Obamacare 2017 Rates and Health Insurance Providers for Stark County,Massillon,OH

Obamacare Providers, Plans and 2017 Rates for Stark 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 Stark County, Ohio.

Currently, there are 97 plans offered in Stark 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 Stark 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 Massillon, OH 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 Stark County here.

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CareSource Local: 1-800-479-9502 \| Toll Free: 1-800-479-9502 TTY: 1-800-750-0750
Plan: (HMO) CareSource Gold Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource) Deductible: Individual: $1,000 : Family: $2,000 Out of Pocket Maximum per year: Individual: $2,500 : Family: $5,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$266.91 $302.94 $341.11 $476.70 $724.39	$533.82 $605.88 $682.22 $953.40 $1448.78	$703.31 $775.37 $851.71 $1122.89	$872.80 $944.86 $1021.20 $1292.38	$1042.29 $1114.35 $1190.69 $1461.87	$436.40 $472.43 $510.60 $646.19	$605.89 $641.92 $680.09 $815.68	$775.38 $811.41 $849.58 $985.17	$169.49
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AultCare Insurance Company Local: 1-330-363-6360 \| Toll Free: 1-800-344-8858 TTY: 1-330-363-2393
Plan: (PPO) AultCare Gold 750 No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $750 : Family: $1,500 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
Gold	21 30 40 50 60	$435.76 $494.59 $556.90 $778.26 $1182.65	$871.52 $989.18 $1113.80 $1556.52 $2365.30	$1148.23 $1265.89 $1390.51 $1833.23	$1424.94 $1542.60 $1667.22 $2109.94	$1701.65 $1819.31 $1943.93 $2386.65	$712.47 $771.30 $833.61 $1054.97	$989.18 $1048.01 $1110.32 $1331.68	$1265.89 $1324.72 $1387.03 $1608.39	$276.71
Plan: (PPO) AultCare Gold 350 No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $350 : Family: $700 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	$452.03 $513.06 $577.70 $807.33 $1226.82	$904.06 $1026.12 $1155.40 $1614.66 $2453.64	$1191.10 $1313.16 $1442.44 $1901.70	$1478.14 $1600.20 $1729.48 $2188.74	$1765.18 $1887.24 $2016.52 $2475.78	$739.07 $800.10 $864.74 $1094.37	$1026.11 $1087.14 $1151.78 $1381.41	$1313.15 $1374.18 $1438.82 $1668.45	$287.04
Plan: (PPO) AultCare Gold 750 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $750 : Family: $1,500 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
Gold	21 30 40 50 60	$442.56 $502.30 $565.59 $790.41 $1201.10	$885.12 $1004.60 $1131.18 $1580.82 $2402.20	$1166.14 $1285.62 $1412.20 $1861.84	$1447.16 $1566.64 $1693.22 $2142.86	$1728.18 $1847.66 $1974.24 $2423.88	$723.58 $783.32 $846.61 $1071.43	$1004.60 $1064.34 $1127.63 $1352.45	$1285.62 $1345.36 $1408.65 $1633.47	$281.02
Plan: (PPO) AultCare Gold 350 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $350 : Family: $700 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	$459.43 $521.45 $587.15 $820.53 $1246.88	$918.86 $1042.90 $1174.30 $1641.06 $2493.76	$1210.59 $1334.63 $1466.03 $1932.79	$1502.32 $1626.36 $1757.76 $2224.52	$1794.05 $1918.09 $2049.49 $2516.25	$751.16 $813.18 $878.88 $1112.26	$1042.89 $1104.91 $1170.61 $1403.99	$1334.62 $1396.64 $1462.34 $1695.72	$291.73
Plan: (PPO) AultCare Bronze 6000 No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $6,000 : Family: $12,000 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	$256.35 $290.95 $327.61 $457.83 $695.72	$512.70 $581.90 $655.22 $915.66 $1391.44	$675.48 $744.68 $818.00 $1078.44	$838.26 $907.46 $980.78 $1241.22	$1001.04 $1070.24 $1143.56 $1404.00	$419.13 $453.73 $490.39 $620.61	$581.91 $616.51 $653.17 $783.39	$744.69 $779.29 $815.95 $946.17	$162.78
Plan: (PPO) AultCare Bronze 5000 No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $5,000 : Family: $10,000 Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$264.76 $300.50 $338.36 $472.85 $718.55	$529.52 $601.00 $676.72 $945.70 $1437.10	$697.64 $769.12 $844.84 $1113.82	$865.76 $937.24 $1012.96 $1281.94	$1033.88 $1105.36 $1181.08 $1450.06	$432.88 $468.62 $506.48 $640.97	$601.00 $636.74 $674.60 $809.09	$769.12 $804.86 $842.72 $977.21	$168.12
Plan: (PPO) AultCare Silver 5000 No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $5,000 : Family: $10,000 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	$323.62 $367.31 $413.59 $577.99 $878.31	$647.24 $734.62 $827.18 $1155.98 $1756.62	$852.74 $940.12 $1032.68 $1361.48	$1058.24 $1145.62 $1238.18 $1566.98	$1263.74 $1351.12 $1443.68 $1772.48	$529.12 $572.81 $619.09 $783.49	$734.62 $778.31 $824.59 $988.99	$940.12 $983.81 $1030.09 $1194.49	$205.50
Plan: (PPO) AultCare Silver 3000 No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $3,000 : Family: $6,000 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
Silver	21 30 40 50 60	$350.87 $398.24 $448.42 $626.66 $952.27	$701.74 $796.48 $896.84 $1253.32 $1904.54	$924.54 $1019.28 $1119.64 $1476.12	$1147.34 $1242.08 $1342.44 $1698.92	$1370.14 $1464.88 $1565.24 $1921.72	$573.67 $621.04 $671.22 $849.46	$796.47 $843.84 $894.02 $1072.26	$1019.27 $1066.64 $1116.82 $1295.06	$222.80
Plan: (PPO) AultCare Silver 2500 No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $2,500 : Family: $5,000 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
Silver	21 30 40 50 60	$355.48 $403.47 $454.31 $634.89 $964.78	$710.96 $806.94 $908.62 $1269.78 $1929.56	$936.69 $1032.67 $1134.35 $1495.51	$1162.42 $1258.40 $1360.08 $1721.24	$1388.15 $1484.13 $1585.81 $1946.97	$581.21 $629.20 $680.04 $860.62	$806.94 $854.93 $905.77 $1086.35	$1032.67 $1080.66 $1131.50 $1312.08	$225.73
Plan: (PPO) AultCare Gold 1200 No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $1,200 : Family: $2,400 Out of Pocket Maximum per year: Individual: $5,700 : Family: $11,400 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	$437.03 $496.02 $558.52 $780.53 $1186.09	$874.06 $992.04 $1117.04 $1561.06 $2372.18	$1151.57 $1269.55 $1394.55 $1838.57	$1429.08 $1547.06 $1672.06 $2116.08	$1706.59 $1824.57 $1949.57 $2393.59	$714.54 $773.53 $836.03 $1058.04	$992.05 $1051.04 $1113.54 $1335.55	$1269.56 $1328.55 $1391.05 $1613.06	$277.51
Plan: (PPO) AultCare Catastrophic Select Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare 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	$160.44 $182.10 $205.04 $286.55 $435.44	$320.88 $364.20 $410.08 $573.10 $870.88	$422.76 $466.08 $511.96 $674.98	$524.64 $567.96 $613.84 $776.86	$626.52 $669.84 $715.72 $878.74	$262.32 $283.98 $306.92 $388.43	$364.20 $385.86 $408.80 $490.31	$466.08 $487.74 $510.68 $592.19	$101.88
Plan: (PPO) AultCare Bronze 6000 Select Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $6,000 : Family: $12,000 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	$221.56 $251.47 $283.16 $395.71 $601.32	$443.12 $502.94 $566.32 $791.42 $1202.64	$583.81 $643.63 $707.01 $932.11	$724.50 $784.32 $847.70 $1072.80	$865.19 $925.01 $988.39 $1213.49	$362.25 $392.16 $423.85 $536.40	$502.94 $532.85 $564.54 $677.09	$643.63 $673.54 $705.23 $817.78	$140.69
Plan: (PPO) AultCare Bronze 5000 Select Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $5,000 : Family: $10,000 Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$229.22 $260.17 $292.95 $409.39 $622.11	$458.44 $520.34 $585.90 $818.78 $1244.22	$604.00 $665.90 $731.46 $964.34	$749.56 $811.46 $877.02 $1109.90	$895.12 $957.02 $1022.58 $1255.46	$374.78 $405.73 $438.51 $554.95	$520.34 $551.29 $584.07 $700.51	$665.90 $696.85 $729.63 $846.07	$145.56
Plan: (PPO) AultCare Silver 5000 Select Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $5,000 : Family: $10,000 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	$279.98 $317.77 $357.81 $500.04 $759.85	$559.96 $635.54 $715.62 $1000.08 $1519.70	$737.74 $813.32 $893.40 $1177.86	$915.52 $991.10 $1071.18 $1355.64	$1093.30 $1168.88 $1248.96 $1533.42	$457.76 $495.55 $535.59 $677.82	$635.54 $673.33 $713.37 $855.60	$813.32 $851.11 $891.15 $1033.38	$177.78
Plan: (PPO) AultCare Silver 3000 Select Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $3,000 : Family: $6,000 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
Silver	21 30 40 50 60	$303.41 $344.38 $387.76 $541.90 $823.47	$606.82 $688.76 $775.52 $1083.80 $1646.94	$799.49 $881.43 $968.19 $1276.47	$992.16 $1074.10 $1160.86 $1469.14	$1184.83 $1266.77 $1353.53 $1661.81	$496.08 $537.05 $580.43 $734.57	$688.75 $729.72 $773.10 $927.24	$881.42 $922.39 $965.77 $1119.91	$192.67
Plan: (PPO) AultCare Silver 2500 Select Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $2,500 : Family: $5,000 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
Silver	21 30 40 50 60	$307.03 $348.47 $392.38 $548.35 $833.27	$614.06 $696.94 $784.76 $1096.70 $1666.54	$809.02 $891.90 $979.72 $1291.66	$1003.98 $1086.86 $1174.68 $1486.62	$1198.94 $1281.82 $1369.64 $1681.58	$501.99 $543.43 $587.34 $743.31	$696.95 $738.39 $782.30 $938.27	$891.91 $933.35 $977.26 $1133.23	$194.96
Plan: (PPO) AultCare Gold 1200 Select Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $1,200 : Family: $2,400 Out of Pocket Maximum per year: Individual: $5,700 : Family: $11,400 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	$376.90 $427.78 $481.68 $673.14 $1022.90	$753.80 $855.56 $963.36 $1346.28 $2045.80	$993.13 $1094.89 $1202.69 $1585.61	$1232.46 $1334.22 $1442.02 $1824.94	$1471.79 $1573.55 $1681.35 $2064.27	$616.23 $667.11 $721.01 $912.47	$855.56 $906.44 $960.34 $1151.80	$1094.89 $1145.77 $1199.67 $1391.13	$239.33
Plan: (PPO) AultCare Gold 750 Select Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $750 : Family: $1,500 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
Gold	21 30 40 50 60	$376.17 $426.96 $480.75 $671.85 $1020.94	$752.34 $853.92 $961.50 $1343.70 $2041.88	$991.21 $1092.79 $1200.37 $1582.57	$1230.08 $1331.66 $1439.24 $1821.44	$1468.95 $1570.53 $1678.11 $2060.31	$615.04 $665.83 $719.62 $910.72	$853.91 $904.70 $958.49 $1149.59	$1092.78 $1143.57 $1197.36 $1388.46	$238.87
Plan: (PPO) AultCare Gold 350 Select Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $350 : Family: $700 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	$390.51 $443.23 $499.07 $697.45 $1059.85	$781.02 $886.46 $998.14 $1394.90 $2119.70	$1028.99 $1134.43 $1246.11 $1642.87	$1276.96 $1382.40 $1494.08 $1890.84	$1524.93 $1630.37 $1742.05 $2138.81	$638.48 $691.20 $747.04 $945.42	$886.45 $939.17 $995.01 $1193.39	$1134.42 $1187.14 $1242.98 $1441.36	$247.97
Plan: (PPO) AultCare Catastrophic Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare 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	$188.75 $214.24 $241.23 $337.12 $512.28	$377.50 $428.48 $482.46 $674.24 $1024.56	$497.36 $548.34 $602.32 $794.10	$617.22 $668.20 $722.18 $913.96	$737.08 $788.06 $842.04 $1033.82	$308.61 $334.10 $361.09 $456.98	$428.47 $453.96 $480.95 $576.84	$548.33 $573.82 $600.81 $696.70	$119.86
Plan: (PPO) AultCare Bronze 6000 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $6,000 : Family: $12,000 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	$260.66 $295.85 $333.12 $465.54 $707.43	$521.32 $591.70 $666.24 $931.08 $1414.86	$686.84 $757.22 $831.76 $1096.60	$852.36 $922.74 $997.28 $1262.12	$1017.88 $1088.26 $1162.80 $1427.64	$426.18 $461.37 $498.64 $631.06	$591.70 $626.89 $664.16 $796.58	$757.22 $792.41 $829.68 $962.10	$165.52
Plan: (PPO) AultCare Bronze 5000 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $5,000 : Family: $10,000 Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$269.67 $306.08 $344.64 $481.63 $731.89	$539.34 $612.16 $689.28 $963.26 $1463.78	$710.58 $783.40 $860.52 $1134.50	$881.82 $954.64 $1031.76 $1305.74	$1053.06 $1125.88 $1203.00 $1476.98	$440.91 $477.32 $515.88 $652.87	$612.15 $648.56 $687.12 $824.11	$783.39 $819.80 $858.36 $995.35	$171.24
Plan: (PPO) AultCare Silver 5000 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $5,000 : Family: $10,000 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	$329.38 $373.85 $420.95 $588.28 $893.94	$658.76 $747.70 $841.90 $1176.56 $1787.88	$867.92 $956.86 $1051.06 $1385.72	$1077.08 $1166.02 $1260.22 $1594.88	$1286.24 $1375.18 $1469.38 $1804.04	$538.54 $583.01 $630.11 $797.44	$747.70 $792.17 $839.27 $1006.60	$956.86 $1001.33 $1048.43 $1215.76	$209.16
Plan: (PPO) AultCare Silver 3000 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $3,000 : Family: $6,000 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
Silver	21 30 40 50 60	$356.96 $405.15 $456.19 $637.53 $968.78	$713.92 $810.30 $912.38 $1275.06 $1937.56	$940.59 $1036.97 $1139.05 $1501.73	$1167.26 $1263.64 $1365.72 $1728.40	$1393.93 $1490.31 $1592.39 $1955.07	$583.63 $631.82 $682.86 $864.20	$810.30 $858.49 $909.53 $1090.87	$1036.97 $1085.16 $1136.20 $1317.54	$226.67
Plan: (PPO) AultCare Silver 2500 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $2,500 : Family: $5,000 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
Silver	21 30 40 50 60	$361.21 $409.97 $461.62 $645.12 $980.32	$722.42 $819.94 $923.24 $1290.24 $1960.64	$951.79 $1049.31 $1152.61 $1519.61	$1181.16 $1278.68 $1381.98 $1748.98	$1410.53 $1508.05 $1611.35 $1978.35	$590.58 $639.34 $690.99 $874.49	$819.95 $868.71 $920.36 $1103.86	$1049.32 $1098.08 $1149.73 $1333.23	$229.37
Plan: (PPO) AultCare Gold 1200 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $1,200 : Family: $2,400 Out of Pocket Maximum per year: Individual: $5,700 : Family: $11,400 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	$443.41 $503.27 $566.68 $791.93 $1203.41	$886.82 $1006.54 $1133.36 $1583.86 $2406.82	$1168.39 $1288.11 $1414.93 $1865.43	$1449.96 $1569.68 $1696.50 $2147.00	$1731.53 $1851.25 $1978.07 $2428.57	$724.98 $784.84 $848.25 $1073.50	$1006.55 $1066.41 $1129.82 $1355.07	$1288.12 $1347.98 $1411.39 $1636.64	$281.57
Plan: (PPO) AultCare Catastrophic No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare 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	$185.80 $210.89 $237.46 $331.85 $504.27	$371.60 $421.78 $474.92 $663.70 $1008.54	$489.59 $539.77 $592.91 $781.69	$607.58 $657.76 $710.90 $899.68	$725.57 $775.75 $828.89 $1017.67	$303.79 $328.88 $355.45 $449.84	$421.78 $446.87 $473.44 $567.83	$539.77 $564.86 $591.43 $685.82	$117.99
Plan: (PPO) AultCare Gold 350 Select No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $350 : Family: $700 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	$384.23 $436.10 $491.04 $686.23 $1042.79	$768.46 $872.20 $982.08 $1372.46 $2085.58	$1012.44 $1116.18 $1226.06 $1616.44	$1256.42 $1360.16 $1470.04 $1860.42	$1500.40 $1604.14 $1714.02 $2104.40	$628.21 $680.08 $735.02 $930.21	$872.19 $924.06 $979.00 $1174.19	$1116.17 $1168.04 $1222.98 $1418.17	$243.98
Plan: (PPO) AultCare Gold 750 Select No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $750 : Family: $1,500 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
Gold	21 30 40 50 60	$370.39 $420.40 $473.36 $661.52 $1005.25	$740.78 $840.80 $946.72 $1323.04 $2010.50	$975.98 $1076.00 $1181.92 $1558.24	$1211.18 $1311.20 $1417.12 $1793.44	$1446.38 $1546.40 $1652.32 $2028.64	$605.59 $655.60 $708.56 $896.72	$840.79 $890.80 $943.76 $1131.92	$1075.99 $1126.00 $1178.96 $1367.12	$235.20
Plan: (PPO) AultCare Gold 1200 Select No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $1,200 : Family: $2,400 Out of Pocket Maximum per year: Individual: $5,700 : Family: $11,400 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	$371.47 $421.62 $474.74 $663.45 $1008.18	$742.94 $843.24 $949.48 $1326.90 $2016.36	$978.82 $1079.12 $1185.36 $1562.78	$1214.70 $1315.00 $1421.24 $1798.66	$1450.58 $1550.88 $1657.12 $2034.54	$607.35 $657.50 $710.62 $899.33	$843.23 $893.38 $946.50 $1135.21	$1079.11 $1129.26 $1182.38 $1371.09	$235.88
Plan: (PPO) AultCare Silver 2500 Select No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $2,500 : Family: $5,000 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
Silver	21 30 40 50 60	$302.16 $342.95 $386.16 $539.66 $820.07	$604.32 $685.90 $772.32 $1079.32 $1640.14	$796.19 $877.77 $964.19 $1271.19	$988.06 $1069.64 $1156.06 $1463.06	$1179.93 $1261.51 $1347.93 $1654.93	$494.03 $534.82 $578.03 $731.53	$685.90 $726.69 $769.90 $923.40	$877.77 $918.56 $961.77 $1115.27	$191.87
Plan: (PPO) AultCare Bronze 6600 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $6,550 : Family: $13,100 Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$260.07 $295.18 $332.38 $464.49 $705.84	$520.14 $590.36 $664.76 $928.98 $1411.68	$685.29 $755.51 $829.91 $1094.13	$850.44 $920.66 $995.06 $1259.28	$1015.59 $1085.81 $1160.21 $1424.43	$425.22 $460.33 $497.53 $629.64	$590.37 $625.48 $662.68 $794.79	$755.52 $790.63 $827.83 $959.94	$165.15
Plan: (PPO) AultCare Silver 3000 Select No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $3,000 : Family: $6,000 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
Silver	21 30 40 50 60	$298.24 $338.51 $381.15 $532.66 $809.43	$596.48 $677.02 $762.30 $1065.32 $1618.86	$785.86 $866.40 $951.68 $1254.70	$975.24 $1055.78 $1141.06 $1444.08	$1164.62 $1245.16 $1330.44 $1633.46	$487.62 $527.89 $570.53 $722.04	$677.00 $717.27 $759.91 $911.42	$866.38 $906.65 $949.29 $1100.80	$189.38
Plan: (PPO) AultCare Silver 5000 Select No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $5,000 : Family: $10,000 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	$275.08 $312.21 $351.55 $491.29 $746.56	$550.16 $624.42 $703.10 $982.58 $1493.12	$724.84 $799.10 $877.78 $1157.26	$899.52 $973.78 $1052.46 $1331.94	$1074.20 $1148.46 $1227.14 $1506.62	$449.76 $486.89 $526.23 $665.97	$624.44 $661.57 $700.91 $840.65	$799.12 $836.25 $875.59 $1015.33	$174.68
Plan: (PPO) AultCare Bronze 5000 Select No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $5,000 : Family: $10,000 Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$225.04 $255.42 $287.60 $401.93 $610.77	$450.08 $510.84 $575.20 $803.86 $1221.54	$592.98 $653.74 $718.10 $946.76	$735.88 $796.64 $861.00 $1089.66	$878.78 $939.54 $1003.90 $1232.56	$367.94 $398.32 $430.50 $544.83	$510.84 $541.22 $573.40 $687.73	$653.74 $684.12 $716.30 $830.63	$142.90
Plan: (PPO) AultCare Bronze 6000 Select No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $6,000 : Family: $12,000 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	$217.89 $247.31 $278.47 $389.16 $591.36	$435.78 $494.62 $556.94 $778.32 $1182.72	$574.14 $632.98 $695.30 $916.68	$712.50 $771.34 $833.66 $1055.04	$850.86 $909.70 $972.02 $1193.40	$356.25 $385.67 $416.83 $527.52	$494.61 $524.03 $555.19 $665.88	$632.97 $662.39 $693.55 $804.24	$138.36
Plan: (PPO) AultCare Catastrophic Select No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare 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	$157.93 $179.26 $201.84 $282.07 $428.63	$315.86 $358.52 $403.68 $564.14 $857.26	$416.15 $458.81 $503.97 $664.43	$516.44 $559.10 $604.26 $764.72	$616.73 $659.39 $704.55 $865.01	$258.22 $279.55 $302.13 $382.36	$358.51 $379.84 $402.42 $482.65	$458.80 $480.13 $502.71 $582.94	$100.29
Plan: (PPO) AultCare Silver 6850 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $6,850 : Family: $13,700 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$289.96 $329.11 $370.57 $517.88 $786.96	$579.92 $658.22 $741.14 $1035.76 $1573.92	$764.05 $842.35 $925.27 $1219.89	$948.18 $1026.48 $1109.40 $1404.02	$1132.31 $1210.61 $1293.53 $1588.15	$474.09 $513.24 $554.70 $702.01	$658.22 $697.37 $738.83 $886.14	$842.35 $881.50 $922.96 $1070.27	$184.13
Plan: (PPO) AultCare Silver 6850 Select Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $6,850 : Family: $13,700 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$246.47 $279.74 $314.99 $440.19 $668.92	$492.94 $559.48 $629.98 $880.38 $1337.84	$649.45 $715.99 $786.49 $1036.89	$805.96 $872.50 $943.00 $1193.40	$962.47 $1029.01 $1099.51 $1349.91	$402.98 $436.25 $471.50 $596.70	$559.49 $592.76 $628.01 $753.21	$716.00 $749.27 $784.52 $909.72	$156.51
Plan: (PPO) AultCare Silver 6850 No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $6,850 : Family: $13,700 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$285.33 $323.85 $364.66 $509.60 $774.39	$570.66 $647.70 $729.32 $1019.20 $1548.78	$751.85 $828.89 $910.51 $1200.39	$933.04 $1010.08 $1091.70 $1381.58	$1114.23 $1191.27 $1272.89 $1562.77	$466.52 $505.04 $545.85 $690.79	$647.71 $686.23 $727.04 $871.98	$828.90 $867.42 $908.23 $1053.17	$181.19
Plan: (PPO) AultCare Silver 6850 Select No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $6,850 : Family: $13,700 Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$242.53 $275.28 $309.96 $433.16 $658.23	$485.06 $550.56 $619.92 $866.32 $1316.46	$639.07 $704.57 $773.93 $1020.33	$793.08 $858.58 $927.94 $1174.34	$947.09 $1012.59 $1081.95 $1328.35	$396.54 $429.29 $463.97 $587.17	$550.55 $583.30 $617.98 $741.18	$704.56 $737.31 $771.99 $895.19	$154.01
Plan: (PPO) AultCare Bronze 6600 Select Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $6,550 : Family: $13,100 Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$221.06 $250.91 $282.52 $394.82 $599.97	$442.12 $501.82 $565.04 $789.64 $1199.94	$582.50 $642.20 $705.42 $930.02	$722.88 $782.58 $845.80 $1070.40	$863.26 $922.96 $986.18 $1210.78	$361.44 $391.29 $422.90 $535.20	$501.82 $531.67 $563.28 $675.58	$642.20 $672.05 $703.66 $815.96	$140.38
Plan: (PPO) AultCare Bronze 6600 No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $6,550 : Family: $13,100 Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$255.97 $290.53 $327.13 $457.16 $694.71	$511.94 $581.06 $654.26 $914.32 $1389.42	$674.48 $743.60 $816.80 $1076.86	$837.02 $906.14 $979.34 $1239.40	$999.56 $1068.68 $1141.88 $1401.94	$418.51 $453.07 $489.67 $619.70	$581.05 $615.61 $652.21 $782.24	$743.59 $778.15 $814.75 $944.78	$162.54
Plan: (PPO) AultCare Bronze 6600 Select No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) Deductible: Individual: $6,550 : Family: $13,100 Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$217.58 $246.95 $278.06 $388.59 $590.50	$435.16 $493.90 $556.12 $777.18 $1181.00	$573.32 $632.06 $694.28 $915.34	$711.48 $770.22 $832.44 $1053.50	$849.64 $908.38 $970.60 $1191.66	$355.74 $385.11 $416.22 $526.75	$493.90 $523.27 $554.38 $664.91	$632.06 $661.43 $692.54 $803.07	$138.16
Plan: (PPO) AultCare Bronze Standard Select No Pediatric Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company) 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	$217.34 $246.68 $277.76 $388.17 $589.86	$434.68 $493.36 $555.52 $776.34 $1179.72	$572.69 $631.37 $693.53 $914.35	$710.70 $769.38 $831.54 $1052.36	$848.71 $907.39 $969.55 $1190.37	$355.35 $384.69 $415.77 $526.18	$493.36 $522.70 $553.78 $664.19	$631.37 $660.71 $691.79 $802.20	$138.01
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Plan: (PPO) Anthem Catastrophic Pathway X PPO 7150 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) 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	$182.58 $207.23 $233.34 $326.09 $495.52	$365.16 $414.46 $466.68 $652.18 $991.04	$481.10 $530.40 $582.62 $768.12	$597.04 $646.34 $698.56 $884.06	$712.98 $762.28 $814.50 $1000.00	$298.52 $323.17 $349.28 $442.03	$414.46 $439.11 $465.22 $557.97	$530.40 $555.05 $581.16 $673.91	$115.94
Plan: (PPO) Anthem Bronze Pathway X PPO 0 for HSA Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) Deductible: Individual: $6,550 : Family: $13,100 Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$227.57 $258.29 $290.83 $406.44 $617.62	$455.14 $516.58 $581.66 $812.88 $1235.24	$599.65 $661.09 $726.17 $957.39	$744.16 $805.60 $870.68 $1101.90	$888.67 $950.11 $1015.19 $1246.41	$372.08 $402.80 $435.34 $550.95	$516.59 $547.31 $579.85 $695.46	$661.10 $691.82 $724.36 $839.97	$144.51
Plan: (PPO) Anthem Bronze Pathway X PPO 5150 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) Deductible: Individual: $5,150 : Family: $10,300 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	$227.25 $257.93 $290.43 $405.87 $616.76	$454.50 $515.86 $580.86 $811.74 $1233.52	$598.80 $660.16 $725.16 $956.04	$743.10 $804.46 $869.46 $1100.34	$887.40 $948.76 $1013.76 $1244.64	$371.55 $402.23 $434.73 $550.17	$515.85 $546.53 $579.03 $694.47	$660.15 $690.83 $723.33 $838.77	$144.30
Plan: (PPO) Anthem Bronze Pathway X PPO 6800 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) Deductible: Individual: $6,800 : Family: $13,600 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	$229.62 $260.62 $293.45 $410.10 $623.19	$459.24 $521.24 $586.90 $820.20 $1246.38	$605.05 $667.05 $732.71 $966.01	$750.86 $812.86 $878.52 $1111.82	$896.67 $958.67 $1024.33 $1257.63	$375.43 $406.43 $439.26 $555.91	$521.24 $552.24 $585.07 $701.72	$667.05 $698.05 $730.88 $847.53	$145.81
Plan: (PPO) Anthem Silver Pathway X PPO 3000 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) 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	$270.41 $306.92 $345.58 $482.95 $733.89	$540.82 $613.84 $691.16 $965.90 $1467.78	$712.53 $785.55 $862.87 $1137.61	$884.24 $957.26 $1034.58 $1309.32	$1055.95 $1128.97 $1206.29 $1481.03	$442.12 $478.63 $517.29 $654.66	$613.83 $650.34 $689.00 $826.37	$785.54 $822.05 $860.71 $998.08	$171.71
Plan: (PPO) Anthem Silver Pathway X PPO 10 for HSA Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) Deductible: Individual: $2,700 : Family: $5,400 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
Silver	21 30 40 50 60	$273.39 $310.30 $349.39 $488.27 $741.98	$546.78 $620.60 $698.78 $976.54 $1483.96	$720.38 $794.20 $872.38 $1150.14	$893.98 $967.80 $1045.98 $1323.74	$1067.58 $1141.40 $1219.58 $1497.34	$446.99 $483.90 $522.99 $661.87	$620.59 $657.50 $696.59 $835.47	$794.19 $831.10 $870.19 $1009.07	$173.60
Plan: (PPO) Anthem Bronze Pathway X PPO 5850 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) Deductible: Individual: $5,850 : Family: $11,700 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	$221.99 $251.96 $283.70 $396.47 $602.48	$443.98 $503.92 $567.40 $792.94 $1204.96	$584.94 $644.88 $708.36 $933.90	$725.90 $785.84 $849.32 $1074.86	$866.86 $926.80 $990.28 $1215.82	$362.95 $392.92 $424.66 $537.43	$503.91 $533.88 $565.62 $678.39	$644.87 $674.84 $706.58 $819.35	$140.96
Plan: (PPO) Anthem Silver Pathway X PPO 4050 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) Deductible: Individual: $4,050 : Family: $8,100 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	$272.60 $309.40 $348.38 $486.86 $739.84	$545.20 $618.80 $696.76 $973.72 $1479.68	$718.30 $791.90 $869.86 $1146.82	$891.40 $965.00 $1042.96 $1319.92	$1064.50 $1138.10 $1216.06 $1493.02	$445.70 $482.50 $521.48 $659.96	$618.80 $655.60 $694.58 $833.06	$791.90 $828.70 $867.68 $1006.16	$173.10
Plan: (PPO) Anthem Silver Pathway X PPO 2000 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) Deductible: Individual: $2,000 : Family: $4,000 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	$280.28 $318.12 $358.20 $500.58 $760.68	$560.56 $636.24 $716.40 $1001.16 $1521.36	$738.54 $814.22 $894.38 $1179.14	$916.52 $992.20 $1072.36 $1357.12	$1094.50 $1170.18 $1250.34 $1535.10	$458.26 $496.10 $536.18 $678.56	$636.24 $674.08 $714.16 $856.54	$814.22 $852.06 $892.14 $1034.52	$177.98
Plan: (PPO) Anthem Silver Pathway X PPO 2500 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) 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	$278.60 $316.21 $356.05 $497.58 $756.12	$557.20 $632.42 $712.10 $995.16 $1512.24	$734.11 $809.33 $889.01 $1172.07	$911.02 $986.24 $1065.92 $1348.98	$1087.93 $1163.15 $1242.83 $1525.89	$455.51 $493.12 $532.96 $674.49	$632.42 $670.03 $709.87 $851.40	$809.33 $846.94 $886.78 $1028.31	$176.91
Plan: (PPO) Anthem Silver Pathway X PPO 3500 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) Deductible: Individual: $3,500 : Family: $7,000 Out of Pocket Maximum per year: Individual: $5,700 : Family: $11,400 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	$271.81 $308.50 $347.37 $485.45 $737.69	$543.62 $617.00 $694.74 $970.90 $1475.38	$716.22 $789.60 $867.34 $1143.50	$888.82 $962.20 $1039.94 $1316.10	$1061.42 $1134.80 $1212.54 $1488.70	$444.41 $481.10 $519.97 $658.05	$617.01 $653.70 $692.57 $830.65	$789.61 $826.30 $865.17 $1003.25	$172.60
Plan: (HMO) Anthem Bronze Pathway X HMO 5000 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) Deductible: Individual: $5,000 : Family: $10,000 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
Bronze	21 30 40 50 60	$191.27 $217.09 $244.44 $341.61 $519.11	$382.54 $434.18 $488.88 $683.22 $1038.22	$504.00 $555.64 $610.34 $804.68	$625.46 $677.10 $731.80 $926.14	$746.92 $798.56 $853.26 $1047.60	$312.73 $338.55 $365.90 $463.07	$434.19 $460.01 $487.36 $584.53	$555.65 $581.47 $608.82 $705.99	$121.46
Plan: (HMO) Anthem Bronze Pathway X HMO 5200 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) Deductible: Individual: $5,200 : Family: $10,400 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	$193.74 $219.89 $247.60 $346.02 $525.81	$387.48 $439.78 $495.20 $692.04 $1051.62	$510.50 $562.80 $618.22 $815.06	$633.52 $685.82 $741.24 $938.08	$756.54 $808.84 $864.26 $1061.10	$316.76 $342.91 $370.62 $469.04	$439.78 $465.93 $493.64 $592.06	$562.80 $588.95 $616.66 $715.08	$123.02
Plan: (HMO) Anthem Bronze Pathway X HMO 7150 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) 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
Bronze	21 30 40 50 60	$188.63 $214.10 $241.07 $336.89 $511.94	$377.26 $428.20 $482.14 $673.78 $1023.88	$497.04 $547.98 $601.92 $793.56	$616.82 $667.76 $721.70 $913.34	$736.60 $787.54 $841.48 $1033.12	$308.41 $333.88 $360.85 $456.67	$428.19 $453.66 $480.63 $576.45	$547.97 $573.44 $600.41 $696.23	$119.78
Plan: (HMO) Anthem Silver Pathway X HMO 4250 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) Deductible: Individual: $4,250 : Family: $8,500 Out of Pocket Maximum per year: Individual: $5,250 : Family: $10,500 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$226.70 $257.30 $289.72 $404.89 $615.26	$453.40 $514.60 $579.44 $809.78 $1230.52	$597.35 $658.55 $723.39 $953.73	$741.30 $802.50 $867.34 $1097.68	$885.25 $946.45 $1011.29 $1241.63	$370.65 $401.25 $433.67 $548.84	$514.60 $545.20 $577.62 $692.79	$658.55 $689.15 $721.57 $836.74	$143.95
Plan: (HMO) Anthem Silver Pathway X HMO 2850 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) Deductible: Individual: $2,850 : Family: $5,700 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
Silver	21 30 40 50 60	$226.78 $257.40 $289.82 $405.03 $615.48	$453.56 $514.80 $579.64 $810.06 $1230.96	$597.57 $658.81 $723.65 $954.07	$741.58 $802.82 $867.66 $1098.08	$885.59 $946.83 $1011.67 $1242.09	$370.79 $401.41 $433.83 $549.04	$514.80 $545.42 $577.84 $693.05	$658.81 $689.43 $721.85 $837.06	$144.01
Plan: (HMO) Anthem Gold Pathway X HMO 1450 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) Deductible: Individual: $1,450 : Family: $4,350 Out of Pocket Maximum per year: Individual: $4,200 : Family: $8,400 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	$289.83 $328.96 $370.40 $517.64 $786.60	$579.66 $657.92 $740.80 $1035.28 $1573.20	$763.70 $841.96 $924.84 $1219.32	$947.74 $1026.00 $1108.88 $1403.36	$1131.78 $1210.04 $1292.92 $1587.40	$473.87 $513.00 $554.44 $701.68	$657.91 $697.04 $738.48 $885.72	$841.95 $881.08 $922.52 $1069.76	$184.04
Plan: (HMO) Anthem Silver Core Pathway X HMO 5300 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) Deductible: Individual: $5,300 : Family: $10,600 Out of Pocket Maximum per year: Individual: $6,750 : Family: $13,500 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$212.37 $241.04 $271.41 $379.29 $576.37	$424.74 $482.08 $542.82 $758.58 $1152.74	$559.59 $616.93 $677.67 $893.43	$694.44 $751.78 $812.52 $1028.28	$829.29 $886.63 $947.37 $1163.13	$347.22 $375.89 $406.26 $514.14	$482.07 $510.74 $541.11 $648.99	$616.92 $645.59 $675.96 $783.84	$134.85
Plan: (HMO) Anthem Bronze Pathway X HMO 0 for HSA Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) Deductible: Individual: $6,550 : Family: $13,100 Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Bronze	21 30 40 50 60	$195.09 $221.43 $249.33 $348.43 $529.47	$390.18 $442.86 $498.66 $696.86 $1058.94	$514.06 $566.74 $622.54 $820.74	$637.94 $690.62 $746.42 $944.62	$761.82 $814.50 $870.30 $1068.50	$318.97 $345.31 $373.21 $472.31	$442.85 $469.19 $497.09 $596.19	$566.73 $593.07 $620.97 $720.07	$123.88
Plan: (HMO) Anthem Silver Pathway X HMO 10 for HSA Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) Deductible: Individual: $3,200 : Family: $6,400 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	$229.47 $260.45 $293.26 $409.83 $622.78	$458.94 $520.90 $586.52 $819.66 $1245.56	$604.65 $666.61 $732.23 $965.37	$750.36 $812.32 $877.94 $1111.08	$896.07 $958.03 $1023.65 $1256.79	$375.18 $406.16 $438.97 $555.54	$520.89 $551.87 $584.68 $701.25	$666.60 $697.58 $730.39 $846.96	$145.71
ADVERTISEMENT
Summa Insurance Company, Inc. Local: 1-330-996-8675 \| Toll Free: 1-888-996-8675 TTY: 1-800-750-0750
Plan: (PPO) SummaCare Value with SCConnect Network and 3 Free PCP Visits Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (Summa Insurance Company, 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	$162.11 $183.99 $207.17 $289.52 $439.95	$324.22 $367.98 $414.34 $579.04 $879.90	$427.16 $470.92 $517.28 $681.98	$530.10 $573.86 $620.22 $784.92	$633.04 $676.80 $723.16 $887.86	$265.05 $286.93 $310.11 $392.46	$367.99 $389.87 $413.05 $495.40	$470.93 $492.81 $515.99 $598.34	$102.94
ADVERTISEMENT
Community Insurance Company(Anthem BCBS) Local: 1-855-748-1808 \| Toll Free: 1-855-748-1808
Plan: (HMO) Anthem Silver Pathway X HMO 3500 Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-748-1808 - Provider Directory for This Plan: (Community Insurance Company(Anthem BCBS)) Deductible: Individual: $3,500 : Family: $7,000 Out of Pocket Maximum per year: Individual: $5,700 : Family: $11,400 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	$231.84 $263.14 $296.29 $414.07 $629.21	$463.68 $526.28 $592.58 $828.14 $1258.42	$610.90 $673.50 $739.80 $975.36	$758.12 $820.72 $887.02 $1122.58	$905.34 $967.94 $1034.24 $1269.80	$379.06 $410.36 $443.51 $561.29	$526.28 $557.58 $590.73 $708.51	$673.50 $704.80 $737.95 $855.73	$147.22
ADVERTISEMENT
Buckeye Community Health Plan Local: 1-877-687-1189 \| Toll Free: 1-877-687-1189 TTY: 1-877-941-9236
Plan: (HMO) Ambetter Secure Care 1 (2017) with 3 Free PCP Visits Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan) 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	$227.84 $258.58 $291.16 $406.90 $618.32	$455.68 $517.16 $582.32 $813.80 $1236.64	$600.35 $661.83 $726.99 $958.47	$745.02 $806.50 $871.66 $1103.14	$889.69 $951.17 $1016.33 $1247.81	$372.51 $403.25 $435.83 $551.57	$517.18 $547.92 $580.50 $696.24	$661.85 $692.59 $725.17 $840.91	$144.67
Plan: (HMO) Ambetter Balanced Care 1 (2017) Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan) Deductible: Individual: $5,500 : Family: $11,000 Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$167.07 $189.62 $213.50 $298.37 $453.41	$334.14 $379.24 $427.00 $596.74 $906.82	$440.22 $485.32 $533.08 $702.82	$546.30 $591.40 $639.16 $808.90	$652.38 $697.48 $745.24 $914.98	$273.15 $295.70 $319.58 $404.45	$379.23 $401.78 $425.66 $510.53	$485.31 $507.86 $531.74 $616.61	$106.08
Plan: (HMO) Ambetter Balanced Care 2 (2017) Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan) Deductible: Individual: $6,500 : Family: $13,000 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	$163.80 $185.90 $209.32 $292.52 $444.52	$327.60 $371.80 $418.64 $585.04 $889.04	$431.60 $475.80 $522.64 $689.04	$535.60 $579.80 $626.64 $793.04	$639.60 $683.80 $730.64 $897.04	$267.80 $289.90 $313.32 $396.52	$371.80 $393.90 $417.32 $500.52	$475.80 $497.90 $521.32 $604.52	$104.00
Plan: (HMO) Ambetter Balanced Care 10 (2017) Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan) 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	$177.55 $201.51 $226.90 $317.09 $481.85	$355.10 $403.02 $453.80 $634.18 $963.70	$467.84 $515.76 $566.54 $746.92	$580.58 $628.50 $679.28 $859.66	$693.32 $741.24 $792.02 $972.40	$290.29 $314.25 $339.64 $429.83	$403.03 $426.99 $452.38 $542.57	$515.77 $539.73 $565.12 $655.31	$112.74
Plan: (HMO) Ambetter Balanced Care 12 (2017) Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan) 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	$180.01 $204.30 $230.04 $321.48 $488.52	$360.02 $408.60 $460.08 $642.96 $977.04	$474.32 $522.90 $574.38 $757.26	$588.62 $637.20 $688.68 $871.56	$702.92 $751.50 $802.98 $985.86	$294.31 $318.60 $344.34 $435.78	$408.61 $432.90 $458.64 $550.08	$522.91 $547.20 $572.94 $664.38	$114.30
Plan: (HMO) Ambetter Balanced Care 1 (2017) + Vision Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan) Deductible: Individual: $5,500 : Family: $11,000 Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$170.60 $193.62 $218.01 $304.67 $462.97	$341.20 $387.24 $436.02 $609.34 $925.94	$449.52 $495.56 $544.34 $717.66	$557.84 $603.88 $652.66 $825.98	$666.16 $712.20 $760.98 $934.30	$278.92 $301.94 $326.33 $412.99	$387.24 $410.26 $434.65 $521.31	$495.56 $518.58 $542.97 $629.63	$108.32
Plan: (HMO) Ambetter Balanced Care 2 (2017) + Vision Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan) Deductible: Individual: $6,500 : Family: $13,000 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	$167.25 $189.82 $213.73 $298.69 $453.89	$334.50 $379.64 $427.46 $597.38 $907.78	$440.70 $485.84 $533.66 $703.58	$546.90 $592.04 $639.86 $809.78	$653.10 $698.24 $746.06 $915.98	$273.45 $296.02 $319.93 $404.89	$379.65 $402.22 $426.13 $511.09	$485.85 $508.42 $532.33 $617.29	$106.20
Plan: (HMO) Ambetter Balanced Care 10 (2017) + Vision Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan) 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	$181.30 $205.76 $231.69 $323.78 $492.02	$362.60 $411.52 $463.38 $647.56 $984.04	$477.72 $526.64 $578.50 $762.68	$592.84 $641.76 $693.62 $877.80	$707.96 $756.88 $808.74 $992.92	$296.42 $320.88 $346.81 $438.90	$411.54 $436.00 $461.93 $554.02	$526.66 $551.12 $577.05 $669.14	$115.12
Plan: (HMO) Ambetter Balanced Care 1 (2017) + Vision + Adult Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan) Deductible: Individual: $5,500 : Family: $11,000 Out of Pocket Maximum per year: Individual: $6,500 : Family: $13,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Silver	21 30 40 50 60	$177.55 $201.51 $226.90 $317.10 $481.86	$355.10 $403.02 $453.80 $634.20 $963.72	$467.84 $515.76 $566.54 $746.94	$580.58 $628.50 $679.28 $859.68	$693.32 $741.24 $792.02 $972.42	$290.29 $314.25 $339.64 $429.84	$403.03 $426.99 $452.38 $542.58	$515.77 $539.73 $565.12 $655.32	$112.74
Plan: (HMO) Ambetter Balanced Care 2 (2017) + Vision + Adult Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan) Deductible: Individual: $6,500 : Family: $13,000 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	$174.07 $197.56 $222.45 $310.88 $472.41	$348.14 $395.12 $444.90 $621.76 $944.82	$458.67 $505.65 $555.43 $732.29	$569.20 $616.18 $665.96 $842.82	$679.73 $726.71 $776.49 $953.35	$284.60 $308.09 $332.98 $421.41	$395.13 $418.62 $443.51 $531.94	$505.66 $529.15 $554.04 $642.47	$110.53
Plan: (HMO) Ambetter Balanced Care 10 (2017) + Vision + Adult Dental Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-687-1189 - Provider Directory for This Plan: (Buckeye Community Health Plan) 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	$188.69 $214.16 $241.14 $336.99 $512.09	$377.38 $428.32 $482.28 $673.98 $1024.18	$497.19 $548.13 $602.09 $793.79	$617.00 $667.94 $721.90 $913.60	$736.81 $787.75 $841.71 $1033.41	$308.50 $333.97 $360.95 $456.80	$428.31 $453.78 $480.76 $576.61	$548.12 $573.59 $600.57 $696.42	$119.81
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Summa Insurance Company, Inc. Local: 1-330-996-8675 \| Toll Free: 1-888-996-8675 TTY: 1-800-750-0750
Plan: (PPO) SummaCare Silver 3000 with SCConnect Network and 3 Free PCP Visits Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (Summa Insurance Company, Inc.) 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	$232.67 $264.07 $297.34 $415.53 $631.44	$465.34 $528.14 $594.68 $831.06 $1262.88	$613.08 $675.88 $742.42 $978.80	$760.82 $823.62 $890.16 $1126.54	$908.56 $971.36 $1037.90 $1274.28	$380.41 $411.81 $445.08 $563.27	$528.15 $559.55 $592.82 $711.01	$675.89 $707.29 $740.56 $858.75	$147.74
Plan: (PPO) SummaCare Silver 5000 with SCConnect Network and 3 Free PCP Visits Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (Summa Insurance Company, Inc.) Deductible: Individual: $5,000 : Family: $10,000 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	$235.98 $267.82 $301.56 $421.43 $640.41	$471.96 $535.64 $603.12 $842.86 $1280.82	$621.80 $685.48 $752.96 $992.70	$771.64 $835.32 $902.80 $1142.54	$921.48 $985.16 $1052.64 $1292.38	$385.82 $417.66 $451.40 $571.27	$535.66 $567.50 $601.24 $721.11	$685.50 $717.34 $751.08 $870.95	$149.84
Plan: (PPO) SummaCare Gold 750 with SCConnect Network and 3 Free PCP Visits Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (Summa Insurance Company, Inc.) Deductible: Individual: $750 : Family: $1,500 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
Gold	21 30 40 50 60	$298.17 $338.42 $381.05 $532.52 $809.22	$596.34 $676.84 $762.10 $1065.04 $1618.44	$785.67 $866.17 $951.43 $1254.37	$975.00 $1055.50 $1140.76 $1443.70	$1164.33 $1244.83 $1330.09 $1633.03	$487.50 $527.75 $570.38 $721.85	$676.83 $717.08 $759.71 $911.18	$866.16 $906.41 $949.04 $1100.51	$189.33
Plan: (PPO) SummaCare Silver 3500 Standard with SCConnect Network Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-996-8675 - Provider Directory for This Plan: (Summa Insurance Company, 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	$234.23 $265.83 $299.33 $418.31 $635.66	$468.46 $531.66 $598.66 $836.62 $1271.32	$617.19 $680.39 $747.39 $985.35	$765.92 $829.12 $896.12 $1134.08	$914.65 $977.85 $1044.85 $1282.81	$382.96 $414.56 $448.06 $567.04	$531.69 $563.29 $596.79 $715.77	$680.42 $712.02 $745.52 $864.50	$148.73
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Molina Healthcare of Ohio, Inc. Local: 1-888-296-7677 \| Toll Free: 1-888-296-7677
Plan: (HMO) Molina Marketplace Gold Plan Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-296-7677 - Provider Directory for This Plan: (Molina Healthcare of Ohio, Inc.) Deductible: Individual: $1,025 : Family: $2,050 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
Gold	21 30 40 50 60	$264.70 $300.43 $338.29 $472.75 $718.40	$529.40 $600.86 $676.58 $945.50 $1436.80	$697.48 $768.94 $844.66 $1113.58	$865.56 $937.02 $1012.74 $1281.66	$1033.64 $1105.10 $1180.82 $1449.74	$432.78 $468.51 $506.37 $640.83	$600.86 $636.59 $674.45 $808.91	$768.94 $804.67 $842.53 $976.99	$168.08
Plan: (HMO) Molina Marketplace Silver Plan Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-296-7677 - Provider Directory for This Plan: (Molina Healthcare of Ohio, Inc.) Deductible: Individual: $2,400 : Family: $4,800 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	$207.96 $236.03 $265.77 $371.41 $564.40	$415.92 $472.06 $531.54 $742.82 $1128.80	$547.97 $604.11 $663.59 $874.87	$680.02 $736.16 $795.64 $1006.92	$812.07 $868.21 $927.69 $1138.97	$340.01 $368.08 $397.82 $503.46	$472.06 $500.13 $529.87 $635.51	$604.11 $632.18 $661.92 $767.56	$132.05
Plan: (HMO) Molina Marketplace Bronze Plan Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-296-7677 - Provider Directory for This Plan: (Molina Healthcare of Ohio, 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	$178.92 $203.07 $228.66 $319.55 $485.58	$357.84 $406.14 $457.32 $639.10 $971.16	$471.45 $519.75 $570.93 $752.71	$585.06 $633.36 $684.54 $866.32	$698.67 $746.97 $798.15 $979.93	$292.53 $316.68 $342.27 $433.16	$406.14 $430.29 $455.88 $546.77	$519.75 $543.90 $569.49 $660.38	$113.61
Plan: (HMO) Molina Marketplace Options Silver Plan Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-296-7677 - Provider Directory for This Plan: (Molina Healthcare of Ohio, 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	$209.87 $238.21 $268.22 $374.83 $569.59	$419.74 $476.42 $536.44 $749.66 $1139.18	$553.01 $609.69 $669.71 $882.93	$686.28 $742.96 $802.98 $1016.20	$819.55 $876.23 $936.25 $1149.47	$343.14 $371.48 $401.49 $508.10	$476.41 $504.75 $534.76 $641.37	$609.68 $638.02 $668.03 $774.64	$133.27
Plan: (HMO) Molina Marketplace Options Bronze Plan Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-888-296-7677 - Provider Directory for This Plan: (Molina Healthcare of Ohio, 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	$184.08 $208.93 $235.25 $328.77 $499.59	$368.16 $417.86 $470.50 $657.54 $999.18	$485.05 $534.75 $587.39 $774.43	$601.94 $651.64 $704.28 $891.32	$718.83 $768.53 $821.17 $1008.21	$300.97 $325.82 $352.14 $445.66	$417.86 $442.71 $469.03 $562.55	$534.75 $559.60 $585.92 $679.44	$116.89
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CareSource Local: 1-800-479-9502 \| Toll Free: 1-800-479-9502 TTY: 1-800-750-0750
Plan: (HMO) CareSource Silver Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource) Deductible: Individual: $3,300 : Family: $6,600 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
Silver	21 30 40 50 60	$220.84 $250.66 $282.24 $394.42 $599.36	$441.68 $501.32 $564.48 $788.84 $1198.72	$581.91 $641.55 $704.71 $929.07	$722.14 $781.78 $844.94 $1069.30	$862.37 $922.01 $985.17 $1209.53	$361.07 $390.89 $422.47 $534.65	$501.30 $531.12 $562.70 $674.88	$641.53 $671.35 $702.93 $815.11	$140.23
Plan: (HMO) CareSource Bronze Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource) Deductible: Individual: $6,650 : Family: $13,300 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	$190.85 $216.61 $243.90 $340.85 $517.96	$381.70 $433.22 $487.80 $681.70 $1035.92	$502.89 $554.41 $608.99 $802.89	$624.08 $675.60 $730.18 $924.08	$745.27 $796.79 $851.37 $1045.27	$312.04 $337.80 $365.09 $462.04	$433.23 $458.99 $486.28 $583.23	$554.42 $580.18 $607.47 $704.42	$121.19
Plan: (HMO) CareSource Gold Dental and Vision Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource) Deductible: Individual: $1,000 : Family: $2,000 Out of Pocket Maximum per year: Individual: $2,500 : Family: $5,000 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$282.48 $320.61 $361.01 $504.51 $766.65	$564.96 $641.22 $722.02 $1009.02 $1533.30	$744.33 $820.59 $901.39 $1188.39	$923.70 $999.96 $1080.76 $1367.76	$1103.07 $1179.33 $1260.13 $1547.13	$461.85 $499.98 $540.38 $683.88	$641.22 $679.35 $719.75 $863.25	$820.59 $858.72 $899.12 $1042.62	$179.37
Plan: (HMO) CareSource Silver Dental and Vision Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource) Deductible: Individual: $3,300 : Family: $6,600 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
Silver	21 30 40 50 60	$236.74 $268.69 $302.55 $422.81 $642.50	$473.48 $537.38 $605.10 $845.62 $1285.00	$623.81 $687.71 $755.43 $995.95	$774.14 $838.04 $905.76 $1146.28	$924.47 $988.37 $1056.09 $1296.61	$387.07 $419.02 $452.88 $573.14	$537.40 $569.35 $603.21 $723.47	$687.73 $719.68 $753.54 $873.80	$150.33
Plan: (HMO) CareSource Bronze Dental and Vision Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource) Deductible: Individual: $6,650 : Family: $13,300 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	$206.83 $234.75 $264.33 $369.39 $561.33	$413.66 $469.50 $528.66 $738.78 $1122.66	$545.00 $600.84 $660.00 $870.12	$676.34 $732.18 $791.34 $1001.46	$807.68 $863.52 $922.68 $1132.80	$338.17 $366.09 $395.67 $500.73	$469.51 $497.43 $527.01 $632.07	$600.85 $628.77 $658.35 $763.41	$131.34
Plan: (HMO) CareSource Federal Simple Choice Gold Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource) Deductible: Individual: $1,250 : Family: $2,500 Out of Pocket Maximum per year: Individual: $4,750 : Family: $9,500 Monthly Premiums:
Metal level	Age	Individual	Couple	Couple w 1 Kid	Couple w 2 Kids	Couple w3+Kids	Single w 1 Kid	Single w 2 Kids	Single w3+Kids	Child any age
Gold	21 30 40 50 60	$244.06 $277.00 $311.90 $435.88 $662.36	$488.12 $554.00 $623.80 $871.76 $1324.72	$643.09 $708.97 $778.77 $1026.73	$798.06 $863.94 $933.74 $1181.70	$953.03 $1018.91 $1088.71 $1336.67	$399.03 $431.97 $466.87 $590.85	$554.00 $586.94 $621.84 $745.82	$708.97 $741.91 $776.81 $900.79	$154.97
Plan: (HMO) CareSource Federal Simple Choice Silver Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource) 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	$201.35 $228.52 $257.31 $359.60 $546.44	$402.70 $457.04 $514.62 $719.20 $1092.88	$530.55 $584.89 $642.47 $847.05	$658.40 $712.74 $770.32 $974.90	$786.25 $840.59 $898.17 $1102.75	$329.20 $356.37 $385.16 $487.45	$457.05 $484.22 $513.01 $615.30	$584.90 $612.07 $640.86 $743.15	$127.85
Plan: (HMO) CareSource Federal Simple Choice Bronze Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource) 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	$177.12 $201.03 $226.36 $316.34 $480.70	$354.24 $402.06 $452.72 $632.68 $961.40	$466.71 $514.53 $565.19 $745.15	$579.18 $627.00 $677.66 $857.62	$691.65 $739.47 $790.13 $970.09	$289.59 $313.50 $338.83 $428.81	$402.06 $425.97 $451.30 $541.28	$514.53 $538.44 $563.77 $653.75	$112.47
Plan: (HMO) CareSource Low Premium Silver Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-479-9502 - Provider Directory for This Plan: (CareSource) Deductible: Individual: $6,150 : Family: $12,300 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
Silver	21 30 40 50 60	$189.19 $214.73 $241.78 $337.89 $513.46	$378.38 $429.46 $483.56 $675.78 $1026.92	$498.51 $549.59 $603.69 $795.91	$618.64 $669.72 $723.82 $916.04	$738.77 $789.85 $843.95 $1036.17	$309.32 $334.86 $361.91 $458.02	$429.45 $454.99 $482.04 $578.15	$549.58 $575.12 $602.17 $698.28	$120.13

Providers for Zip Code 44646

Obamacare Providers, Plans and 2017 Rates for Stark County

2017 Rates and Providers

Currently, there are 97 plans offered in Stark County.

CareSource

Plan: (HMO) CareSource Gold

AultCare Insurance Company

Plan: (PPO) AultCare Gold 750 No Pediatric Dental

Plan: (PPO) AultCare Gold 350 No Pediatric Dental

Plan: (PPO) AultCare Gold 750

Plan: (PPO) AultCare Gold 350

Plan: (PPO) AultCare Bronze 6000 No Pediatric Dental

Plan: (PPO) AultCare Bronze 5000 No Pediatric Dental

Plan: (PPO) AultCare Silver 5000 No Pediatric Dental

Plan: (PPO) AultCare Silver 3000 No Pediatric Dental

Plan: (PPO) AultCare Silver 2500 No Pediatric Dental

Plan: (PPO) AultCare Gold 1200 No Pediatric Dental

Plan: (PPO) AultCare Catastrophic Select

Plan: (PPO) AultCare Bronze 6000 Select

Plan: (PPO) AultCare Bronze 5000 Select

Plan: (PPO) AultCare Silver 5000 Select

Plan: (PPO) AultCare Silver 3000 Select

Plan: (PPO) AultCare Silver 2500 Select

Plan: (PPO) AultCare Gold 1200 Select

Plan: (PPO) AultCare Gold 750 Select

Plan: (PPO) AultCare Gold 350 Select

Plan: (PPO) AultCare Catastrophic

Plan: (PPO) AultCare Bronze 6000

Plan: (PPO) AultCare Bronze 5000

Plan: (PPO) AultCare Silver 5000

Plan: (PPO) AultCare Silver 3000

Plan: (PPO) AultCare Silver 2500

Plan: (PPO) AultCare Gold 1200

Plan: (PPO) AultCare Catastrophic No Pediatric Dental

Plan: (PPO) AultCare Gold 350 Select No Pediatric Dental

Plan: (PPO) AultCare Gold 750 Select No Pediatric Dental

Plan: (PPO) AultCare Gold 1200 Select No Pediatric Dental

Plan: (PPO) AultCare Silver 2500 Select No Pediatric Dental

Plan: (PPO) AultCare Bronze 6600

Plan: (PPO) AultCare Silver 3000 Select No Pediatric Dental

Plan: (PPO) AultCare Silver 5000 Select No Pediatric Dental

Plan: (PPO) AultCare Bronze 5000 Select No Pediatric Dental

Plan: (PPO) AultCare Bronze 6000 Select No Pediatric Dental

Plan: (PPO) AultCare Catastrophic Select No Pediatric Dental

Plan: (PPO) AultCare Silver 6850

Plan: (PPO) AultCare Silver 6850 Select

Plan: (PPO) AultCare Silver 6850 No Pediatric Dental

Plan: (PPO) AultCare Silver 6850 Select No Pediatric Dental

Plan: (PPO) AultCare Bronze 6600 Select

Plan: (PPO) AultCare Bronze 6600 No Pediatric Dental

Plan: (PPO) AultCare Bronze 6600 Select No Pediatric Dental

Plan: (PPO) AultCare Bronze Standard Select No Pediatric Dental

Community Insurance Company(Anthem BCBS)

Plan: (PPO) Anthem Catastrophic Pathway X PPO 7150

Plan: (PPO) Anthem Bronze Pathway X PPO 0 for HSA

Plan: (PPO) Anthem Bronze Pathway X PPO 5150

Plan: (PPO) Anthem Bronze Pathway X PPO 6800

Plan: (PPO) Anthem Silver Pathway X PPO 3000

Plan: (PPO) Anthem Silver Pathway X PPO 10 for HSA

Plan: (PPO) Anthem Bronze Pathway X PPO 5850

Plan: (PPO) Anthem Silver Pathway X PPO 4050

Plan: (PPO) Anthem Silver Pathway X PPO 2000

Plan: (PPO) Anthem Silver Pathway X PPO 2500

Plan: (PPO) Anthem Silver Pathway X PPO 3500

Plan: (HMO) Anthem Bronze Pathway X HMO 5000

Plan: (HMO) Anthem Bronze Pathway X HMO 5200

Plan: (HMO) Anthem Bronze Pathway X HMO 7150

Plan: (HMO) Anthem Silver Pathway X HMO 4250

Plan: (HMO) Anthem Silver Pathway X HMO 2850

Plan: (HMO) Anthem Gold Pathway X HMO 1450

Plan: (HMO) Anthem Silver Core Pathway X HMO 5300

Plan: (HMO) Anthem Bronze Pathway X HMO 0 for HSA

Plan: (HMO) Anthem Silver Pathway X HMO 10 for HSA

Summa Insurance Company, Inc.

Plan: (PPO) SummaCare Value with SCConnect Network and 3 Free PCP Visits

Community Insurance Company(Anthem BCBS)

Plan: (HMO) Anthem Silver Pathway X HMO 3500

Buckeye Community Health Plan

Plan: (HMO) Ambetter Secure Care 1 (2017) with 3 Free PCP Visits

Plan: (HMO) Ambetter Balanced Care 1 (2017)