSA $6550 - 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:
$6,550
: 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 |
$323.22 $366.85 $413.08 $577.27 $877.22 |
$646.44 $733.70 $826.16 $1154.54 $1754.44 |
$851.68 $938.94 $1031.40 $1359.78 |
$1056.92 $1144.18 $1236.64 $1565.02 |
$1262.16 $1349.42 $1441.88 $1770.26 |
$528.46 $572.09 $618.32 $782.51 |
$733.70 $777.33 $823.56 $987.75 |
$938.94 $982.57 $1028.80 $1192.99 |
$205.24 |
Plan: (POS) Bronze HSA $5750 - 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:
$5,750
: Family:
$11,500 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 |
$325.38 $369.31 $415.84 $581.13 $883.08 |
$650.76 $738.62 $831.68 $1162.26 $1766.16 |
$857.38 $945.24 $1038.30 $1368.88 |
$1064.00 $1151.86 $1244.92 $1575.50 |
$1270.62 $1358.48 $1451.54 $1782.12 |
$532.00 $575.93 $622.46 $787.75 |
$738.62 $782.55 $829.08 $994.37 |
$945.24 $989.17 $1035.70 $1200.99 |
$206.62 |