Obamacare Providers, Plans and 2017 Rates for Sauk 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 Sauk County, Wisconsin.
Currently, there are 91 plans offered in Sauk County.
Below, you’ll find a summary of plans and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options. For detailed information on available subsidies to make your coverage affordable, you must complete an application at HealthCare.gov or contact the provider directly.
The table below shows premiums for the following scenarios:
- Individual
- Couple
- Couple with 1 2 or 3 children
- Individual with 1 2 or 3 children
- A child alone
Each scenario is covered for age
- Age 21, 30, 40, 50
- Age 60 (Individual and Couple only)
For each plan, there are links that go to the insurance provider's website in a new window. You can find links to:
- a summary of plan benefits and costs,
- a plan brochure, and
- a "Provider Directory" -- where you can find out which doctors and hospitals in the Baraboo, WI area accept this insurance coverage as within the plan's "network".
‡Source: HealthCare.gov has released sample rates for all counties in those states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Sauk County here.
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Unity Health Plans Insurance CorporationLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 TTY: 1-608-643-1421 |
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Plan: (HMO) Prime Gold Wise Savings with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$389.59 $442.18 $497.89 $695.81 $1057.34 |
$779.18 $884.36 $995.78 $1391.62 $2114.68 |
$1026.57 $1131.75 $1243.17 $1639.01 |
$1273.96 $1379.14 $1490.56 $1886.40 |
$1521.35 $1626.53 $1737.95 $2133.79 |
$636.98 $689.57 $745.28 $943.20 |
$884.37 $936.96 $992.67 $1190.59 |
$1131.76 $1184.35 $1240.06 $1437.98 |
$247.39 |
Plan: (HMO) Prime Gold 30/60Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,200
: Family:
$2,400 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$362.63 $411.58 $463.43 $647.65 $984.16 |
$725.26 $823.16 $926.86 $1295.30 $1968.32 |
$955.53 $1053.43 $1157.13 $1525.57 |
$1185.80 $1283.70 $1387.40 $1755.84 |
$1416.07 $1513.97 $1617.67 $1986.11 |
$592.90 $641.85 $693.70 $877.92 |
$823.17 $872.12 $923.97 $1108.19 |
$1053.44 $1102.39 $1154.24 $1338.46 |
$230.27 |
Plan: (HMO) Prime Gold Wise SavingsSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$367.65 $417.28 $469.85 $656.62 $997.80 |
$735.30 $834.56 $939.70 $1313.24 $1995.60 |
$968.76 $1068.02 $1173.16 $1546.70 |
$1202.22 $1301.48 $1406.62 $1780.16 |
$1435.68 $1534.94 $1640.08 $2013.62 |
$601.11 $650.74 $703.31 $890.08 |
$834.57 $884.20 $936.77 $1123.54 |
$1068.03 $1117.66 $1170.23 $1357.00 |
$233.46 |
Plan: (HMO) Prime Gold StandardSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,250
: Family:
$2,500 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$376.46 $427.27 $481.11 $672.34 $1021.69 |
$752.92 $854.54 $962.22 $1344.68 $2043.38 |
$991.97 $1093.59 $1201.27 $1583.73 |
$1231.02 $1332.64 $1440.32 $1822.78 |
$1470.07 $1571.69 $1679.37 $2061.83 |
$615.51 $666.32 $720.16 $911.39 |
$854.56 $905.37 $959.21 $1150.44 |
$1093.61 $1144.42 $1198.26 $1389.49 |
$239.05 |
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Gundersen Health Plan, Inc.Local: 1-608-775-8092 | Toll Free: 1-855-685-6404 |
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Plan: (POS) Platinum $500 - 20%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)
Deductible: Individual:
$500
: Family:
$1,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Platinum | 21 30 40 50 60 |
$535.75 $608.08 $684.69 $956.85 $1454.03 |
$1071.50 $1216.16 $1369.38 $1913.70 $2908.06 |
$1411.70 $1556.36 $1709.58 $2253.90 |
$1751.90 $1896.56 $2049.78 $2594.10 |
$2092.10 $2236.76 $2389.98 $2934.30 |
$875.95 $948.28 $1024.89 $1297.05 |
$1216.15 $1288.48 $1365.09 $1637.25 |
$1556.35 $1628.68 $1705.29 $1977.45 |
$340.20 |
Plan: (POS) Gold $1750 - 30%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)
Deductible: Individual:
$1,750
: Family:
$3,500 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$474.11 $538.11 $605.91 $846.76 $1286.73 |
$948.22 $1076.22 $1211.82 $1693.52 $2573.46 |
$1249.28 $1377.28 $1512.88 $1994.58 |
$1550.34 $1678.34 $1813.94 $2295.64 |
$1851.40 $1979.40 $2115.00 $2596.70 |
$775.17 $839.17 $906.97 $1147.82 |
$1076.23 $1140.23 $1208.03 $1448.88 |
$1377.29 $1441.29 $1509.09 $1749.94 |
$301.06 |
Plan: (POS) Gold $3500 - 0%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$449.25 $509.90 $574.14 $802.36 $1219.26 |
$898.50 $1019.80 $1148.28 $1604.72 $2438.52 |
$1183.77 $1305.07 $1433.55 $1889.99 |
$1469.04 $1590.34 $1718.82 $2175.26 |
$1754.31 $1875.61 $2004.09 $2460.53 |
$734.52 $795.17 $859.41 $1087.63 |
$1019.79 $1080.44 $1144.68 $1372.90 |
$1305.06 $1365.71 $1429.95 $1658.17 |
$285.27 |
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Group Health Cooperative of South Central WisconsinLocal: 1-608-828-4831 | Toll Free: 1-855-344-2729 TTY: 1-608-828-4815 |
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Plan: (HMO) Platinum Zero Primary Care Visit Copay No Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$0
: Family:
$0 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Platinum | 21 30 40 50 60 |
$411.51 $467.06 $525.91 $734.95 $1116.83 |
$823.02 $934.12 $1051.82 $1469.90 $2233.66 |
$1084.33 $1195.43 $1313.13 $1731.21 |
$1345.64 $1456.74 $1574.44 $1992.52 |
$1606.95 $1718.05 $1835.75 $2253.83 |
$672.82 $728.37 $787.22 $996.26 |
$934.13 $989.68 $1048.53 $1257.57 |
$1195.44 $1250.99 $1309.84 $1518.88 |
$261.31 |
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Unity Health Plans Insurance CorporationLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 TTY: 1-608-643-1421 |
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Plan: (HMO) Prime Gold 30/60 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,200
: Family:
$2,400 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$384.27 $436.14 $491.09 $686.30 $1042.90 |
$768.54 $872.28 $982.18 $1372.60 $2085.80 |
$1012.55 $1116.29 $1226.19 $1616.61 |
$1256.56 $1360.30 $1470.20 $1860.62 |
$1500.57 $1604.31 $1714.21 $2104.63 |
$628.28 $680.15 $735.10 $930.31 |
$872.29 $924.16 $979.11 $1174.32 |
$1116.30 $1168.17 $1223.12 $1418.33 |
$244.01 |
Plan: (HMO) Prime Silver 30/60 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$5,250
: Family:
$10,500 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$323.59 $367.27 $413.55 $577.93 $878.22 |
$647.18 $734.54 $827.10 $1155.86 $1756.44 |
$852.66 $940.02 $1032.58 $1361.34 |
$1058.14 $1145.50 $1238.06 $1566.82 |
$1263.62 $1350.98 $1443.54 $1772.30 |
$529.07 $572.75 $619.03 $783.41 |
$734.55 $778.23 $824.51 $988.89 |
$940.03 $983.71 $1029.99 $1194.37 |
$205.48 |
Plan: (HMO) Prime Silver 25/50 Value with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$3,200
: Family:
$6,400 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$326.51 $370.59 $417.28 $583.14 $886.14 |
$653.02 $741.18 $834.56 $1166.28 $1772.28 |
$860.35 $948.51 $1041.89 $1373.61 |
$1067.68 $1155.84 $1249.22 $1580.94 |
$1275.01 $1363.17 $1456.55 $1788.27 |
$533.84 $577.92 $624.61 $790.47 |
$741.17 $785.25 $831.94 $997.80 |
$948.50 $992.58 $1039.27 $1205.13 |
$207.33 |
Plan: (HMO) Prime Silver 40/90 Value with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$4,350
: Family:
$8,700 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$313.58 $355.90 $400.74 $560.04 $851.03 |
$627.16 $711.80 $801.48 $1120.08 $1702.06 |
$826.28 $910.92 $1000.60 $1319.20 |
$1025.40 $1110.04 $1199.72 $1518.32 |
$1224.52 $1309.16 $1398.84 $1717.44 |
$512.70 $555.02 $599.86 $759.16 |
$711.82 $754.14 $798.98 $958.28 |
$910.94 $953.26 $998.10 $1157.40 |
$199.12 |
Plan: (HMO) Prime Silver Maintenance with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,750
: Family:
$3,500 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$335.84 $381.18 $429.20 $599.81 $911.47 |
$671.68 $762.36 $858.40 $1199.62 $1822.94 |
$884.94 $975.62 $1071.66 $1412.88 |
$1098.20 $1188.88 $1284.92 $1626.14 |
$1311.46 $1402.14 $1498.18 $1839.40 |
$549.10 $594.44 $642.46 $813.07 |
$762.36 $807.70 $855.72 $1026.33 |
$975.62 $1020.96 $1068.98 $1239.59 |
$213.26 |
Plan: (HMO) Prime Bronze 55/125 with DentalSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$6,900
: Family:
$13,800 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$278.43 $316.01 $355.83 $497.27 $755.65 |
$556.86 $632.02 $711.66 $994.54 $1511.30 |
$733.66 $808.82 $888.46 $1171.34 |
$910.46 $985.62 $1065.26 $1348.14 |
$1087.26 $1162.42 $1242.06 $1524.94 |
$455.23 $492.81 $532.63 $674.07 |
$632.03 $669.61 $709.43 $850.87 |
$808.83 $846.41 $886.23 $1027.67 |
$176.80 |
Plan: (HMO) Prime Silver 30/60Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$5,250
: Family:
$10,500 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$305.37 $346.59 $390.26 $545.38 $828.76 |
$610.74 $693.18 $780.52 $1090.76 $1657.52 |
$804.65 $887.09 $974.43 $1284.67 |
$998.56 $1081.00 $1168.34 $1478.58 |
$1192.47 $1274.91 $1362.25 $1672.49 |
$499.28 $540.50 $584.17 $739.29 |
$693.19 $734.41 $778.08 $933.20 |
$887.10 $928.32 $971.99 $1127.11 |
$193.91 |
Plan: (HMO) Prime Silver 25/50 ValueSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$3,200
: Family:
$6,400 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$308.12 $349.72 $393.78 $550.30 $836.24 |
$616.24 $699.44 $787.56 $1100.60 $1672.48 |
$811.90 $895.10 $983.22 $1296.26 |
$1007.56 $1090.76 $1178.88 $1491.92 |
$1203.22 $1286.42 $1374.54 $1687.58 |
$503.78 $545.38 $589.44 $745.96 |
$699.44 $741.04 $785.10 $941.62 |
$895.10 $936.70 $980.76 $1137.28 |
$195.66 |
Plan: (HMO) Prime Silver 40/90 ValueSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$4,350
: Family:
$8,700 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$295.92 $335.86 $378.17 $528.50 $803.10 |
$591.84 $671.72 $756.34 $1057.00 $1606.20 |
$779.74 $859.62 $944.24 $1244.90 |
$967.64 $1047.52 $1132.14 $1432.80 |
$1155.54 $1235.42 $1320.04 $1620.70 |
$483.82 $523.76 $566.07 $716.40 |
$671.72 $711.66 $753.97 $904.30 |
$859.62 $899.56 $941.87 $1092.20 |
$187.90 |
Plan: (HMO) Prime Silver MaintenanceSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,750
: Family:
$3,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$316.93 $359.71 $405.03 $566.03 $860.13 |
$633.86 $719.42 $810.06 $1132.06 $1720.26 |
$835.11 $920.67 $1011.31 $1333.31 |
$1036.36 $1121.92 $1212.56 $1534.56 |
$1237.61 $1323.17 $1413.81 $1735.81 |
$518.18 $560.96 $606.28 $767.28 |
$719.43 $762.21 $807.53 $968.53 |
$920.68 $963.46 $1008.78 $1169.78 |
$201.25 |
Plan: (HMO) Prime Bronze 55/125Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$6,900
: Family:
$13,800 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$262.75 $298.21 $335.79 $469.26 $713.09 |
$525.50 $596.42 $671.58 $938.52 $1426.18 |
$692.34 $763.26 $838.42 $1105.36 |
$859.18 $930.10 $1005.26 $1272.20 |
$1026.02 $1096.94 $1172.10 $1439.04 |
$429.59 $465.05 $502.63 $636.10 |
$596.43 $631.89 $669.47 $802.94 |
$763.27 $798.73 $836.31 $969.78 |
$166.84 |
Plan: (HMO) Prime Silver StandardSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$316.44 $359.16 $404.41 $565.16 $858.81 |
$632.88 $718.32 $808.82 $1130.32 $1717.62 |
$833.82 $919.26 $1009.76 $1331.26 |
$1034.76 $1120.20 $1210.70 $1532.20 |
$1235.70 $1321.14 $1411.64 $1733.14 |
$517.38 $560.10 $605.35 $766.10 |
$718.32 $761.04 $806.29 $967.04 |
$919.26 $961.98 $1007.23 $1167.98 |
$200.94 |
Plan: (HMO) Prime Bronze StandardSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$6,650
: Family:
$13,300 Monthly Premiums: |
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Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$262.26 $297.66 $335.17 $468.39 $711.77 |
$524.52 $595.32 $670.34 $936.78 $1423.54 |
$691.05 $761.85 $836.87 $1103.31 |
$857.58 $928.38 $1003.40 $1269.84 |
$1024.11 $1094.91 $1169.93 $1436.37 |
$428.79 $464.19 $501.70 $634.92 |
$595.32 $630.72 $668.23 $801.45 |
$761.85 $797.25 $834.76 $967.98 |
$166.53 |
Plan: (HMO) Prime Gold DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$1,500
: Family:
$3,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$348.15 $395.15 $444.93 $621.79 $944.87 |
$696.30 $790.30 $889.86 $1243.58 $1889.74 |
$917.37 $1011.37 $1110.93 $1464.65 |
$1138.44 $1232.44 $1332.00 $1685.72 |
$1359.51 $1453.51 $1553.07 $1906.79 |
$569.22 $616.22 $666.00 $842.86 |
$790.29 $837.29 $887.07 $1063.93 |
$1011.36 $1058.36 $1108.14 $1285.00 |
$221.07 |
Plan: (HMO) Prime Silver DeductibleSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$2,650
: Family:
$5,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$302.51 $343.34 $386.60 $540.27 $820.99 |
$605.02 $686.68 $773.20 $1080.54 $1641.98 |
$797.11 $878.77 $965.29 $1272.63 |
$989.20 $1070.86 $1157.38 $1464.72 |
$1181.29 $1262.95 $1349.47 $1656.81 |
$494.60 $535.43 $578.69 $732.36 |
$686.69 $727.52 $770.78 $924.45 |
$878.78 $919.61 $962.87 $1116.54 |
$192.09 |
Plan: (HMO) Prime Bronze HSASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$259.83 $294.90 $332.06 $464.05 $705.17 |
$519.66 $589.80 $664.12 $928.10 $1410.34 |
$684.65 $754.79 $829.11 $1093.09 |
$849.64 $919.78 $994.10 $1258.08 |
$1014.63 $1084.77 $1159.09 $1423.07 |
$424.82 $459.89 $497.05 $629.04 |
$589.81 $624.88 $662.04 $794.03 |
$754.80 $789.87 $827.03 $959.02 |
$164.99 |
Plan: (HMO) Prime CatastrophicSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-362-3310 - Provider Directory for This Plan: (Unity Health Plans Insurance Corporation)
Deductible: Individual:
$7,150
: Family:
$14,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Catastrophic | 21 30 40 50 60 |
$191.23 $217.04 $244.38 $341.53 $518.98 |
$382.46 $434.08 $488.76 $683.06 $1037.96 |
$503.89 $555.51 $610.19 $804.49 |
$625.32 $676.94 $731.62 $925.92 |
$746.75 $798.37 $853.05 $1047.35 |
$312.66 $338.47 $365.81 $462.96 |
$434.09 $459.90 $487.24 $584.39 |
$555.52 $581.33 $608.67 $705.82 |
|
ADVERTISEMENT
|
||||||||||
Dean Health PlanLocal: 1-608-828-1302 | Toll Free: 1-800-279-1302 TTY: 1-608-827-4086 |
||||||||||
Plan: (HMO) Dean Catastrophic Safety NetSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$7,150
: Family:
$14,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Catastrophic | 21 30 40 50 60 |
$123.63 $140.32 $157.99 $220.80 $335.52 |
$247.26 $280.64 $315.98 $441.60 $671.04 |
$325.76 $359.14 $394.48 $520.10 |
$404.26 $437.64 $472.98 $598.60 |
$482.76 $516.14 $551.48 $677.10 |
$202.13 $218.82 $236.49 $299.30 |
$280.63 $297.32 $314.99 $377.80 |
$359.13 $375.82 $393.49 $456.30 |
$78.50 |
Plan: (HMO) Dean Silver Copay Plus 2750XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$2,750
: Family:
$5,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$238.22 $270.38 $304.44 $425.46 $646.53 |
$476.44 $540.76 $608.88 $850.92 $1293.06 |
$627.71 $692.03 $760.15 $1002.19 |
$778.98 $843.30 $911.42 $1153.46 |
$930.25 $994.57 $1062.69 $1304.73 |
$389.49 $421.65 $455.71 $576.73 |
$540.76 $572.92 $606.98 $728.00 |
$692.03 $724.19 $758.25 $879.27 |
$151.27 |
Plan: (HMO) Dean Silver Classic 2500XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$236.52 $268.45 $302.27 $422.43 $641.92 |
$473.04 $536.90 $604.54 $844.86 $1283.84 |
$623.23 $687.09 $754.73 $995.05 |
$773.42 $837.28 $904.92 $1145.24 |
$923.61 $987.47 $1055.11 $1295.43 |
$386.71 $418.64 $452.46 $572.62 |
$536.90 $568.83 $602.65 $722.81 |
$687.09 $719.02 $752.84 $873.00 |
$150.19 |
ADVERTISEMENT
|
||||||||||
Group Health Cooperative of South Central WisconsinLocal: 1-608-828-4831 | Toll Free: 1-855-344-2729 TTY: 1-608-828-4815 |
||||||||||
Plan: (HMO) Gold 2000 Deductible HSA w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$2,000
: Family:
$4,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$355.10 $403.04 $453.82 $634.21 $963.74 |
$710.20 $806.08 $907.64 $1268.42 $1927.48 |
$935.69 $1031.57 $1133.13 $1493.91 |
$1161.18 $1257.06 $1358.62 $1719.40 |
$1386.67 $1482.55 $1584.11 $1944.89 |
$580.59 $628.53 $679.31 $859.70 |
$806.08 $854.02 $904.80 $1085.19 |
$1031.57 $1079.51 $1130.29 $1310.68 |
$225.49 |
ADVERTISEMENT
|
||||||||||
Dean Health PlanLocal: 1-608-828-1302 | Toll Free: 1-800-279-1302 TTY: 1-608-827-4086 |
||||||||||
Plan: (HMO) Dean Silver Classic 3750XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$3,750
: Family:
$7,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$226.58 $257.17 $289.57 $404.68 $614.95 |
$453.16 $514.34 $579.14 $809.36 $1229.90 |
$597.04 $658.22 $723.02 $953.24 |
$740.92 $802.10 $866.90 $1097.12 |
$884.80 $945.98 $1010.78 $1241.00 |
$370.46 $401.05 $433.45 $548.56 |
$514.34 $544.93 $577.33 $692.44 |
$658.22 $688.81 $721.21 $836.32 |
$143.88 |
Plan: (HMO) Dean Silver Value Copay 5000XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$223.21 $253.34 $285.26 $398.65 $605.78 |
$446.42 $506.68 $570.52 $797.30 $1211.56 |
$588.16 $648.42 $712.26 $939.04 |
$729.90 $790.16 $854.00 $1080.78 |
$871.64 $931.90 $995.74 $1222.52 |
$364.95 $395.08 $427.00 $540.39 |
$506.69 $536.82 $568.74 $682.13 |
$648.43 $678.56 $710.48 $823.87 |
$141.74 |
Plan: (HMO) Dean Gold Value Copay 2650XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$2,650
: Family:
$5,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$258.89 $293.84 $330.86 $462.38 $702.62 |
$517.78 $587.68 $661.72 $924.76 $1405.24 |
$682.17 $752.07 $826.11 $1089.15 |
$846.56 $916.46 $990.50 $1253.54 |
$1010.95 $1080.85 $1154.89 $1417.93 |
$423.28 $458.23 $495.25 $626.77 |
$587.67 $622.62 $659.64 $791.16 |
$752.06 $787.01 $824.03 $955.55 |
$164.39 |
Plan: (HMO) Dean Bronze Value Copay 7150XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$7,150
: Family:
$14,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$182.99 $207.69 $233.86 $326.82 $496.63 |
$365.98 $415.38 $467.72 $653.64 $993.26 |
$482.18 $531.58 $583.92 $769.84 |
$598.38 $647.78 $700.12 $886.04 |
$714.58 $763.98 $816.32 $1002.24 |
$299.19 $323.89 $350.06 $443.02 |
$415.39 $440.09 $466.26 $559.22 |
$531.59 $556.29 $582.46 $675.42 |
$116.20 |
ADVERTISEMENT
|
||||||||||
Gundersen Health Plan, Inc.Local: 1-608-775-8092 | Toll Free: 1-855-685-6404 |
||||||||||
Plan: (POS) Silver $4000 - 10%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)
Deductible: Individual:
$4,000
: Family:
$8,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$414.17 $470.08 $529.31 $739.71 $1124.06 |
$828.34 $940.16 $1058.62 $1479.42 $2248.12 |
$1091.34 $1203.16 $1321.62 $1742.42 |
$1354.34 $1466.16 $1584.62 $2005.42 |
$1617.34 $1729.16 $1847.62 $2268.42 |
$677.17 $733.08 $792.31 $1002.71 |
$940.17 $996.08 $1055.31 $1265.71 |
$1203.17 $1259.08 $1318.31 $1528.71 |
$263.00 |
ADVERTISEMENT
|
||||||||||
Dean Health PlanLocal: 1-608-828-1302 | Toll Free: 1-800-279-1302 TTY: 1-608-827-4086 |
||||||||||
Plan: (HMO) Dean Silver HSA-E 3000XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$225.23 $255.63 $287.84 $402.26 $611.27 |
$450.46 $511.26 $575.68 $804.52 $1222.54 |
$593.48 $654.28 $718.70 $947.54 |
$736.50 $797.30 $861.72 $1090.56 |
$879.52 $940.32 $1004.74 $1233.58 |
$368.25 $398.65 $430.86 $545.28 |
$511.27 $541.67 $573.88 $688.30 |
$654.29 $684.69 $716.90 $831.32 |
$143.02 |
Plan: (HMO) Dean Gold Copay Plus 1500XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$1,500
: Family:
$3,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$259.92 $295.01 $332.18 $464.22 $705.43 |
$519.84 $590.02 $664.36 $928.44 $1410.86 |
$684.89 $755.07 $829.41 $1093.49 |
$849.94 $920.12 $994.46 $1258.54 |
$1014.99 $1085.17 $1159.51 $1423.59 |
$424.97 $460.06 $497.23 $629.27 |
$590.02 $625.11 $662.28 $794.32 |
$755.07 $790.16 $827.33 $959.37 |
$165.05 |
Plan: (HMO) Dean Silver Copay Plus 3500XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$239.57 $271.92 $306.18 $427.88 $650.21 |
$479.14 $543.84 $612.36 $855.76 $1300.42 |
$631.27 $695.97 $764.49 $1007.89 |
$783.40 $848.10 $916.62 $1160.02 |
$935.53 $1000.23 $1068.75 $1312.15 |
$391.70 $424.05 $458.31 $580.01 |
$543.83 $576.18 $610.44 $732.14 |
$695.96 $728.31 $762.57 $884.27 |
$152.13 |
Plan: (HMO) Dean Bronze HSA-E 6550XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$181.63 $206.15 $232.13 $324.40 $492.95 |
$363.26 $412.30 $464.26 $648.80 $985.90 |
$478.60 $527.64 $579.60 $764.14 |
$593.94 $642.98 $694.94 $879.48 |
$709.28 $758.32 $810.28 $994.82 |
$296.97 $321.49 $347.47 $439.74 |
$412.31 $436.83 $462.81 $555.08 |
$527.65 $552.17 $578.15 $670.42 |
$115.34 |
ADVERTISEMENT
|
||||||||||
Gundersen Health Plan, Inc.Local: 1-608-775-8092 | Toll Free: 1-855-685-6404 |
||||||||||
Plan: (POS) Silver $2500 - 50%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$410.32 $465.71 $524.39 $732.83 $1113.61 |
$820.64 $931.42 $1048.78 $1465.66 $2227.22 |
$1081.19 $1191.97 $1309.33 $1726.21 |
$1341.74 $1452.52 $1569.88 $1986.76 |
$1602.29 $1713.07 $1830.43 $2247.31 |
$670.87 $726.26 $784.94 $993.38 |
$931.42 $986.81 $1045.49 $1253.93 |
$1191.97 $1247.36 $1306.04 $1514.48 |
$260.55 |
ADVERTISEMENT
|
||||||||||
Dean Health PlanLocal: 1-608-828-1302 | Toll Free: 1-800-279-1302 TTY: 1-608-827-4086 |
||||||||||
Plan: (EPO) Dean Focus Network Silver Value Copay 5000XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$200.88 $228.00 $256.73 $358.78 $545.19 |
$401.76 $456.00 $513.46 $717.56 $1090.38 |
$529.32 $583.56 $641.02 $845.12 |
$656.88 $711.12 $768.58 $972.68 |
$784.44 $838.68 $896.14 $1100.24 |
$328.44 $355.56 $384.29 $486.34 |
$456.00 $483.12 $511.85 $613.90 |
$583.56 $610.68 $639.41 $741.46 |
$127.56 |
Plan: (EPO) Dean Focus Network Bronze Value Copay 7150XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$7,150
: Family:
$14,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$165.20 $187.50 $211.13 $295.05 $448.36 |
$330.40 $375.00 $422.26 $590.10 $896.72 |
$435.30 $479.90 $527.16 $695.00 |
$540.20 $584.80 $632.06 $799.90 |
$645.10 $689.70 $736.96 $904.80 |
$270.10 $292.40 $316.03 $399.95 |
$375.00 $397.30 $420.93 $504.85 |
$479.90 $502.20 $525.83 $609.75 |
$104.90 |
Plan: (EPO) Dean Focus Network Silver HSA-E 3000XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$3,000
: Family:
$6,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$202.67 $230.03 $259.01 $361.96 $550.04 |
$405.34 $460.06 $518.02 $723.92 $1100.08 |
$534.03 $588.75 $646.71 $852.61 |
$662.72 $717.44 $775.40 $981.30 |
$791.41 $846.13 $904.09 $1109.99 |
$331.36 $358.72 $387.70 $490.65 |
$460.05 $487.41 $516.39 $619.34 |
$588.74 $616.10 $645.08 $748.03 |
$128.69 |
Plan: (EPO) Dean Focus Network Bronze HSA-E 6550XSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$164.00 $186.14 $209.59 $292.90 $445.09 |
$328.00 $372.28 $419.18 $585.80 $890.18 |
$432.14 $476.42 $523.32 $689.94 |
$536.28 $580.56 $627.46 $794.08 |
$640.42 $684.70 $731.60 $898.22 |
$268.14 $290.28 $313.73 $397.04 |
$372.28 $394.42 $417.87 $501.18 |
$476.42 $498.56 $522.01 $605.32 |
$104.14 |
ADVERTISEMENT
|
||||||||||
Gundersen Health Plan, Inc.Local: 1-608-775-8092 | Toll Free: 1-855-685-6404 |
||||||||||
Plan: (POS) Platinum $1000 - 0%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)
Deductible: Individual:
$1,000
: Family:
$2,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Platinum | 21 30 40 50 60 |
$530.87 $602.54 $678.45 $948.13 $1440.78 |
$1061.74 $1205.08 $1356.90 $1896.26 $2881.56 |
$1398.84 $1542.18 $1694.00 $2233.36 |
$1735.94 $1879.28 $2031.10 $2570.46 |
$2073.04 $2216.38 $2368.20 $2907.56 |
$867.97 $939.64 $1015.55 $1285.23 |
$1205.07 $1276.74 $1352.65 $1622.33 |
$1542.17 $1613.84 $1689.75 $1959.43 |
$337.10 |
Plan: (POS) Silver $2500 - 20%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$432.56 $490.96 $552.81 $772.55 $1173.97 |
$865.12 $981.92 $1105.62 $1545.10 $2347.94 |
$1139.80 $1256.60 $1380.30 $1819.78 |
$1414.48 $1531.28 $1654.98 $2094.46 |
$1689.16 $1805.96 $1929.66 $2369.14 |
$707.24 $765.64 $827.49 $1047.23 |
$981.92 $1040.32 $1102.17 $1321.91 |
$1256.60 $1315.00 $1376.85 $1596.59 |
$274.68 |
Plan: (POS) Bronze $3750 - 50%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)
Deductible: Individual:
$3,750
: Family:
$7,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$342.16 $388.35 $437.28 $611.10 $928.62 |
$684.32 $776.70 $874.56 $1222.20 $1857.24 |
$901.59 $993.97 $1091.83 $1439.47 |
$1118.86 $1211.24 $1309.10 $1656.74 |
$1336.13 $1428.51 $1526.37 $1874.01 |
$559.43 $605.62 $654.55 $828.37 |
$776.70 $822.89 $871.82 $1045.64 |
$993.97 $1040.16 $1089.09 $1262.91 |
$217.27 |
Plan: (POS) Bronze $5000 - 10%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$357.07 $405.27 $456.34 $637.73 $969.09 |
$714.14 $810.54 $912.68 $1275.46 $1938.18 |
$940.88 $1037.28 $1139.42 $1502.20 |
$1167.62 $1264.02 $1366.16 $1728.94 |
$1394.36 $1490.76 $1592.90 $1955.68 |
$583.81 $632.01 $683.08 $864.47 |
$810.55 $858.75 $909.82 $1091.21 |
$1037.29 $1085.49 $1136.56 $1317.95 |
$226.74 |
Plan: (POS) Bronze $6500 - 10%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)
Deductible: Individual:
$6,500
: Family:
$13,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$338.11 $383.75 $432.10 $603.86 $917.63 |
$676.22 $767.50 $864.20 $1207.72 $1835.26 |
$890.92 $982.20 $1078.90 $1422.42 |
$1105.62 $1196.90 $1293.60 $1637.12 |
$1320.32 $1411.60 $1508.30 $1851.82 |
$552.81 $598.45 $646.80 $818.56 |
$767.51 $813.15 $861.50 $1033.26 |
$982.21 $1027.85 $1076.20 $1247.96 |
$214.70 |
Plan: (POS) Catastrophic $7150 - 0%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)
Deductible: Individual:
$7,150
: Family:
$14,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Catastrophic | 21 30 40 50 60 |
$316.61 $359.35 $404.63 $565.47 $859.28 |
$633.22 $718.70 $809.26 $1130.94 $1718.56 |
$834.27 $919.75 $1010.31 $1331.99 |
$1035.32 $1120.80 $1211.36 $1533.04 |
$1236.37 $1321.85 $1412.41 $1734.09 |
$517.66 $560.40 $605.68 $766.52 |
$718.71 $761.45 $806.73 $967.57 |
$919.76 $962.50 $1007.78 $1168.62 |
$201.05 |
Plan: (POS) Silver HSA $4400 - 0%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)
Deductible: Individual:
$4,400
: Family:
$8,800 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$378.54 $429.64 $483.77 $676.07 $1027.36 |
$757.08 $859.28 $967.54 $1352.14 $2054.72 |
$997.45 $1099.65 $1207.91 $1592.51 |
$1237.82 $1340.02 $1448.28 $1832.88 |
$1478.19 $1580.39 $1688.65 $2073.25 |
$618.91 $670.01 $724.14 $916.44 |
$859.28 $910.38 $964.51 $1156.81 |
$1099.65 $1150.75 $1204.88 $1397.18 |
$240.37 |
Plan: (POS) Silver HSA $2000 - 50%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)
Deductible: Individual:
$2,000
: Family:
$4,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$393.88 $447.05 $503.38 $703.47 $1068.99 |
$787.76 $894.10 $1006.76 $1406.94 $2137.98 |
$1037.87 $1144.21 $1256.87 $1657.05 |
$1287.98 $1394.32 $1506.98 $1907.16 |
$1538.09 $1644.43 $1757.09 $2157.27 |
$643.99 $697.16 $753.49 $953.58 |
$894.10 $947.27 $1003.60 $1203.69 |
$1144.21 $1197.38 $1253.71 $1453.80 |
$250.11 |
Plan: (POS) Bronze HSA $4400 - 50%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)
Deductible: Individual:
$4,400
: Family:
$8,800 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$342.85 $389.13 $438.16 $612.33 $930.49 |
$685.70 $778.26 $876.32 $1224.66 $1860.98 |
$903.41 $995.97 $1094.03 $1442.37 |
$1121.12 $1213.68 $1311.74 $1660.08 |
$1338.83 $1431.39 $1529.45 $1877.79 |
$560.56 $606.84 $655.87 $830.04 |
$778.27 $824.55 $873.58 $1047.75 |
$995.98 $1042.26 $1091.29 $1265.46 |
$217.71 |
Plan: (POS) Bronze HSA $6550 - 0%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$323.22 $366.85 $413.08 $577.27 $877.22 |
$646.44 $733.70 $826.16 $1154.54 $1754.44 |
$851.68 $938.94 $1031.40 $1359.78 |
$1056.92 $1144.18 $1236.64 $1565.02 |
$1262.16 $1349.42 $1441.88 $1770.26 |
$528.46 $572.09 $618.32 $782.51 |
$733.70 $777.33 $823.56 $987.75 |
$938.94 $982.57 $1028.80 $1192.99 |
$205.24 |
Plan: (POS) Bronze HSA $5750 - 20%Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-685-6404 - Provider Directory for This Plan: (Gundersen Health Plan, Inc.)
Deductible: Individual:
$5,750
: Family:
$11,500 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$325.38 $369.31 $415.84 $581.13 $883.08 |
$650.76 $738.62 $831.68 $1162.26 $1766.16 |
$857.38 $945.24 $1038.30 $1368.88 |
$1064.00 $1151.86 $1244.92 $1575.50 |
$1270.62 $1358.48 $1451.54 $1782.12 |
$532.00 $575.93 $622.46 $787.75 |
$738.62 $782.55 $829.08 $994.37 |
$945.24 $989.17 $1035.70 $1200.99 |
$206.62 |
ADVERTISEMENT
|
||||||||||
Group Health Cooperative of South Central WisconsinLocal: 1-608-828-4831 | Toll Free: 1-855-344-2729 TTY: 1-608-828-4815 |
||||||||||
Plan: (HMO) Platinum 500 Ded/1000 MOOP w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$500
: Family:
$1,000 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 |
$423.55 $480.73 $541.30 $756.46 $1149.51 |
$847.10 $961.46 $1082.60 $1512.92 $2299.02 |
$1116.06 $1230.42 $1351.56 $1781.88 |
$1385.02 $1499.38 $1620.52 $2050.84 |
$1653.98 $1768.34 $1889.48 $2319.80 |
$692.51 $749.69 $810.26 $1025.42 |
$961.47 $1018.65 $1079.22 $1294.38 |
$1230.43 $1287.61 $1348.18 $1563.34 |
$268.96 |
Plan: (HMO) Gold 1000 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$1,000
: Family:
$2,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$367.62 $417.24 $469.81 $656.56 $997.70 |
$735.24 $834.48 $939.62 $1313.12 $1995.40 |
$968.68 $1067.92 $1173.06 $1546.56 |
$1202.12 $1301.36 $1406.50 $1780.00 |
$1435.56 $1534.80 $1639.94 $2013.44 |
$601.06 $650.68 $703.25 $890.00 |
$834.50 $884.12 $936.69 $1123.44 |
$1067.94 $1117.56 $1170.13 $1356.88 |
$233.44 |
Plan: (HMO) Silver 30 Copay w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$323.69 $367.38 $413.67 $578.10 $878.48 |
$647.38 $734.76 $827.34 $1156.20 $1756.96 |
$852.92 $940.30 $1032.88 $1361.74 |
$1058.46 $1145.84 $1238.42 $1567.28 |
$1264.00 $1351.38 $1443.96 $1772.82 |
$529.23 $572.92 $619.21 $783.64 |
$734.77 $778.46 $824.75 $989.18 |
$940.31 $984.00 $1030.29 $1194.72 |
$205.54 |
Plan: (HMO) Silver 2000 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$2,000
: Family:
$4,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$310.70 $352.64 $397.07 $554.91 $843.23 |
$621.40 $705.28 $794.14 $1109.82 $1686.46 |
$818.70 $902.58 $991.44 $1307.12 |
$1016.00 $1099.88 $1188.74 $1504.42 |
$1213.30 $1297.18 $1386.04 $1701.72 |
$508.00 $549.94 $594.37 $752.21 |
$705.30 $747.24 $791.67 $949.51 |
$902.60 $944.54 $988.97 $1146.81 |
$197.30 |
Plan: (HMO) Silver 4000 Deductible HSA w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$4,000
: Family:
$8,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$293.00 $332.55 $374.45 $523.29 $795.19 |
$586.00 $665.10 $748.90 $1046.58 $1590.38 |
$772.06 $851.16 $934.96 $1232.64 |
$958.12 $1037.22 $1121.02 $1418.70 |
$1144.18 $1223.28 $1307.08 $1604.76 |
$479.06 $518.61 $560.51 $709.35 |
$665.12 $704.67 $746.57 $895.41 |
$851.18 $890.73 $932.63 $1081.47 |
$186.06 |
Plan: (HMO) Bronze 4000 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$4,000
: Family:
$8,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$279.79 $317.57 $357.58 $499.71 $759.35 |
$559.58 $635.14 $715.16 $999.42 $1518.70 |
$737.25 $812.81 $892.83 $1177.09 |
$914.92 $990.48 $1070.50 $1354.76 |
$1092.59 $1168.15 $1248.17 $1532.43 |
$457.46 $495.24 $535.25 $677.38 |
$635.13 $672.91 $712.92 $855.05 |
$812.80 $850.58 $890.59 $1032.72 |
$177.67 |
Plan: (HMO) Select Platinum 500 Ded/1000 MOOP w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$500
: Family:
$1,000 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 |
$385.06 $437.05 $492.11 $687.72 $1045.06 |
$770.12 $874.10 $984.22 $1375.44 $2090.12 |
$1014.64 $1118.62 $1228.74 $1619.96 |
$1259.16 $1363.14 $1473.26 $1864.48 |
$1503.68 $1607.66 $1717.78 $2109.00 |
$629.58 $681.57 $736.63 $932.24 |
$874.10 $926.09 $981.15 $1176.76 |
$1118.62 $1170.61 $1225.67 $1421.28 |
$244.52 |
Plan: (HMO) Select Gold 1000 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$1,000
: Family:
$2,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$334.24 $379.37 $427.16 $596.95 $907.13 |
$668.48 $758.74 $854.32 $1193.90 $1814.26 |
$880.73 $970.99 $1066.57 $1406.15 |
$1092.98 $1183.24 $1278.82 $1618.40 |
$1305.23 $1395.49 $1491.07 $1830.65 |
$546.49 $591.62 $639.41 $809.20 |
$758.74 $803.87 $851.66 $1021.45 |
$970.99 $1016.12 $1063.91 $1233.70 |
$212.25 |
Plan: (HMO) Select Gold 2000 Deductible HSA w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$2,000
: Family:
$4,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$322.85 $366.44 $412.60 $576.61 $876.21 |
$645.70 $732.88 $825.20 $1153.22 $1752.42 |
$850.71 $937.89 $1030.21 $1358.23 |
$1055.72 $1142.90 $1235.22 $1563.24 |
$1260.73 $1347.91 $1440.23 $1768.25 |
$527.86 $571.45 $617.61 $781.62 |
$732.87 $776.46 $822.62 $986.63 |
$937.88 $981.47 $1027.63 $1191.64 |
$205.01 |
Plan: (HMO) Select Silver 30 Copay w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$294.30 $334.03 $376.12 $525.62 $798.73 |
$588.60 $668.06 $752.24 $1051.24 $1597.46 |
$775.49 $854.95 $939.13 $1238.13 |
$962.38 $1041.84 $1126.02 $1425.02 |
$1149.27 $1228.73 $1312.91 $1611.91 |
$481.19 $520.92 $563.01 $712.51 |
$668.08 $707.81 $749.90 $899.40 |
$854.97 $894.70 $936.79 $1086.29 |
$186.89 |
Plan: (HMO) Select Silver 2000 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$2,000
: Family:
$4,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$281.86 $319.91 $360.22 $503.40 $764.97 |
$563.72 $639.82 $720.44 $1006.80 $1529.94 |
$742.70 $818.80 $899.42 $1185.78 |
$921.68 $997.78 $1078.40 $1364.76 |
$1100.66 $1176.76 $1257.38 $1543.74 |
$460.84 $498.89 $539.20 $682.38 |
$639.82 $677.87 $718.18 $861.36 |
$818.80 $856.85 $897.16 $1040.34 |
$178.98 |
Plan: (HMO) Select Bronze 6550 Deductible HSA w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$237.50 $269.56 $303.52 $424.17 $644.56 |
$475.00 $539.12 $607.04 $848.34 $1289.12 |
$625.81 $689.93 $757.85 $999.15 |
$776.62 $840.74 $908.66 $1149.96 |
$927.43 $991.55 $1059.47 $1300.77 |
$388.31 $420.37 $454.33 $574.98 |
$539.12 $571.18 $605.14 $725.79 |
$689.93 $721.99 $755.95 $876.60 |
$150.81 |
Plan: (HMO) Select Silver 4000 Deductible HSA w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$4,000
: Family:
$8,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$266.41 $302.37 $340.47 $475.80 $723.03 |
$532.82 $604.74 $680.94 $951.60 $1446.06 |
$701.99 $773.91 $850.11 $1120.77 |
$871.16 $943.08 $1019.28 $1289.94 |
$1040.33 $1112.25 $1188.45 $1459.11 |
$435.58 $471.54 $509.64 $644.97 |
$604.75 $640.71 $678.81 $814.14 |
$773.92 $809.88 $847.98 $983.31 |
$169.17 |
Plan: (HMO) Select Bronze 4000 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$4,000
: Family:
$8,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$254.40 $288.75 $325.12 $454.36 $690.44 |
$508.80 $577.50 $650.24 $908.72 $1380.88 |
$670.35 $739.05 $811.79 $1070.27 |
$831.90 $900.60 $973.34 $1231.82 |
$993.45 $1062.15 $1134.89 $1393.37 |
$415.95 $450.30 $486.67 $615.91 |
$577.50 $611.85 $648.22 $777.46 |
$739.05 $773.40 $809.77 $939.01 |
$161.55 |
Plan: (HMO) Silver 3500 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$316.43 $359.15 $404.40 $565.14 $858.79 |
$632.86 $718.30 $808.80 $1130.28 $1717.58 |
$833.80 $919.24 $1009.74 $1331.22 |
$1034.74 $1120.18 $1210.68 $1532.16 |
$1235.68 $1321.12 $1411.62 $1733.10 |
$517.37 $560.09 $605.34 $766.08 |
$718.31 $761.03 $806.28 $967.02 |
$919.25 $961.97 $1007.22 $1167.96 |
$200.94 |
Plan: (HMO) Select Silver 3500 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$287.70 $326.54 $367.68 $513.83 $780.82 |
$575.40 $653.08 $735.36 $1027.66 $1561.64 |
$758.09 $835.77 $918.05 $1210.35 |
$940.78 $1018.46 $1100.74 $1393.04 |
$1123.47 $1201.15 $1283.43 $1575.73 |
$470.39 $509.23 $550.37 $696.52 |
$653.08 $691.92 $733.06 $879.21 |
$835.77 $874.61 $915.75 $1061.90 |
$182.69 |
Plan: (HMO) Bronze 6550 Deductible HSA w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$6,550
: Family:
$13,100 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$262.35 $297.76 $335.28 $468.55 $712.00 |
$524.70 $595.52 $670.56 $937.10 $1424.00 |
$691.29 $762.11 $837.15 $1103.69 |
$857.88 $928.70 $1003.74 $1270.28 |
$1024.47 $1095.29 $1170.33 $1436.87 |
$428.94 $464.35 $501.87 $635.14 |
$595.53 $630.94 $668.46 $801.73 |
$762.12 $797.53 $835.05 $968.32 |
$166.59 |
Plan: (HMO) Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$500
: Family:
$1,000 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 |
$402.69 $457.06 $514.64 $719.21 $1092.90 |
$805.38 $914.12 $1029.28 $1438.42 $2185.80 |
$1061.09 $1169.83 $1284.99 $1694.13 |
$1316.80 $1425.54 $1540.70 $1949.84 |
$1572.51 $1681.25 $1796.41 $2205.55 |
$658.40 $712.77 $770.35 $974.92 |
$914.11 $968.48 $1026.06 $1230.63 |
$1169.82 $1224.19 $1281.77 $1486.34 |
$255.71 |
Plan: (HMO) Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$500
: Family:
$1,000 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 |
$392.36 $445.32 $501.43 $700.74 $1064.85 |
$784.72 $890.64 $1002.86 $1401.48 $2129.70 |
$1033.87 $1139.79 $1252.01 $1650.63 |
$1283.02 $1388.94 $1501.16 $1899.78 |
$1532.17 $1638.09 $1750.31 $2148.93 |
$641.51 $694.47 $750.58 $949.89 |
$890.66 $943.62 $999.73 $1199.04 |
$1139.81 $1192.77 $1248.88 $1448.19 |
$249.15 |
Plan: (HMO) Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$1,500
: Family:
$3,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$365.04 $414.32 $466.52 $651.96 $990.71 |
$730.08 $828.64 $933.04 $1303.92 $1981.42 |
$961.88 $1060.44 $1164.84 $1535.72 |
$1193.68 $1292.24 $1396.64 $1767.52 |
$1425.48 $1524.04 $1628.44 $1999.32 |
$596.84 $646.12 $698.32 $883.76 |
$828.64 $877.92 $930.12 $1115.56 |
$1060.44 $1109.72 $1161.92 $1347.36 |
$231.80 |
Plan: (HMO) Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$349.66 $396.86 $446.86 $624.49 $948.97 |
$699.32 $793.72 $893.72 $1248.98 $1897.94 |
$921.36 $1015.76 $1115.76 $1471.02 |
$1143.40 $1237.80 $1337.80 $1693.06 |
$1365.44 $1459.84 $1559.84 $1915.10 |
$571.70 $618.90 $668.90 $846.53 |
$793.74 $840.94 $890.94 $1068.57 |
$1015.78 $1062.98 $1112.98 $1290.61 |
$222.04 |
Plan: (HMO) Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$321.55 $364.96 $410.94 $574.28 $872.67 |
$643.10 $729.92 $821.88 $1148.56 $1745.34 |
$847.28 $934.10 $1026.06 $1352.74 |
$1051.46 $1138.28 $1230.24 $1556.92 |
$1255.64 $1342.46 $1434.42 $1761.10 |
$525.73 $569.14 $615.12 $778.46 |
$729.91 $773.32 $819.30 $982.64 |
$934.09 $977.50 $1023.48 $1186.82 |
$204.18 |
Plan: (HMO) Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$4,250
: Family:
$8,500 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 |
$317.09 $359.89 $405.23 $566.31 $860.56 |
$634.18 $719.78 $810.46 $1132.62 $1721.12 |
$835.53 $921.13 $1011.81 $1333.97 |
$1036.88 $1122.48 $1213.16 $1535.32 |
$1238.23 $1323.83 $1414.51 $1736.67 |
$518.44 $561.24 $606.58 $767.66 |
$719.79 $762.59 $807.93 $969.01 |
$921.14 $963.94 $1009.28 $1170.36 |
$201.35 |
Plan: (HMO) Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$313.71 $356.06 $400.92 $560.28 $851.40 |
$627.42 $712.12 $801.84 $1120.56 $1702.80 |
$826.63 $911.33 $1001.05 $1319.77 |
$1025.84 $1110.54 $1200.26 $1518.98 |
$1225.05 $1309.75 $1399.47 $1718.19 |
$512.92 $555.27 $600.13 $759.49 |
$712.13 $754.48 $799.34 $958.70 |
$911.34 $953.69 $998.55 $1157.91 |
$199.21 |
Plan: (HMO) Select Platinum Zero Primary Care Visit Copay No Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$0
: Family:
$0 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 |
$374.15 $424.65 $478.16 $668.22 $1015.42 |
$748.30 $849.30 $956.32 $1336.44 $2030.84 |
$985.88 $1086.88 $1193.90 $1574.02 |
$1223.46 $1324.46 $1431.48 $1811.60 |
$1461.04 $1562.04 $1669.06 $2049.18 |
$611.73 $662.23 $715.74 $905.80 |
$849.31 $899.81 $953.32 $1143.38 |
$1086.89 $1137.39 $1190.90 $1380.96 |
$237.58 |
Plan: (HMO) Select Platinum Zero Primary Care Visit Copay 500 Ded/3000 MOOP w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$500
: Family:
$1,000 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 |
$366.13 $415.56 $467.91 $653.90 $993.67 |
$732.26 $831.12 $935.82 $1307.80 $1987.34 |
$964.75 $1063.61 $1168.31 $1540.29 |
$1197.24 $1296.10 $1400.80 $1772.78 |
$1429.73 $1528.59 $1633.29 $2005.27 |
$598.62 $648.05 $700.40 $886.39 |
$831.11 $880.54 $932.89 $1118.88 |
$1063.60 $1113.03 $1165.38 $1351.37 |
$232.49 |
Plan: (HMO) Select Platinum Zero Primary Care Visit Copay 500 Ded/4500 MOOP w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$500
: Family:
$1,000 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 |
$356.73 $404.89 $455.90 $637.12 $968.17 |
$713.46 $809.78 $911.80 $1274.24 $1936.34 |
$939.99 $1036.31 $1138.33 $1500.77 |
$1166.52 $1262.84 $1364.86 $1727.30 |
$1393.05 $1489.37 $1591.39 $1953.83 |
$583.26 $631.42 $682.43 $863.65 |
$809.79 $857.95 $908.96 $1090.18 |
$1036.32 $1084.48 $1135.49 $1316.71 |
$226.53 |
Plan: (HMO) Select Gold Zero Primary Care Visit Copay 1500 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$1,500
: Family:
$3,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$331.89 $376.69 $424.15 $592.74 $900.73 |
$663.78 $753.38 $848.30 $1185.48 $1801.46 |
$874.53 $964.13 $1059.05 $1396.23 |
$1085.28 $1174.88 $1269.80 $1606.98 |
$1296.03 $1385.63 $1480.55 $1817.73 |
$542.64 $587.44 $634.90 $803.49 |
$753.39 $798.19 $845.65 $1014.24 |
$964.14 $1008.94 $1056.40 $1224.99 |
$210.75 |
Plan: (HMO) Select Gold Zero Primary Care Visit Copay 2500 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$2,500
: Family:
$5,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Gold | 21 30 40 50 60 |
$317.92 $360.84 $406.30 $567.80 $862.82 |
$635.84 $721.68 $812.60 $1135.60 $1725.64 |
$837.72 $923.56 $1014.48 $1337.48 |
$1039.60 $1125.44 $1216.36 $1539.36 |
$1241.48 $1327.32 $1418.24 $1741.24 |
$519.80 $562.72 $608.18 $769.68 |
$721.68 $764.60 $810.06 $971.56 |
$923.56 $966.48 $1011.94 $1173.44 |
$201.88 |
Plan: (HMO) Select Silver Zero Primary Care Visit Copay 3500 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$292.35 $331.81 $373.62 $522.13 $793.42 |
$584.70 $663.62 $747.24 $1044.26 $1586.84 |
$770.34 $849.26 $932.88 $1229.90 |
$955.98 $1034.90 $1118.52 $1415.54 |
$1141.62 $1220.54 $1304.16 $1601.18 |
$477.99 $517.45 $559.26 $707.77 |
$663.63 $703.09 $744.90 $893.41 |
$849.27 $888.73 $930.54 $1079.05 |
$185.64 |
Plan: (HMO) Select Silver Zero Primary Care Visit Copay 4250 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$4,250
: Family:
$8,500 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 |
$288.28 $327.20 $368.42 $514.87 $782.39 |
$576.56 $654.40 $736.84 $1029.74 $1564.78 |
$759.62 $837.46 $919.90 $1212.80 |
$942.68 $1020.52 $1102.96 $1395.86 |
$1125.74 $1203.58 $1286.02 $1578.92 |
$471.34 $510.26 $551.48 $697.93 |
$654.40 $693.32 $734.54 $880.99 |
$837.46 $876.38 $917.60 $1064.05 |
$183.06 |
Plan: (HMO) Select Silver Zero Primary Care Visit Copay 5000 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$5,000
: Family:
$10,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$285.20 $323.70 $364.48 $509.36 $774.02 |
$570.40 $647.40 $728.96 $1018.72 $1548.04 |
$751.50 $828.50 $910.06 $1199.82 |
$932.60 $1009.60 $1091.16 $1380.92 |
$1113.70 $1190.70 $1272.26 $1562.02 |
$466.30 $504.80 $545.58 $690.46 |
$647.40 $685.90 $726.68 $871.56 |
$828.50 $867.00 $907.78 $1052.66 |
$181.10 |
Plan: (HMO) Select Gold Standardized Plan w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$1,250
: Family:
$2,500 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 |
$311.61 $353.67 $398.23 $556.53 $845.69 |
$623.22 $707.34 $796.46 $1113.06 $1691.38 |
$821.09 $905.21 $994.33 $1310.93 |
$1018.96 $1103.08 $1192.20 $1508.80 |
$1216.83 $1300.95 $1390.07 $1706.67 |
$509.48 $551.54 $596.10 $754.40 |
$707.35 $749.41 $793.97 $952.27 |
$905.22 $947.28 $991.84 $1150.14 |
$197.87 |
Plan: (HMO) Select Silver Standardized Plan w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$3,500
: Family:
$7,000 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$262.93 $298.42 $336.02 $469.58 $713.57 |
$525.86 $596.84 $672.04 $939.16 $1427.14 |
$692.82 $763.80 $839.00 $1106.12 |
$859.78 $930.76 $1005.96 $1273.08 |
$1026.74 $1097.72 $1172.92 $1440.04 |
$429.89 $465.38 $502.98 $636.54 |
$596.85 $632.34 $669.94 $803.50 |
$763.81 $799.30 $836.90 $970.46 |
$166.96 |
Plan: (HMO) Select Bronze Standardized Plan w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$6,650
: Family:
$13,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Bronze | 21 30 40 50 60 |
$242.36 $275.08 $309.73 $432.85 $657.75 |
$484.72 $550.16 $619.46 $865.70 $1315.50 |
$638.62 $704.06 $773.36 $1019.60 |
$792.52 $857.96 $927.26 $1173.50 |
$946.42 $1011.86 $1081.16 $1327.40 |
$396.26 $428.98 $463.63 $586.75 |
$550.16 $582.88 $617.53 $740.65 |
$704.06 $736.78 $771.43 $894.55 |
$153.90 |
Plan: (HMO) Catastrophic 7150 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$7,150
: Family:
$14,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Catastrophic | 21 30 40 50 60 |
$202.06 $229.33 $258.23 $360.87 $548.37 |
$404.12 $458.66 $516.46 $721.74 $1096.74 |
$532.43 $586.97 $644.77 $850.05 |
$660.74 $715.28 $773.08 $978.36 |
$789.05 $843.59 $901.39 $1106.67 |
$330.37 $357.64 $386.54 $489.18 |
$458.68 $485.95 $514.85 $617.49 |
$586.99 $614.26 $643.16 $745.80 |
$128.31 |
Plan: (HMO) Select Catastrophic 7150 Deductible w/ Massage TherapySummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-344-2729 - Provider Directory for This Plan: (Group Health Cooperative of South Central Wisconsin)
Deductible: Individual:
$7,150
: Family:
$14,300 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Catastrophic | 21 30 40 50 60 |
$183.74 $208.54 $234.82 $328.15 $498.66 |
$367.48 $417.08 $469.64 $656.30 $997.32 |
$484.16 $533.76 $586.32 $772.98 |
$600.84 $650.44 $703.00 $889.66 |
$717.52 $767.12 $819.68 $1006.34 |
$300.42 $325.22 $351.50 $444.83 |
$417.10 $441.90 $468.18 $561.51 |
$533.78 $558.58 $584.86 $678.19 |
$116.68 |