Providers for Zip Code 62301

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Obamacare Providers, Plans and 2017 Rates for Adams 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 Adams County, Illinois.

Currently, there are 25 plans offered in Adams 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 Adams 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 Quincy, IL 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 Adams County here.

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Health Alliance Medical Plans, Inc.

Local: 1-866-247-3296 | Toll Free: 1-866-247-3296

TTY: 1-800-526-0844

Plan: (HMO) HMO HSA 3250 Elite Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-247-3296 - Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)

Deductible: Individual: $3,250 : Family: $6,500
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $328.17
$372.48
$419.40
$586.12
$890.66		 $656.34
$744.96
$838.80
$1172.24
$1781.32		 $864.73
$953.35
$1047.19
$1380.63		 $1073.12
$1161.74
$1255.58
$1589.02		 $1281.51
$1370.13
$1463.97
$1797.41		 $536.56
$580.87
$627.79
$794.51		 $744.95
$789.26
$836.18
$1002.90		 $953.34
$997.65
$1044.57
$1211.29		 $208.39

Plan: (HMO) HMO 4000b Elite Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-247-3296 - Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $338.18
$383.84
$432.20
$604.00
$917.83		 $676.36
$767.68
$864.40
$1208.00
$1835.66		 $891.11
$982.43
$1079.15
$1422.75		 $1105.86
$1197.18
$1293.90
$1637.50		 $1320.61
$1411.93
$1508.65
$1852.25		 $552.93
$598.59
$646.95
$818.75		 $767.68
$813.34
$861.70
$1033.50		 $982.43
$1028.09
$1076.45
$1248.25		 $214.75

Plan: (HMO) HMO 5000c Elite Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-247-3296 - Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,250 : Family: $12,500

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $315.12
$357.66
$402.72
$562.80
$855.23		 $630.24
$715.32
$805.44
$1125.60
$1710.46		 $830.34
$915.42
$1005.54
$1325.70		 $1030.44
$1115.52
$1205.64
$1525.80		 $1230.54
$1315.62
$1405.74
$1725.90		 $515.22
$557.76
$602.82
$762.90		 $715.32
$757.86
$802.92
$963.00		 $915.42
$957.96
$1003.02
$1163.10		 $200.10

Plan: (HMO) HMO 1500a Elite Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-247-3296 - Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
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		 $407.87
$462.93
$521.25
$728.45
$1106.95		 $815.74
$925.86
$1042.50
$1456.90
$2213.90		 $1074.73
$1184.85
$1301.49
$1715.89		 $1333.72
$1443.84
$1560.48
$1974.88		 $1592.71
$1702.83
$1819.47
$2233.87		 $666.86
$721.92
$780.24
$987.44		 $925.85
$980.91
$1039.23
$1246.43		 $1184.84
$1239.90
$1298.22
$1505.42		 $258.99

Plan: (HMO) HMO 6650 Elite Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-247-3296 - Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)

Deductible: Individual: $6,650 : Family: $13,300
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
Bronze 21
30
40
50
60		 $246.80
$280.11
$315.41
$440.78
$669.81		 $493.60
$560.22
$630.82
$881.56
$1339.62		 $650.32
$716.94
$787.54
$1038.28		 $807.04
$873.66
$944.26
$1195.00		 $963.76
$1030.38
$1100.98
$1351.72		 $403.52
$436.83
$472.13
$597.50		 $560.24
$593.55
$628.85
$754.22		 $716.96
$750.27
$785.57
$910.94		 $156.72

Plan: (HMO) HMO 7150 Elite Catastrophic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-247-3296 - Provider Directory for This Plan: (Health Alliance Medical Plans, 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		 $246.60
$279.89
$315.15
$440.43
$669.27		 $493.20
$559.78
$630.30
$880.86
$1338.54		 $649.79
$716.37
$786.89
$1037.45		 $806.38
$872.96
$943.48
$1194.04		 $962.97
$1029.55
$1100.07
$1350.63		 $403.19
$436.48
$471.74
$597.02		 $559.78
$593.07
$628.33
$753.61		 $716.37
$749.66
$784.92
$910.20		 $156.59

Plan: (HMO) HMO 3000b Elite Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-247-3296 - Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $312.39
$354.56
$399.23
$557.93
$847.83		 $624.78
$709.12
$798.46
$1115.86
$1695.66		 $823.15
$907.49
$996.83
$1314.23		 $1021.52
$1105.86
$1195.20
$1512.60		 $1219.89
$1304.23
$1393.57
$1710.97		 $510.76
$552.93
$597.60
$756.30		 $709.13
$751.30
$795.97
$954.67		 $907.50
$949.67
$994.34
$1153.04		 $198.37

Plan: (HMO) HMO 4500 Elite Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-247-3296 - Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)

Deductible: Individual: $4,500 : Family: $9,000
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		 $318.76
$361.80
$407.38
$569.31
$865.12		 $637.52
$723.60
$814.76
$1138.62
$1730.24		 $839.93
$926.01
$1017.17
$1341.03		 $1042.34
$1128.42
$1219.58
$1543.44		 $1244.75
$1330.83
$1421.99
$1745.85		 $521.17
$564.21
$609.79
$771.72		 $723.58
$766.62
$812.20
$974.13		 $925.99
$969.03
$1014.61
$1176.54		 $202.41

Plan: (HMO) HMO 3800 Elite Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-247-3296 - Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)

Deductible: Individual: $3,800 : Family: $7,150
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		 $245.71
$278.88
$314.01
$438.83
$666.85		 $491.42
$557.76
$628.02
$877.66
$1333.70		 $647.44
$713.78
$784.04
$1033.68		 $803.46
$869.80
$940.06
$1189.70		 $959.48
$1025.82
$1096.08
$1345.72		 $401.73
$434.90
$470.03
$594.85		 $557.75
$590.92
$626.05
$750.87		 $713.77
$746.94
$782.07
$906.89		 $156.02

Plan: (HMO) HMO 4000d Elite Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-247-3296 - Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $255.99
$290.55
$327.16
$457.20
$694.76		 $511.98
$581.10
$654.32
$914.40
$1389.52		 $674.53
$743.65
$816.87
$1076.95		 $837.08
$906.20
$979.42
$1239.50		 $999.63
$1068.75
$1141.97
$1402.05		 $418.54
$453.10
$489.71
$619.75		 $581.09
$615.65
$652.26
$782.30		 $743.64
$778.20
$814.81
$944.85		 $162.55

Plan: (HMO) HMO 3500 Elite Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-247-3296 - Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)

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		 $325.14
$369.03
$415.52
$580.69
$882.42		 $650.28
$738.06
$831.04
$1161.38
$1764.84		 $856.74
$944.52
$1037.50
$1367.84		 $1063.20
$1150.98
$1243.96
$1574.30		 $1269.66
$1357.44
$1450.42
$1780.76		 $531.60
$575.49
$621.98
$787.15		 $738.06
$781.95
$828.44
$993.61		 $944.52
$988.41
$1034.90
$1200.07		 $206.46

Plan: (POS) POS 6000b Elite Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-247-3296 - Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)

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

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $339.10
$384.87
$433.36
$605.62
$920.31		 $678.20
$769.74
$866.72
$1211.24
$1840.62		 $893.53
$985.07
$1082.05
$1426.57		 $1108.86
$1200.40
$1297.38
$1641.90		 $1324.19
$1415.73
$1512.71
$1857.23		 $554.43
$600.20
$648.69
$820.95		 $769.76
$815.53
$864.02
$1036.28		 $985.09
$1030.86
$1079.35
$1251.61		 $215.33

Plan: (POS) POS 5000a Elite Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-247-3296 - Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)

Deductible: Individual: $5,000 : 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		 $276.62
$313.97
$353.52
$494.05
$750.76		 $553.24
$627.94
$707.04
$988.10
$1501.52		 $728.90
$803.60
$882.70
$1163.76		 $904.56
$979.26
$1058.36
$1339.42		 $1080.22
$1154.92
$1234.02
$1515.08		 $452.28
$489.63
$529.18
$669.71		 $627.94
$665.29
$704.84
$845.37		 $803.60
$840.95
$880.50
$1021.03		 $175.66

Plan: (POS) POS 6650 Elite Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-247-3296 - Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)

Deductible: Individual: $6,650 : Family: $13,300
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
Bronze 21
30
40
50
60		 $266.87
$302.89
$341.05
$476.62
$724.27		 $533.74
$605.78
$682.10
$953.24
$1448.54		 $703.20
$775.24
$851.56
$1122.70		 $872.66
$944.70
$1021.02
$1292.16		 $1042.12
$1114.16
$1190.48
$1461.62		 $436.33
$472.35
$510.51
$646.08		 $605.79
$641.81
$679.97
$815.54		 $775.25
$811.27
$849.43
$985.00		 $169.46
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Blue Cross Blue Shield of Illinois

Local: 1-800-538-8833 | Toll Free: 1-800-538-8833

TTY: 1-800-526-0844

Plan: (PPO) Blue Choice Preferred Security PPO? 100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

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		 $299.00
$339.36
$382.12
$534.01
$811.48		 $598.00
$678.72
$764.24
$1068.02
$1622.96		 $787.86
$868.58
$954.10
$1257.88		 $977.72
$1058.44
$1143.96
$1447.74		 $1167.58
$1248.30
$1333.82
$1637.60		 $488.86
$529.22
$571.98
$723.87		 $678.72
$719.08
$761.84
$913.73		 $868.58
$908.94
$951.70
$1103.59		 $189.86
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Health Alliance Medical Plans, Inc.

Local: 1-866-247-3296 | Toll Free: 1-866-247-3296

TTY: 1-800-526-0844

Plan: (POS) POS 3500 Elite Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-866-247-3296 - Provider Directory for This Plan: (Health Alliance Medical Plans, Inc.)

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		 $344.56
$391.07
$440.34
$615.38
$935.13		 $689.12
$782.14
$880.68
$1230.76
$1870.26		 $907.91
$1000.93
$1099.47
$1449.55		 $1126.70
$1219.72
$1318.26
$1668.34		 $1345.49
$1438.51
$1537.05
$1887.13		 $563.35
$609.86
$659.13
$834.17		 $782.14
$828.65
$877.92
$1052.96		 $1000.93
$1047.44
$1096.71
$1271.75		 $218.79
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Blue Cross Blue Shield of Illinois

Local: 1-800-538-8833 | Toll Free: 1-800-538-8833

TTY: 1-800-526-0844

Plan: (PPO) Blue Cross Blue Shield Premier? 101, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $1,750 : Family: $5,250
Out of Pocket Maximum per year: Individual: $3,300 : Family: $9,900

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
Gold 21
30
40
50
60		 $460.43
$522.59
$588.43
$822.33
$1249.61		 $920.86
$1045.18
$1176.86
$1644.66
$2499.22		 $1213.23
$1337.55
$1469.23
$1937.03		 $1505.60
$1629.92
$1761.60
$2229.40		 $1797.97
$1922.29
$2053.97
$2521.77		 $752.80
$814.96
$880.80
$1114.70		 $1045.17
$1107.33
$1173.17
$1407.07		 $1337.54
$1399.70
$1465.54
$1699.44		 $292.37

Plan: (PPO) Blue Cross Blue Shield Solution? 102, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $3,750 : Family: $11,250
Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $385.66
$437.73
$492.88
$688.80
$1046.69		 $771.32
$875.46
$985.76
$1377.60
$2093.38		 $1016.22
$1120.36
$1230.66
$1622.50		 $1261.12
$1365.26
$1475.56
$1867.40		 $1506.02
$1610.16
$1720.46
$2112.30		 $630.56
$682.63
$737.78
$933.70		 $875.46
$927.53
$982.68
$1178.60		 $1120.36
$1172.43
$1227.58
$1423.50		 $244.90

Plan: (PPO) Blue Cross Blue Shield Basic? 103, a Multi-State Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $6,250 : 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
Bronze 21
30
40
50
60		 $304.71
$345.84
$389.42
$544.21
$826.98		 $609.42
$691.68
$778.84
$1088.42
$1653.96		 $802.91
$885.17
$972.33
$1281.91		 $996.40
$1078.66
$1165.82
$1475.40		 $1189.89
$1272.15
$1359.31
$1668.89		 $498.20
$539.33
$582.91
$737.70		 $691.69
$732.82
$776.40
$931.19		 $885.18
$926.31
$969.89
$1124.68		 $193.49

Plan: (PPO) Blue Choice Preferred Silver PPO? 102

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $3,000 : Family: $9,000
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		 $387.28
$439.56
$494.94
$691.68
$1051.08		 $774.56
$879.12
$989.88
$1383.36
$2102.16		 $1020.48
$1125.04
$1235.80
$1629.28		 $1266.40
$1370.96
$1481.72
$1875.20		 $1512.32
$1616.88
$1727.64
$2121.12		 $633.20
$685.48
$740.86
$937.60		 $879.12
$931.40
$986.78
$1183.52		 $1125.04
$1177.32
$1232.70
$1429.44		 $245.92

Plan: (PPO) Blue Choice Preferred Silver PPO? 103 - Three $0 PCP Visits

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $3,250 : Family: $9,750
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $390.95
$443.72
$499.63
$698.23
$1061.03		 $781.90
$887.44
$999.26
$1396.46
$2122.06		 $1030.15
$1135.69
$1247.51
$1644.71		 $1278.40
$1383.94
$1495.76
$1892.96		 $1526.65
$1632.19
$1744.01
$2141.21		 $639.20
$691.97
$747.88
$946.48		 $887.45
$940.22
$996.13
$1194.73		 $1135.70
$1188.47
$1244.38
$1442.98		 $248.25

Plan: (PPO) Blue Choice Preferred Bronze PPO? 105

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $5,000 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $321.76
$365.20
$411.21
$574.67
$873.26		 $643.52
$730.40
$822.42
$1149.34
$1746.52		 $847.84
$934.72
$1026.74
$1353.66		 $1052.16
$1139.04
$1231.06
$1557.98		 $1256.48
$1343.36
$1435.38
$1762.30		 $526.08
$569.52
$615.53
$778.99		 $730.40
$773.84
$819.85
$983.31		 $934.72
$978.16
$1024.17
$1187.63		 $204.32

Plan: (PPO) Blue Choice Preferred Bronze PPO? 106

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $6,500 : Family: $13,100
Out of Pocket Maximum per year: Individual: $6,500 : 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		 $328.46
$372.80
$419.77
$586.62
$891.43		 $656.92
$745.60
$839.54
$1173.24
$1782.86		 $865.49
$954.17
$1048.11
$1381.81		 $1074.06
$1162.74
$1256.68
$1590.38		 $1282.63
$1371.31
$1465.25
$1798.95		 $537.03
$581.37
$628.34
$795.19		 $745.60
$789.94
$836.91
$1003.76		 $954.17
$998.51
$1045.48
$1212.33		 $208.57

Plan: (PPO) Blue Choice Preferred Bronze PPO? 107 - One $0 PCP Visit

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

Deductible: Individual: $6,750 : 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
Bronze 21
30
40
50
60		 $304.02
$345.07
$388.54
$542.99
$825.12		 $608.04
$690.14
$777.08
$1085.98
$1650.24		 $801.10
$883.20
$970.14
$1279.04		 $994.16
$1076.26
$1163.20
$1472.10		 $1187.22
$1269.32
$1356.26
$1665.16		 $497.08
$538.13
$581.60
$736.05		 $690.14
$731.19
$774.66
$929.11		 $883.20
$924.25
$967.72
$1122.17		 $193.06

Plan: (PPO) Blue Choice Preferred Silver PPO? 109 - Standardized

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-538-8833 - Provider Directory for This Plan: (Blue Cross Blue Shield of Illinois)

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		 $392.31
$445.27
$501.37
$700.66
$1064.73		 $784.62
$890.54
$1002.74
$1401.32
$2129.46		 $1033.74
$1139.66
$1251.86
$1650.44		 $1282.86
$1388.78
$1500.98
$1899.56		 $1531.98
$1637.90
$1750.10
$2148.68		 $641.43
$694.39
$750.49
$949.78		 $890.55
$943.51
$999.61
$1198.90		 $1139.67
$1192.63
$1248.73
$1448.02		 $249.12

 

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