Providers for Zip Code 71923

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Obamacare Providers, Plans and 2017 Rates for Clark 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 Clark County, Arkansas.

Currently, there are 26 plans offered in Clark 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)

 

Note: If you are over 65, you qualify for Medicare. Click here to see listings of 2017 Medicare Advantage plans for Clark County

 

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 Arkadelphia, AR 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 Clark County here.

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USAble Mutual Insurance Company

Local: 1-800-800-4298 | Toll Free: 1-800-800-4298

TTY: 1-800-800-4298

Plan: (PPO) Blue Cross Blue Shield Gold 500, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-4298 - Provider Directory for This Plan: (USAble Mutual Insurance Company)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $312.33
$354.49
$399.16
$557.82
$847.66		 $624.66
$708.98
$798.32
$1115.64
$1695.32		 $822.99
$907.31
$996.65
$1313.97		 $1021.32
$1105.64
$1194.98
$1512.30		 $1219.65
$1303.97
$1393.31
$1710.63		 $510.66
$552.82
$597.49
$756.15		 $708.99
$751.15
$795.82
$954.48		 $907.32
$949.48
$994.15
$1152.81		 $198.33
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QualChoice Life & Health Insurance Company, Inc.

Local: 1-501-228-7111 x7006 | Toll Free: 1-800-235-7111

TTY: 1-501-219-5188

Plan: (PPO) Silver 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-235-7111 - Provider Directory for This Plan: (QualChoice Life & Health Insurance Company, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: 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
Silver 21
30
40
50
60		 $281.04
$318.98
$359.17
$501.94
$762.75		 $562.08
$637.96
$718.34
$1003.88
$1525.50		 $740.54
$816.42
$896.80
$1182.34		 $919.00
$994.88
$1075.26
$1360.80		 $1097.46
$1173.34
$1253.72
$1539.26		 $459.50
$497.44
$537.63
$680.40		 $637.96
$675.90
$716.09
$858.86		 $816.42
$854.36
$894.55
$1037.32		 $178.46

Plan: (PPO) Gold 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-235-7111 - Provider Directory for This Plan: (QualChoice Life & Health Insurance Company, Inc.)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $296.06
$336.03
$378.36
$528.76
$803.50		 $592.12
$672.06
$756.72
$1057.52
$1607.00		 $780.12
$860.06
$944.72
$1245.52		 $968.12
$1048.06
$1132.72
$1433.52		 $1156.12
$1236.06
$1320.72
$1621.52		 $484.06
$524.03
$566.36
$716.76		 $672.06
$712.03
$754.36
$904.76		 $860.06
$900.03
$942.36
$1092.76		 $188.00
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Celtic Insurance Company

Local: 1-877-617-0390 | Toll Free: 1-877-617-0390

TTY: 1-877-617-0392

Plan: (PPO) Ambetter Secure Care 2 (2017) with 3 Free PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-617-0390 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $275.15
$312.29
$351.63
$491.40
$746.74		 $550.30
$624.58
$703.26
$982.80
$1493.48		 $725.02
$799.30
$877.98
$1157.52		 $899.74
$974.02
$1052.70
$1332.24		 $1074.46
$1148.74
$1227.42
$1506.96		 $449.87
$487.01
$526.35
$666.12		 $624.59
$661.73
$701.07
$840.84		 $799.31
$836.45
$875.79
$1015.56		 $174.72

Plan: (PPO) Ambetter Essential Care 6 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-617-0390 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $7,000 : Family: $14,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $192.59
$218.57
$246.11
$343.94
$522.65		 $385.18
$437.14
$492.22
$687.88
$1045.30		 $507.47
$559.43
$614.51
$810.17		 $629.76
$681.72
$736.80
$932.46		 $752.05
$804.01
$859.09
$1054.75		 $314.88
$340.86
$368.40
$466.23		 $437.17
$463.15
$490.69
$588.52		 $559.46
$585.44
$612.98
$710.81		 $122.29
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USAble Mutual Insurance Company

Local: 1-800-800-4298 | Toll Free: 1-800-800-4298

TTY: 1-800-800-4298

Plan: (PPO) Bronze 6400 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-4298 - Provider Directory for This Plan: (USAble Mutual Insurance Company)

Deductible: Individual: $6,400 : Family: $12,800
Out of Pocket Maximum per year: Individual: $6,400 : Family: $12,800

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		 $197.36
$224.00
$252.23
$352.48
$535.64		 $394.72
$448.00
$504.46
$704.96
$1071.28		 $520.04
$573.32
$629.78
$830.28		 $645.36
$698.64
$755.10
$955.60		 $770.68
$823.96
$880.42
$1080.92		 $322.68
$349.32
$377.55
$477.80		 $448.00
$474.64
$502.87
$603.12		 $573.32
$599.96
$628.19
$728.44		 $125.32
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Celtic Insurance Company

Local: 1-877-617-0390 | Toll Free: 1-877-617-0390

TTY: 1-877-617-0392

Plan: (PPO) Ambetter Balanced Care 7 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-617-0390 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $245.02
$278.08
$313.12
$437.58
$664.95		 $490.04
$556.16
$626.24
$875.16
$1329.90		 $645.62
$711.74
$781.82
$1030.74		 $801.20
$867.32
$937.40
$1186.32		 $956.78
$1022.90
$1092.98
$1341.90		 $400.60
$433.66
$468.70
$593.16		 $556.18
$589.24
$624.28
$748.74		 $711.76
$744.82
$779.86
$904.32		 $155.58

Plan: (PPO) Ambetter Balanced Care 6 (2017)

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-617-0390 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $212.19
$240.82
$271.16
$378.95
$575.84		 $424.38
$481.64
$542.32
$757.90
$1151.68		 $559.11
$616.37
$677.05
$892.63		 $693.84
$751.10
$811.78
$1027.36		 $828.57
$885.83
$946.51
$1162.09		 $346.92
$375.55
$405.89
$513.68		 $481.65
$510.28
$540.62
$648.41		 $616.38
$645.01
$675.35
$783.14		 $134.73

Plan: (PPO) Ambetter Essential Care 6 (2017) + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-617-0390 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $7,000 : Family: $14,000

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		 $207.06
$235.00
$264.61
$369.79
$561.93		 $414.12
$470.00
$529.22
$739.58
$1123.86		 $545.60
$601.48
$660.70
$871.06		 $677.08
$732.96
$792.18
$1002.54		 $808.56
$864.44
$923.66
$1134.02		 $338.54
$366.48
$396.09
$501.27		 $470.02
$497.96
$527.57
$632.75		 $601.50
$629.44
$659.05
$764.23		 $131.48

Plan: (PPO) Ambetter Balanced Care 7 (2017) + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-617-0390 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,000 : Family: $12,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $263.43
$298.98
$336.65
$470.47
$714.92		 $526.86
$597.96
$673.30
$940.94
$1429.84		 $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: (PPO) Ambetter Balanced Care 6 (2017) + Vision + Adult Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-617-0390 - Provider Directory for This Plan: (Celtic Insurance Company)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $228.13
$258.92
$291.54
$407.42
$619.12		 $456.26
$517.84
$583.08
$814.84
$1238.24		 $601.12
$662.70
$727.94
$959.70		 $745.98
$807.56
$872.80
$1104.56		 $890.84
$952.42
$1017.66
$1249.42		 $372.99
$403.78
$436.40
$552.28		 $517.85
$548.64
$581.26
$697.14		 $662.71
$693.50
$726.12
$842.00		 $144.86
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QCA Health Plan, Inc.

Local: 1-501-228-7111 x7006 | Toll Free: 1-800-235-7111

TTY: 1-501-219-5188

Plan: (POS) Bronze Classic Saver 5000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-235-7111 - Provider Directory for This Plan: (QCA Health Plan, Inc.)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,450 : Family: $12,900

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $211.53
$240.09
$270.33
$377.79
$574.09		 $423.06
$480.18
$540.66
$755.58
$1148.18		 $557.38
$614.50
$674.98
$889.90		 $691.70
$748.82
$809.30
$1024.22		 $826.02
$883.14
$943.62
$1158.54		 $345.85
$374.41
$404.65
$512.11		 $480.17
$508.73
$538.97
$646.43		 $614.49
$643.05
$673.29
$780.75		 $134.32

Plan: (POS) Silver Classic 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-235-7111 - Provider Directory for This Plan: (QCA Health Plan, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: 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
Silver 21
30
40
50
60		 $281.04
$318.98
$359.17
$501.94
$762.75		 $562.08
$637.96
$718.34
$1003.88
$1525.50		 $740.54
$816.42
$896.80
$1182.34		 $919.00
$994.88
$1075.26
$1360.80		 $1097.46
$1173.34
$1253.72
$1539.26		 $459.50
$497.44
$537.63
$680.40		 $637.96
$675.90
$716.09
$858.86		 $816.42
$854.36
$894.55
$1037.32		 $178.46

Plan: (POS) Catastrophic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-235-7111 - Provider Directory for This Plan: (QCA Health Plan, Inc.)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: 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		 $137.19
$155.71
$175.32
$245.01
$372.32		 $274.38
$311.42
$350.64
$490.02
$744.64		 $361.49
$398.53
$437.75
$577.13		 $448.60
$485.64
$524.86
$664.24		 $535.71
$572.75
$611.97
$751.35		 $224.30
$242.82
$262.43
$332.12		 $311.41
$329.93
$349.54
$419.23		 $398.52
$417.04
$436.65
$506.34

Plan: (POS) Gold Classic 2000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-235-7111 - Provider Directory for This Plan: (QCA Health Plan, Inc.)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $296.06
$336.03
$378.36
$528.76
$803.50		 $592.12
$672.06
$756.72
$1057.52
$1607.00		 $780.12
$860.06
$944.72
$1245.52		 $968.12
$1048.06
$1132.72
$1433.52		 $1156.12
$1236.06
$1320.72
$1621.52		 $484.06
$524.03
$566.36
$716.76		 $672.06
$712.03
$754.36
$904.76		 $860.06
$900.03
$942.36
$1092.76		 $188.00

Plan: (POS) Silver Classic Saver 3500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-235-7111 - Provider Directory for This Plan: (QCA Health Plan, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $260.34
$295.49
$332.72
$464.97
$706.57		 $520.68
$590.98
$665.44
$929.94
$1413.14		 $686.00
$756.30
$830.76
$1095.26		 $851.32
$921.62
$996.08
$1260.58		 $1016.64
$1086.94
$1161.40
$1425.90		 $425.66
$460.81
$498.04
$630.29		 $590.98
$626.13
$663.36
$795.61		 $756.30
$791.45
$828.68
$960.93		 $165.32
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USAble Mutual Insurance Company

Local: 1-800-800-4298 | Toll Free: 1-800-800-4298

TTY: 1-800-800-4298

Plan: (PPO) Gold 500 with PCP/Rx Copays

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-4298 - Provider Directory for This Plan: (USAble Mutual Insurance Company)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $5,500 : Family: $11,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $311.95
$354.06
$398.67
$557.14
$846.63		 $623.90
$708.12
$797.34
$1114.28
$1693.26		 $821.99
$906.21
$995.43
$1312.37		 $1020.08
$1104.30
$1193.52
$1510.46		 $1218.17
$1302.39
$1391.61
$1708.55		 $510.04
$552.15
$596.76
$755.23		 $708.13
$750.24
$794.85
$953.32		 $906.22
$948.33
$992.94
$1151.41		 $198.09

Plan: (PPO) Gold 1000 with PCP/Specialist/Rx Copays

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-4298 - Provider Directory for This Plan: (USAble Mutual Insurance Company)

Deductible: Individual: $1,000 : Family: $2,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $298.27
$338.54
$381.19
$532.71
$809.50		 $596.54
$677.08
$762.38
$1065.42
$1619.00		 $785.94
$866.48
$951.78
$1254.82		 $975.34
$1055.88
$1141.18
$1444.22		 $1164.74
$1245.28
$1330.58
$1633.62		 $487.67
$527.94
$570.59
$722.11		 $677.07
$717.34
$759.99
$911.51		 $866.47
$906.74
$949.39
$1100.91		 $189.40

Plan: (PPO) Silver 1500 with PCP/Rx Copays

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-4298 - Provider Directory for This Plan: (USAble Mutual Insurance Company)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: 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
Silver 21
30
40
50
60		 $248.85
$282.44
$318.03
$444.45
$675.38		 $497.70
$564.88
$636.06
$888.90
$1350.76		 $655.72
$722.90
$794.08
$1046.92		 $813.74
$880.92
$952.10
$1204.94		 $971.76
$1038.94
$1110.12
$1362.96		 $406.87
$440.46
$476.05
$602.47		 $564.89
$598.48
$634.07
$760.49		 $722.91
$756.50
$792.09
$918.51		 $158.02

Plan: (PPO) Catastrophic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-4298 - Provider Directory for This Plan: (USAble Mutual Insurance Company)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: 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		 $190.02
$215.67
$242.85
$339.38
$515.71		 $380.04
$431.34
$485.70
$678.76
$1031.42		 $500.70
$552.00
$606.36
$799.42		 $621.36
$672.66
$727.02
$920.08		 $742.02
$793.32
$847.68
$1040.74		 $310.68
$336.33
$363.51
$460.04		 $431.34
$456.99
$484.17
$580.70		 $552.00
$577.65
$604.83
$701.36		 $120.66

Plan: (PPO) Silver 3500 with PCP/Specialist/Rx Copays

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-4298 - Provider Directory for This Plan: (USAble Mutual Insurance Company)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: 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
Silver 21
30
40
50
60		 $255.49
$289.98
$326.52
$456.31
$693.40		 $510.98
$579.96
$653.04
$912.62
$1386.80		 $673.22
$742.20
$815.28
$1074.86		 $835.46
$904.44
$977.52
$1237.10		 $997.70
$1066.68
$1139.76
$1399.34		 $417.73
$452.22
$488.76
$618.55		 $579.97
$614.46
$651.00
$780.79		 $742.21
$776.70
$813.24
$943.03		 $162.24

Plan: (PPO) Silver 2500 with PCP/Rx Copays

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-4298 - Provider Directory for This Plan: (USAble Mutual Insurance Company)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: 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
Silver 21
30
40
50
60		 $246.72
$280.03
$315.31
$440.64
$669.60		 $493.44
$560.06
$630.62
$881.28
$1339.20		 $650.11
$716.73
$787.29
$1037.95		 $806.78
$873.40
$943.96
$1194.62		 $963.45
$1030.07
$1100.63
$1351.29		 $403.39
$436.70
$471.98
$597.31		 $560.06
$593.37
$628.65
$753.98		 $716.73
$750.04
$785.32
$910.65		 $156.67

Plan: (PPO) Silver 3600 HSA

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-4298 - Provider Directory for This Plan: (USAble Mutual Insurance Company)

Deductible: Individual: $3,600 : Family: $7,200
Out of Pocket Maximum per year: Individual: $3,600 : Family: $7,200

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $238.93
$271.19
$305.35
$426.73
$648.46		 $477.86
$542.38
$610.70
$853.46
$1296.92		 $629.58
$694.10
$762.42
$1005.18		 $781.30
$845.82
$914.14
$1156.90		 $933.02
$997.54
$1065.86
$1308.62		 $390.65
$422.91
$457.07
$578.45		 $542.37
$574.63
$608.79
$730.17		 $694.09
$726.35
$760.51
$881.89		 $151.72

Plan: (PPO) Bronze 6350 PCP/Rx Copays

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-4298 - Provider Directory for This Plan: (USAble Mutual Insurance Company)

Deductible: Individual: $6,350 : Family: $12,700
Out of Pocket Maximum per year: 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		 $209.99
$238.34
$268.37
$375.04
$569.91		 $419.98
$476.68
$536.74
$750.08
$1139.82		 $553.32
$610.02
$670.08
$883.42		 $686.66
$743.36
$803.42
$1016.76		 $820.00
$876.70
$936.76
$1150.10		 $343.33
$371.68
$401.71
$508.38		 $476.67
$505.02
$535.05
$641.72		 $610.01
$638.36
$668.39
$775.06		 $133.34

Plan: (PPO) Blue Cross Blue Shield Silver 3000, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-4298 - Provider Directory for This Plan: (USAble Mutual Insurance Company)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: 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
Silver 21
30
40
50
60		 $276.03
$313.29
$352.77
$492.99
$749.15		 $552.06
$626.58
$705.54
$985.98
$1498.30		 $727.34
$801.86
$880.82
$1161.26		 $902.62
$977.14
$1056.10
$1336.54		 $1077.90
$1152.42
$1231.38
$1511.82		 $451.31
$488.57
$528.05
$668.27		 $626.59
$663.85
$703.33
$843.55		 $801.87
$839.13
$878.61
$1018.83		 $175.28

Plan: (PPO) Blue Cross Blue Shield Bronze 6200, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-800-4298 - Provider Directory for This Plan: (USAble Mutual Insurance Company)

Deductible: Individual: $6,200 : Family: $12,400
Out of Pocket Maximum per year: 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		 $212.35
$241.02
$271.38
$379.26
$576.32		 $424.70
$482.04
$542.76
$758.52
$1152.64		 $559.54
$616.88
$677.60
$893.36		 $694.38
$751.72
$812.44
$1028.20		 $829.22
$886.56
$947.28
$1163.04		 $347.19
$375.86
$406.22
$514.10		 $482.03
$510.70
$541.06
$648.94		 $616.87
$645.54
$675.90
$783.78		 $134.84

 

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