Providers for Zip Code 16509

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Obamacare Providers, Plans and 2017 Rates for Erie 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 Erie County, Pennsylvania.

Currently, there are 27 plans offered in Erie 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 Erie 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 Erie, PA 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 Erie County here.

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UPMC Health Options, Inc.

Local: 1-855-489-3494 | Toll Free: 1-855-489-3494

TTY: 1-800-361-2629

Plan: (EPO) UPMC Advantage Gold $750/$10 - Partner Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, Inc.)

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $229.02
$259.94
$292.69
$409.03
$621.56		 $458.04
$519.88
$585.38
$818.06
$1243.12		 $603.47
$665.31
$730.81
$963.49		 $748.90
$810.74
$876.24
$1108.92		 $894.33
$956.17
$1021.67
$1254.35		 $374.45
$405.37
$438.12
$554.46		 $519.88
$550.80
$583.55
$699.89		 $665.31
$696.23
$728.98
$845.32		 $145.43

Plan: (PPO) UPMC Advantage Silver $0/$50 - Premium Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, Inc.)

Deductible: Individual: $0 : Family: $0
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		 $233.68
$265.23
$298.64
$417.35
$634.20		 $467.36
$530.46
$597.28
$834.70
$1268.40		 $615.75
$678.85
$745.67
$983.09		 $764.14
$827.24
$894.06
$1131.48		 $912.53
$975.63
$1042.45
$1279.87		 $382.07
$413.62
$447.03
$565.74		 $530.46
$562.01
$595.42
$714.13		 $678.85
$710.40
$743.81
$862.52		 $148.39

Plan: (PPO) UPMC Advantage Silver $1,750/$30 - Premium Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, Inc.)

Deductible: Individual: $1,750 : Family: $3,500
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
Silver 21
30
40
50
60		 $232.84
$264.27
$297.56
$415.84
$631.91		 $465.68
$528.54
$595.12
$831.68
$1263.82		 $613.53
$676.39
$742.97
$979.53		 $761.38
$824.24
$890.82
$1127.38		 $909.23
$972.09
$1038.67
$1275.23		 $380.69
$412.12
$445.41
$563.69		 $528.54
$559.97
$593.26
$711.54		 $676.39
$707.82
$741.11
$859.39		 $147.85

Plan: (PPO) UPMC Advantage Silver $3,250/$10 - Premium Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, Inc.)

Deductible: Individual: $3,250 : Family: $6,500
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
Silver 21
30
40
50
60		 $229.07
$259.99
$292.75
$409.12
$621.69		 $458.14
$519.98
$585.50
$818.24
$1243.38		 $603.60
$665.44
$730.96
$963.70		 $749.06
$810.90
$876.42
$1109.16		 $894.52
$956.36
$1021.88
$1254.62		 $374.53
$405.45
$438.21
$554.58		 $519.99
$550.91
$583.67
$700.04		 $665.45
$696.37
$729.13
$845.50		 $145.46

Plan: (PPO) UPMC Advantage Gold $750/$10 - Premium Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, Inc.)

Deductible: Individual: $750 : Family: $1,500
Out of Pocket Maximum per year: Individual: $3,500 : Family: $7,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Gold 21
30
40
50
60		 $289.06
$328.08
$369.42
$516.26
$784.51		 $578.12
$656.16
$738.84
$1032.52
$1569.02		 $761.68
$839.72
$922.40
$1216.08		 $945.24
$1023.28
$1105.96
$1399.64		 $1128.80
$1206.84
$1289.52
$1583.20		 $472.62
$511.64
$552.98
$699.82		 $656.18
$695.20
$736.54
$883.38		 $839.74
$878.76
$920.10
$1066.94		 $183.56

Plan: (PPO) UPMC Advantage Platinum $250/$20 - Premium Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, Inc.)

Deductible: Individual: $250 : Family: $500
Out of Pocket Maximum per year: Individual: $1,500 : Family: $3,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Platinum 21
30
40
50
60		 $490.56
$556.79
$626.94
$876.14
$1331.38		 $981.12
$1113.58
$1253.88
$1752.28
$2662.76		 $1292.63
$1425.09
$1565.39
$2063.79		 $1604.14
$1736.60
$1876.90
$2375.30		 $1915.65
$2048.11
$2188.41
$2686.81		 $802.07
$868.30
$938.45
$1187.65		 $1113.58
$1179.81
$1249.96
$1499.16		 $1425.09
$1491.32
$1561.47
$1810.67		 $311.51

Plan: (PPO) UPMC Advantage Bronze $6,950/$35 – Premium Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, Inc.)

Deductible: Individual: $6,950 : Family: $13,900
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		 $204.01
$231.55
$260.72
$364.36
$553.68		 $408.02
$463.10
$521.44
$728.72
$1107.36		 $537.57
$592.65
$650.99
$858.27		 $667.12
$722.20
$780.54
$987.82		 $796.67
$851.75
$910.09
$1117.37		 $333.56
$361.10
$390.27
$493.91		 $463.11
$490.65
$519.82
$623.46		 $592.66
$620.20
$649.37
$753.01		 $129.55

Plan: (PPO) UPMC Advantage Silver HSA $2,600/20% - Premium Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, Inc.)

Deductible: Individual: $2,600 : Family: $5,200
Out of Pocket Maximum per year: Individual: $4,100 : Family: $8,200

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $233.26
$264.75
$298.10
$416.60
$633.06		 $466.52
$529.50
$596.20
$833.20
$1266.12		 $614.64
$677.62
$744.32
$981.32		 $762.76
$825.74
$892.44
$1129.44		 $910.88
$973.86
$1040.56
$1277.56		 $381.38
$412.87
$446.22
$564.72		 $529.50
$560.99
$594.34
$712.84		 $677.62
$709.11
$742.46
$860.96		 $148.12

Plan: (PPO) UPMC Advantage Catastrophic $7,150/$0 - Premium Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, 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		 $177.48
$201.44
$226.82
$316.98
$481.68		 $354.96
$402.88
$453.64
$633.96
$963.36		 $467.66
$515.58
$566.34
$746.66		 $580.36
$628.28
$679.04
$859.36		 $693.06
$740.98
$791.74
$972.06		 $290.18
$314.14
$339.52
$429.68		 $402.88
$426.84
$452.22
$542.38		 $515.58
$539.54
$564.92
$655.08		 $112.70

Plan: (PPO) UPMC Advantage Silver $3,500/$30 - Premium Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, 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		 $226.19
$256.72
$289.07
$403.97
$613.87		 $452.38
$513.44
$578.14
$807.94
$1227.74		 $596.01
$657.07
$721.77
$951.57		 $739.64
$800.70
$865.40
$1095.20		 $883.27
$944.33
$1009.03
$1238.83		 $369.82
$400.35
$432.70
$547.60		 $513.45
$543.98
$576.33
$691.23		 $657.08
$687.61
$719.96
$834.86		 $143.63

Plan: (EPO) UPMC Advantage Bronze $6,950/$35 – Partner Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, Inc.)

Deductible: Individual: $6,950 : Family: $13,900
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		 $161.64
$183.46
$206.57
$288.68
$438.67		 $323.28
$366.92
$413.14
$577.36
$877.34		 $425.92
$469.56
$515.78
$680.00		 $528.56
$572.20
$618.42
$782.64		 $631.20
$674.84
$721.06
$885.28		 $264.28
$286.10
$309.21
$391.32		 $366.92
$388.74
$411.85
$493.96		 $469.56
$491.38
$514.49
$596.60		 $102.64

Plan: (EPO) UPMC Advantage Silver $0/$50 - Partner Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, Inc.)

Deductible: Individual: $0 : Family: $0
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		 $185.14
$210.14
$236.61
$330.66
$502.47		 $370.28
$420.28
$473.22
$661.32
$1004.94		 $487.85
$537.85
$590.79
$778.89		 $605.42
$655.42
$708.36
$896.46		 $722.99
$772.99
$825.93
$1014.03		 $302.71
$327.71
$354.18
$448.23		 $420.28
$445.28
$471.75
$565.80		 $537.85
$562.85
$589.32
$683.37		 $117.57

Plan: (EPO) UPMC Advantage Silver $1,750/$30 - Partner Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, Inc.)

Deductible: Individual: $1,750 : Family: $3,500
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
Silver 21
30
40
50
60		 $184.48
$209.38
$235.76
$329.47
$500.66		 $368.96
$418.76
$471.52
$658.94
$1001.32		 $486.10
$535.90
$588.66
$776.08		 $603.24
$653.04
$705.80
$893.22		 $720.38
$770.18
$822.94
$1010.36		 $301.62
$326.52
$352.90
$446.61		 $418.76
$443.66
$470.04
$563.75		 $535.90
$560.80
$587.18
$680.89		 $117.14

Plan: (EPO) UPMC Advantage Silver $3,250/$10 - Partner Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, Inc.)

Deductible: Individual: $3,250 : Family: $6,500
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
Silver 21
30
40
50
60		 $181.49
$205.99
$231.94
$324.14
$492.56		 $362.98
$411.98
$463.88
$648.28
$985.12		 $478.23
$527.23
$579.13
$763.53		 $593.48
$642.48
$694.38
$878.78		 $708.73
$757.73
$809.63
$994.03		 $296.74
$321.24
$347.19
$439.39		 $411.99
$436.49
$462.44
$554.64		 $527.24
$551.74
$577.69
$669.89		 $115.25

Plan: (EPO) UPMC Advantage Silver HSA $2,600/20% - Partner Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, Inc.)

Deductible: Individual: $2,600 : Family: $5,200
Out of Pocket Maximum per year: Individual: $4,100 : Family: $8,200

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $184.81
$209.76
$236.19
$330.07
$501.56		 $369.62
$419.52
$472.38
$660.14
$1003.12		 $486.98
$536.88
$589.74
$777.50		 $604.34
$654.24
$707.10
$894.86		 $721.70
$771.60
$824.46
$1012.22		 $302.17
$327.12
$353.55
$447.43		 $419.53
$444.48
$470.91
$564.79		 $536.89
$561.84
$588.27
$682.15		 $117.36

Plan: (EPO) UPMC Advantage Platinum $250/$20 - Partner Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, Inc.)

Deductible: Individual: $250 : Family: $500
Out of Pocket Maximum per year: Individual: $1,500 : Family: $3,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Platinum 21
30
40
50
60		 $388.67
$441.14
$496.72
$694.16
$1054.84		 $777.34
$882.28
$993.44
$1388.32
$2109.68		 $1024.15
$1129.09
$1240.25
$1635.13		 $1270.96
$1375.90
$1487.06
$1881.94		 $1517.77
$1622.71
$1733.87
$2128.75		 $635.48
$687.95
$743.53
$940.97		 $882.29
$934.76
$990.34
$1187.78		 $1129.10
$1181.57
$1237.15
$1434.59		 $246.81

Plan: (EPO) UPMC Advantage Catastrophic $7,150/$0 - Partner Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, 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		 $140.62
$159.60
$179.71
$251.14
$381.63		 $281.24
$319.20
$359.42
$502.28
$763.26		 $370.53
$408.49
$448.71
$591.57		 $459.82
$497.78
$538.00
$680.86		 $549.11
$587.07
$627.29
$770.15		 $229.91
$248.89
$269.00
$340.43		 $319.20
$338.18
$358.29
$429.72		 $408.49
$427.47
$447.58
$519.01		 $89.29

Plan: (EPO) UPMC Advantage Silver $3,500/$30 - Partner Network

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-489-3494 - Provider Directory for This Plan: (UPMC Health Options, 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		 $188.52
$213.97
$240.93
$336.69
$511.63		 $377.04
$427.94
$481.86
$673.38
$1023.26		 $496.75
$547.65
$601.57
$793.09		 $616.46
$667.36
$721.28
$912.80		 $736.17
$787.07
$840.99
$1032.51		 $308.23
$333.68
$360.64
$456.40		 $427.94
$453.39
$480.35
$576.11		 $547.65
$573.10
$600.06
$695.82		 $119.71
ADVERTISEMENT

Highmark Inc.

Local: 1-877-959-2550 | Toll Free: 1-877-959-2550

TTY: 1-800-862-0709

Plan: (PPO) Major Events PPO Blue 7150, a Community Blue Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-959-2550 - Provider Directory for This Plan: (Highmark 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		 $199.39
$226.31
$254.82
$356.11
$541.14		 $398.78
$452.62
$509.64
$712.22
$1082.28		 $525.39
$579.23
$636.25
$838.83		 $652.00
$705.84
$762.86
$965.44		 $778.61
$832.45
$889.47
$1092.05		 $326.00
$352.92
$381.43
$482.72		 $452.61
$479.53
$508.04
$609.33		 $579.22
$606.14
$634.65
$735.94		 $126.61

Plan: (EPO) my Connect Blue EPO 1750S, a Community Blue Flex Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-959-2550 - Provider Directory for This Plan: (Highmark Inc.)

Deductible: Individual: $1,750 : Family: $3,500
Out of Pocket Maximum per year: Individual: $6,900 : Family: $13,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $245.10
$278.19
$313.24
$437.75
$665.20		 $490.20
$556.38
$626.48
$875.50
$1330.40		 $645.84
$712.02
$782.12
$1031.14		 $801.48
$867.66
$937.76
$1186.78		 $957.12
$1023.30
$1093.40
$1342.42		 $400.74
$433.83
$468.88
$593.39		 $556.38
$589.47
$624.52
$749.03		 $712.02
$745.11
$780.16
$904.67		 $155.64

Plan: (EPO) my Connect Blue EPO 2500S, a Community Blue Flex Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-959-2550 - Provider Directory for This Plan: (Highmark Inc.)

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		 $247.98
$281.46
$316.92
$442.89
$673.02		 $495.96
$562.92
$633.84
$885.78
$1346.04		 $653.43
$720.39
$791.31
$1043.25		 $810.90
$877.86
$948.78
$1200.72		 $968.37
$1035.33
$1106.25
$1358.19		 $405.45
$438.93
$474.39
$600.36		 $562.92
$596.40
$631.86
$757.83		 $720.39
$753.87
$789.33
$915.30		 $157.47

Plan: (EPO) my Connect Blue EPO 250G, a Community Blue Flex Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-959-2550 - Provider Directory for This Plan: (Highmark Inc.)

Deductible: Individual: $250 : Family: $500
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
Gold 21
30
40
50
60		 $300.28
$340.82
$383.76
$536.30
$814.96		 $600.56
$681.64
$767.52
$1072.60
$1629.92		 $791.24
$872.32
$958.20
$1263.28		 $981.92
$1063.00
$1148.88
$1453.96		 $1172.60
$1253.68
$1339.56
$1644.64		 $490.96
$531.50
$574.44
$726.98		 $681.64
$722.18
$765.12
$917.66		 $872.32
$912.86
$955.80
$1108.34		 $190.68

Plan: (EPO) my Connect Blue EPO 6500B, a Community Blue Flex Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-959-2550 - Provider Directory for This Plan: (Highmark Inc.)

Deductible: Individual: $6,500 : Family: $13,000
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		 $198.21
$224.97
$253.31
$354.00
$537.94		 $396.42
$449.94
$506.62
$708.00
$1075.88		 $522.28
$575.80
$632.48
$833.86		 $648.14
$701.66
$758.34
$959.72		 $774.00
$827.52
$884.20
$1085.58		 $324.07
$350.83
$379.17
$479.86		 $449.93
$476.69
$505.03
$605.72		 $575.79
$602.55
$630.89
$731.58		 $125.86

Plan: (EPO) my Connect Blue EPO 1000G, a Community Blue Flex Plan

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-959-2550 - Provider Directory for This Plan: (Highmark Inc.)

Deductible: Individual: $1,000 : Family: $2,000
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
Gold 21
30
40
50
60		 $293.07
$332.63
$374.54
$523.42
$795.39		 $586.14
$665.26
$749.08
$1046.84
$1590.78		 $772.24
$851.36
$935.18
$1232.94		 $958.34
$1037.46
$1121.28
$1419.04		 $1144.44
$1223.56
$1307.38
$1605.14		 $479.17
$518.73
$560.64
$709.52		 $665.27
$704.83
$746.74
$895.62		 $851.37
$890.93
$932.84
$1081.72		 $186.10
ADVERTISEMENT

Highmark Health Insurance Company

Local: 1-877-959-2553 | Toll Free: 1-877-959-2553

TTY: 1-800-862-0709

Plan: (PPO) Health Savings Blue PPO Embedded 2700

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-959-2553 - Provider Directory for This Plan: (Highmark Health Insurance Company)

Deductible: Individual: $2,700 : Family: $5,400
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		 $408.48
$463.62
$522.04
$729.55
$1108.61		 $816.96
$927.24
$1044.08
$1459.10
$2217.22		 $1076.34
$1186.62
$1303.46
$1718.48		 $1335.72
$1446.00
$1562.84
$1977.86		 $1595.10
$1705.38
$1822.22
$2237.24		 $667.86
$723.00
$781.42
$988.93		 $927.24
$982.38
$1040.80
$1248.31		 $1186.62
$1241.76
$1300.18
$1507.69		 $259.38

Plan: (PPO) Health Savings Blue PPO 1700

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-959-2553 - Provider Directory for This Plan: (Highmark Health Insurance Company)

Deductible: Individual: $1,700 : Family: $3,400
Out of Pocket Maximum per year: Individual: $3,250 : Family: $6,500

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		 $495.77
$562.70
$633.59
$885.45
$1345.52		 $991.54
$1125.40
$1267.18
$1770.90
$2691.04		 $1306.35
$1440.21
$1581.99
$2085.71		 $1621.16
$1755.02
$1896.80
$2400.52		 $1935.97
$2069.83
$2211.61
$2715.33		 $810.58
$877.51
$948.40
$1200.26		 $1125.39
$1192.32
$1263.21
$1515.07		 $1440.20
$1507.13
$1578.02
$1829.88		 $314.81

Plan: (PPO) Comprehensive Care Flex Blue PPO 500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-959-2553 - Provider Directory for This Plan: (Highmark Health Insurance Company)

Deductible: Individual: $500 : Family: $1,000
Out of Pocket Maximum per year: Individual: $1,900 : Family: $3,800

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
Platinum 21
30
40
50
60		 $596.47
$676.99
$762.29
$1065.30
$1618.82		 $1192.94
$1353.98
$1524.58
$2130.60
$3237.64		 $1571.70
$1732.74
$1903.34
$2509.36		 $1950.46
$2111.50
$2282.10
$2888.12		 $2329.22
$2490.26
$2660.86
$3266.88		 $975.23
$1055.75
$1141.05
$1444.06		 $1353.99
$1434.51
$1519.81
$1822.82		 $1732.75
$1813.27
$1898.57
$2201.58		 $378.76

 

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