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Providers for Zip Code 54935

Obamacare 2018 Marketplace Rates For Fond Du Lac County, Wisconsin

Thursday, April 25th, 2024


The health insurance rates listed below are for calendar year 2018.

2018 Rates and Providers

(click here for 2014)

(click here for 2015)

(click here for 2016)

(click here for 2017)

This page gives you an overview of the rates for individual and family health insurance plans available from HealthCare.gov, the marketplace for Fond Du Lac County, Wisconsin.

Obamacare Providers, Plans and 2018 Rates for Fond Du Lac County

Fond Du Lac County is in “Rating Area 11” of Wisconsin.

Currently, there are 39 plans offered in Rating Area 11.

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 for:

  • 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 Fond Du Lac, WI area accept this insurance coverage as within the plan's "network".
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Unity Health Plans Insurance Corporation

Local: 1-608-644-3430 | Toll Free: 1-800-362-3310

TTY: 1-608-643-1421

Plan: (HMO) Elite Gold Healthy You - PCP Copay $30

Summary 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: $2,900 : Family: $5,800
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$491.24
$557.56
$627.80
$877.35
$1,333.22
$982.48
$1,115.12
$1,255.60
$1,754.70
$2,666.44
$1,358.28
$1,490.92
$1,631.40
$2,130.50
$1,734.08
$1,866.72
$2,007.20
$2,506.30
$2,109.88
$2,242.52
$2,383.00
$2,882.10
$867.04
$933.36
$1,003.60
$1,253.15
$1,242.84
$1,309.16
$1,379.40
$1,628.95
$1,618.64
$1,684.96
$1,755.20
$2,004.75
$375.80

Plan: (HMO) Elite Bronze Deductible $6500 with Dental

Summary 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: $6,500 : Family: $13,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$383.87
$435.69
$490.59
$685.59
$1,041.82
$767.74
$871.38
$981.18
$1,371.18
$2,083.64
$1,061.40
$1,165.04
$1,274.84
$1,664.84
$1,355.06
$1,458.70
$1,568.50
$1,958.50
$1,648.72
$1,752.36
$1,862.16
$2,252.16
$677.53
$729.35
$784.25
$979.25
$971.19
$1,023.01
$1,077.91
$1,272.91
$1,264.85
$1,316.67
$1,371.57
$1,566.57
$293.66

Plan: (HMO) Elite Gold Maintenance - PCP Copay $20 with Dental

Summary 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: $1,700 : Family: $3,400
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$547.03
$620.88
$699.10
$976.99
$1,484.63
$1,094.06
$1,241.76
$1,398.20
$1,953.98
$2,969.26
$1,512.54
$1,660.24
$1,816.68
$2,372.46
$1,931.02
$2,078.72
$2,235.16
$2,790.94
$2,349.50
$2,497.20
$2,653.64
$3,209.42
$965.51
$1,039.36
$1,117.58
$1,395.47
$1,383.99
$1,457.84
$1,536.06
$1,813.95
$1,802.47
$1,876.32
$1,954.54
$2,232.43
$418.48

Plan: (HMO) Elite Gold Healthy You - PCP Copay $30 with Dental

Summary 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: $2,900 : Family: $5,800
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$511.81
$580.89
$654.08
$914.08
$1,389.03
$1,023.62
$1,161.78
$1,308.16
$1,828.16
$2,778.06
$1,415.15
$1,553.31
$1,699.69
$2,219.69
$1,806.68
$1,944.84
$2,091.22
$2,611.22
$2,198.21
$2,336.37
$2,482.75
$3,002.75
$903.34
$972.42
$1,045.61
$1,305.61
$1,294.87
$1,363.95
$1,437.14
$1,697.14
$1,686.40
$1,755.48
$1,828.67
$2,088.67
$391.53

Plan: (HMO) Elite Silver 5000 Value - PCP Copay $35 with Dental

Summary 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: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$500.75
$568.35
$639.96
$894.34
$1,359.03
$1,001.50
$1,136.70
$1,279.92
$1,788.68
$2,718.06
$1,384.57
$1,519.77
$1,662.99
$2,171.75
$1,767.64
$1,902.84
$2,046.06
$2,554.82
$2,150.71
$2,285.91
$2,429.13
$2,937.89
$883.82
$951.42
$1,023.03
$1,277.41
$1,266.89
$1,334.49
$1,406.10
$1,660.48
$1,649.96
$1,717.56
$1,789.17
$2,043.55
$383.07

Plan: (HMO) Elite Silver 7100 Value - PCP Copay $75 with Dental

Summary 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: $7,100 : Family: $14,200
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$490.72
$556.96
$627.13
$876.41
$1,331.79
$981.44
$1,113.92
$1,254.26
$1,752.82
$2,663.58
$1,356.83
$1,489.31
$1,629.65
$2,128.21
$1,732.22
$1,864.70
$2,005.04
$2,503.60
$2,107.61
$2,240.09
$2,380.43
$2,878.99
$866.11
$932.35
$1,002.52
$1,251.80
$1,241.50
$1,307.74
$1,377.91
$1,627.19
$1,616.89
$1,683.13
$1,753.30
$2,002.58
$375.39

Plan: (HMO) Elite Gold First $500 with Dental

Summary 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
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
$555.21
$630.16
$709.55
$991.59
$1,506.82
$1,110.42
$1,260.32
$1,419.10
$1,983.18
$3,013.64
$1,535.15
$1,685.05
$1,843.83
$2,407.91
$1,959.88
$2,109.78
$2,268.56
$2,832.64
$2,384.61
$2,534.51
$2,693.29
$3,257.37
$979.94
$1,054.89
$1,134.28
$1,416.32
$1,404.67
$1,479.62
$1,559.01
$1,841.05
$1,829.40
$1,904.35
$1,983.74
$2,265.78
$424.73

Plan: (HMO) Elite Silver 5000 Value - PCP Copay $35

Summary 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: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$480.63
$545.51
$614.24
$858.40
$1,304.43
$961.26
$1,091.02
$1,228.48
$1,716.80
$2,608.86
$1,328.94
$1,458.70
$1,596.16
$2,084.48
$1,696.62
$1,826.38
$1,963.84
$2,452.16
$2,064.30
$2,194.06
$2,331.52
$2,819.84
$848.31
$913.19
$981.92
$1,226.08
$1,215.99
$1,280.87
$1,349.60
$1,593.76
$1,583.67
$1,648.55
$1,717.28
$1,961.44
$367.68

Plan: (HMO) Elite Silver 7100 Value - PCP Copay $75

Summary 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: $7,100 : Family: $14,200
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$471.00
$534.58
$601.93
$841.20
$1,278.28
$942.00
$1,069.16
$1,203.86
$1,682.40
$2,556.56
$1,302.31
$1,429.47
$1,564.17
$2,042.71
$1,662.62
$1,789.78
$1,924.48
$2,403.02
$2,022.93
$2,150.09
$2,284.79
$2,763.33
$831.31
$894.89
$962.24
$1,201.51
$1,191.62
$1,255.20
$1,322.55
$1,561.82
$1,551.93
$1,615.51
$1,682.86
$1,922.13
$360.31

Plan: (HMO) Elite Gold First $500

Summary 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
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
$532.90
$604.84
$681.04
$951.76
$1,446.29
$1,065.80
$1,209.68
$1,362.08
$1,903.52
$2,892.58
$1,473.47
$1,617.35
$1,769.75
$2,311.19
$1,881.14
$2,025.02
$2,177.42
$2,718.86
$2,288.81
$2,432.69
$2,585.09
$3,126.53
$940.57
$1,012.51
$1,088.71
$1,359.43
$1,348.24
$1,420.18
$1,496.38
$1,767.10
$1,755.91
$1,827.85
$1,904.05
$2,174.77
$407.67

Plan: (HMO) Elite Gold Standard - PCP Copay $20

Summary 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: $1,400 : Family: $2,800
Out of Pocket Maximum per year: Individual: $5,000 : Family: $10,000

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$534.64
$606.81
$683.26
$954.86
$1,451.00
$1,069.28
$1,213.62
$1,366.52
$1,909.72
$2,902.00
$1,478.28
$1,622.62
$1,775.52
$2,318.72
$1,887.28
$2,031.62
$2,184.52
$2,727.72
$2,296.28
$2,440.62
$2,593.52
$3,136.72
$943.64
$1,015.81
$1,092.26
$1,363.86
$1,352.64
$1,424.81
$1,501.26
$1,772.86
$1,761.64
$1,833.81
$1,910.26
$2,181.86
$409.00

Plan: (HMO) Elite Silver Standard - PCP Copay $30

Summary 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
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$479.13
$543.80
$612.32
$855.71
$1,300.34
$958.26
$1,087.60
$1,224.64
$1,711.42
$2,600.68
$1,324.79
$1,454.13
$1,591.17
$2,077.95
$1,691.32
$1,820.66
$1,957.70
$2,444.48
$2,057.85
$2,187.19
$2,324.23
$2,811.01
$845.66
$910.33
$978.85
$1,222.24
$1,212.19
$1,276.86
$1,345.38
$1,588.77
$1,578.72
$1,643.39
$1,711.91
$1,955.30
$366.53

Plan: (HMO) Elite Bronze Standard - PCP Copay $35

Summary 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
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Expanded Bronze 21
30
40
50
60
$376.60
$427.44
$481.29
$672.61
$1,022.09
$753.20
$854.88
$962.58
$1,345.22
$2,044.18
$1,041.30
$1,142.98
$1,250.68
$1,633.32
$1,329.40
$1,431.08
$1,538.78
$1,921.42
$1,617.50
$1,719.18
$1,826.88
$2,209.52
$664.70
$715.54
$769.39
$960.71
$952.80
$1,003.64
$1,057.49
$1,248.81
$1,240.90
$1,291.74
$1,345.59
$1,536.91
$288.10

Plan: (HMO) Elite Bronze Deductible $6500

Summary 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: $6,500 : Family: $13,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$368.45
$418.19
$470.88
$658.05
$999.97
$736.90
$836.38
$941.76
$1,316.10
$1,999.94
$1,018.76
$1,118.24
$1,223.62
$1,597.96
$1,300.62
$1,400.10
$1,505.48
$1,879.82
$1,582.48
$1,681.96
$1,787.34
$2,161.68
$650.31
$700.05
$752.74
$939.91
$932.17
$981.91
$1,034.60
$1,221.77
$1,214.03
$1,263.77
$1,316.46
$1,503.63
$281.86

Plan: (HMO) Elite Gold Maintenance - PCP Copay $20

Summary 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: $1,700 : Family: $3,400
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$525.05
$595.93
$671.01
$937.74
$1,424.98
$1,050.10
$1,191.86
$1,342.02
$1,875.48
$2,849.96
$1,451.76
$1,593.52
$1,743.68
$2,277.14
$1,853.42
$1,995.18
$2,145.34
$2,678.80
$2,255.08
$2,396.84
$2,547.00
$3,080.46
$926.71
$997.59
$1,072.67
$1,339.40
$1,328.37
$1,399.25
$1,474.33
$1,741.06
$1,730.03
$1,800.91
$1,875.99
$2,142.72
$401.66

Plan: (HMO) Elite Gold HSA $1800

Summary 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: $1,800 : Family: $3,600
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
$528.83
$600.21
$675.84
$944.48
$1,435.23
$1,057.66
$1,200.42
$1,351.68
$1,888.96
$2,870.46
$1,462.21
$1,604.97
$1,756.23
$2,293.51
$1,866.76
$2,009.52
$2,160.78
$2,698.06
$2,271.31
$2,414.07
$2,565.33
$3,102.61
$933.38
$1,004.76
$1,080.39
$1,349.03
$1,337.93
$1,409.31
$1,484.94
$1,753.58
$1,742.48
$1,813.86
$1,889.49
$2,158.13
$404.55

Plan: (HMO) Elite Silver HSA $3000

Summary 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
Out of Pocket Maximum per year: Individual: $6,600 : Family: $13,200

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
$488.17
$554.07
$623.88
$871.87
$1,324.89
$976.34
$1,108.14
$1,247.76
$1,743.74
$2,649.78
$1,349.79
$1,481.59
$1,621.21
$2,117.19
$1,723.24
$1,855.04
$1,994.66
$2,490.64
$2,096.69
$2,228.49
$2,368.11
$2,864.09
$861.62
$927.52
$997.33
$1,245.32
$1,235.07
$1,300.97
$1,370.78
$1,618.77
$1,608.52
$1,674.42
$1,744.23
$1,992.22
$373.45

Plan: (HMO) Elite Bronze HSA $6550

Summary 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
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$376.08
$426.84
$480.62
$671.66
$1,020.65
$752.16
$853.68
$961.24
$1,343.32
$2,041.30
$1,039.85
$1,141.37
$1,248.93
$1,631.01
$1,327.54
$1,429.06
$1,536.62
$1,918.70
$1,615.23
$1,716.75
$1,824.31
$2,206.39
$663.77
$714.53
$768.31
$959.35
$951.46
$1,002.22
$1,056.00
$1,247.04
$1,239.15
$1,289.91
$1,343.69
$1,534.73
$287.69

Plan: (HMO) Elite Catastrophic

Summary 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: $7,350 : Family: $14,700
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$268.98
$305.29
$343.75
$480.39
$730.00
$537.96
$610.58
$687.50
$960.78
$1,460.00
$743.73
$816.35
$893.27
$1,166.55
$949.50
$1,022.12
$1,099.04
$1,372.32
$1,155.27
$1,227.89
$1,304.81
$1,578.09
$474.75
$511.06
$549.52
$686.16
$680.52
$716.83
$755.29
$891.93
$886.29
$922.60
$961.06
$1,097.70

Plan: (HMO) Elite Bronze HSA $5000

Summary 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: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$380.53
$431.89
$486.31
$679.61
$1,032.74
$761.06
$863.78
$972.62
$1,359.22
$2,065.48
$1,052.16
$1,154.88
$1,263.72
$1,650.32
$1,343.26
$1,445.98
$1,554.82
$1,941.42
$1,634.36
$1,737.08
$1,845.92
$2,232.52
$671.63
$722.99
$777.41
$970.71
$962.73
$1,014.09
$1,068.51
$1,261.81
$1,253.83
$1,305.19
$1,359.61
$1,552.91
$291.10

Plan: (HMO) Elite Bronze Standard HSA $6000

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

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Expanded Bronze 21
30
40
50
60
$384.45
$436.35
$491.32
$686.62
$1,043.39
$768.90
$872.70
$982.64
$1,373.24
$2,086.78
$1,063.00
$1,166.80
$1,276.74
$1,667.34
$1,357.10
$1,460.90
$1,570.84
$1,961.44
$1,651.20
$1,755.00
$1,864.94
$2,255.54
$678.55
$730.45
$785.42
$980.72
$972.65
$1,024.55
$1,079.52
$1,274.82
$1,266.75
$1,318.65
$1,373.62
$1,568.92
$294.10

Plan: (HMO) Elite Silver HSA $5050

Summary 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: $5,050 : Family: $10,100
Out of Pocket Maximum per year: Individual: $5,050 : Family: $10,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$491.19
$557.50
$627.74
$877.26
$1,333.08
$982.38
$1,115.00
$1,255.48
$1,754.52
$2,666.16
$1,358.14
$1,490.76
$1,631.24
$2,130.28
$1,733.90
$1,866.52
$2,007.00
$2,506.04
$2,109.66
$2,242.28
$2,382.76
$2,881.80
$866.95
$933.26
$1,003.50
$1,253.02
$1,242.71
$1,309.02
$1,379.26
$1,628.78
$1,618.47
$1,684.78
$1,755.02
$2,004.54
$375.76
ADVERTISEMENT

Dean Health Plan

Local: 1-608-828-1302 | Toll Free: 1-800-279-1302

TTY: 1-608-827-4086

Plan: (HMO) Dean Catastrophic Safety Net

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)

Deductible: Individual: $7,350 : Family: $14,700
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$209.60
$237.89
$267.87
$374.34
$568.85
$419.20
$475.78
$535.74
$748.68
$1,137.70
$579.54
$636.12
$696.08
$909.02
$739.88
$796.46
$856.42
$1,069.36
$900.22
$956.80
$1,016.76
$1,229.70
$369.94
$398.23
$428.21
$534.68
$530.28
$558.57
$588.55
$695.02
$690.62
$718.91
$748.89
$855.36
$160.34

Plan: (HMO) Dean Silver Copay Plus 3250X

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)

Deductible: Individual: $3,250 : Family: $6,500
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$411.94
$467.55
$526.46
$735.72
$1,118.00
$823.88
$935.10
$1,052.92
$1,471.44
$2,236.00
$1,139.01
$1,250.23
$1,368.05
$1,786.57
$1,454.14
$1,565.36
$1,683.18
$2,101.70
$1,769.27
$1,880.49
$1,998.31
$2,416.83
$727.07
$782.68
$841.59
$1,050.85
$1,042.20
$1,097.81
$1,156.72
$1,365.98
$1,357.33
$1,412.94
$1,471.85
$1,681.11
$315.13

Plan: (HMO) Dean Silver Classic 4750X

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)

Deductible: Individual: $4,750 : Family: $9,500
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$412.96
$468.71
$527.76
$737.55
$1,120.78
$825.92
$937.42
$1,055.52
$1,475.10
$2,241.56
$1,141.84
$1,253.34
$1,371.44
$1,791.02
$1,457.76
$1,569.26
$1,687.36
$2,106.94
$1,773.68
$1,885.18
$2,003.28
$2,422.86
$728.88
$784.63
$843.68
$1,053.47
$1,044.80
$1,100.55
$1,159.60
$1,369.39
$1,360.72
$1,416.47
$1,475.52
$1,685.31
$315.92

Plan: (HMO) Dean Silver Value Copay 5000X

Summary 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
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$431.07
$489.27
$550.91
$769.89
$1,169.93
$862.14
$978.54
$1,101.82
$1,539.78
$2,339.86
$1,191.91
$1,308.31
$1,431.59
$1,869.55
$1,521.68
$1,638.08
$1,761.36
$2,199.32
$1,851.45
$1,967.85
$2,091.13
$2,529.09
$760.84
$819.04
$880.68
$1,099.66
$1,090.61
$1,148.81
$1,210.45
$1,429.43
$1,420.38
$1,478.58
$1,540.22
$1,759.20
$329.77

Plan: (HMO) Dean Gold Value Copay 3500X

Summary 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
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
$364.06
$413.21
$465.27
$650.21
$988.05
$728.12
$826.42
$930.54
$1,300.42
$1,976.10
$1,006.62
$1,104.92
$1,209.04
$1,578.92
$1,285.12
$1,383.42
$1,487.54
$1,857.42
$1,563.62
$1,661.92
$1,766.04
$2,135.92
$642.56
$691.71
$743.77
$928.71
$921.06
$970.21
$1,022.27
$1,207.21
$1,199.56
$1,248.71
$1,300.77
$1,485.71
$278.50

Plan: (HMO) Dean Bronze Value Copay 7350X

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-279-1302 - Provider Directory for This Plan: (Dean Health Plan)

Deductible: Individual: $7,350 : Family: $14,700
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$304.23
$345.30
$388.81
$543.36
$825.69
$608.46
$690.60
$777.62
$1,086.72
$1,651.38
$841.20
$923.34
$1,010.36
$1,319.46
$1,073.94
$1,156.08
$1,243.10
$1,552.20
$1,306.68
$1,388.82
$1,475.84
$1,784.94
$536.97
$578.04
$621.55
$776.10
$769.71
$810.78
$854.29
$1,008.84
$1,002.45
$1,043.52
$1,087.03
$1,241.58
$232.74

Plan: (HMO) Dean Silver HSA-E 3500X

Summary 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
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$434.88
$493.58
$555.77
$776.69
$1,180.25
$869.76
$987.16
$1,111.54
$1,553.38
$2,360.50
$1,202.44
$1,319.84
$1,444.22
$1,886.06
$1,535.12
$1,652.52
$1,776.90
$2,218.74
$1,867.80
$1,985.20
$2,109.58
$2,551.42
$767.56
$826.26
$888.45
$1,109.37
$1,100.24
$1,158.94
$1,221.13
$1,442.05
$1,432.92
$1,491.62
$1,553.81
$1,774.73
$332.68

Plan: (HMO) Dean Gold Copay Plus 1500X

Summary 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
Out of Pocket Maximum per year: 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
Gold 21
30
40
50
60
$373.71
$424.16
$477.60
$667.45
$1,014.25
$747.42
$848.32
$955.20
$1,334.90
$2,028.50
$1,033.31
$1,134.21
$1,241.09
$1,620.79
$1,319.20
$1,420.10
$1,526.98
$1,906.68
$1,605.09
$1,705.99
$1,812.87
$2,192.57
$659.60
$710.05
$763.49
$953.34
$945.49
$995.94
$1,049.38
$1,239.23
$1,231.38
$1,281.83
$1,335.27
$1,525.12
$285.89

Plan: (HMO) Dean Bronze HSA-E 6550X

Summary 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
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$290.92
$330.19
$371.79
$519.57
$789.54
$581.84
$660.38
$743.58
$1,039.14
$1,579.08
$804.39
$882.93
$966.13
$1,261.69
$1,026.94
$1,105.48
$1,188.68
$1,484.24
$1,249.49
$1,328.03
$1,411.23
$1,706.79
$513.47
$552.74
$594.34
$742.12
$736.02
$775.29
$816.89
$964.67
$958.57
$997.84
$1,039.44
$1,187.22
$222.55
ADVERTISEMENT

Common Ground Healthcare Cooperative

Local: 1-877-514-2442 | Toll Free: 1-877-514-2442

TTY: 1-855-643-5001

Plan: (EPO) Envision Aurora Bellin - Gold 2000/80

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Gold 21
30
40
50
60
$502.34
$570.15
$641.98
$897.17
$1,363.33
$1,004.68
$1,140.30
$1,283.96
$1,794.34
$2,726.66
$1,388.96
$1,524.58
$1,668.24
$2,178.62
$1,773.24
$1,908.86
$2,052.52
$2,562.90
$2,157.52
$2,293.14
$2,436.80
$2,947.18
$886.62
$954.43
$1,026.26
$1,281.45
$1,270.90
$1,338.71
$1,410.54
$1,665.73
$1,655.18
$1,722.99
$1,794.82
$2,050.01
$384.28

Plan: (EPO) Envision Aurora Bellin - Silver 4000/75

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$500.04
$567.53
$639.03
$893.05
$1,357.07
$1,000.08
$1,135.06
$1,278.06
$1,786.10
$2,714.14
$1,382.60
$1,517.58
$1,660.58
$2,168.62
$1,765.12
$1,900.10
$2,043.10
$2,551.14
$2,147.64
$2,282.62
$2,425.62
$2,933.66
$882.56
$950.05
$1,021.55
$1,275.57
$1,265.08
$1,332.57
$1,404.07
$1,658.09
$1,647.60
$1,715.09
$1,786.59
$2,040.61
$382.52

Plan: (EPO) Envision Aurora Bellin - Silver 3000/75/Copay40

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $3,000 : Family: $6,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$520.35
$590.59
$664.99
$929.33
$1,412.20
$1,040.70
$1,181.18
$1,329.98
$1,858.66
$2,824.40
$1,438.76
$1,579.24
$1,728.04
$2,256.72
$1,836.82
$1,977.30
$2,126.10
$2,654.78
$2,234.88
$2,375.36
$2,524.16
$3,052.84
$918.41
$988.65
$1,063.05
$1,327.39
$1,316.47
$1,386.71
$1,461.11
$1,725.45
$1,714.53
$1,784.77
$1,859.17
$2,123.51
$398.06

Plan: (EPO) Envision Aurora Bellin - Catastrophic 7350/100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $7,350 : Family: $14,700
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Catastrophic 21
30
40
50
60
$266.67
$302.66
$340.79
$476.25
$723.71
$533.34
$605.32
$681.58
$952.50
$1,447.42
$737.33
$809.31
$885.57
$1,156.49
$941.32
$1,013.30
$1,089.56
$1,360.48
$1,145.31
$1,217.29
$1,293.55
$1,564.47
$470.66
$506.65
$544.78
$680.24
$674.65
$710.64
$748.77
$884.23
$878.64
$914.63
$952.76
$1,088.22
$203.99

Plan: (EPO) Envision Aurora Bellin - Bronze 7350/100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $7,350 : Family: $14,700
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Bronze 21
30
40
50
60
$336.46
$381.87
$429.98
$600.90
$913.13
$672.92
$763.74
$859.96
$1,201.80
$1,826.26
$930.30
$1,021.12
$1,117.34
$1,459.18
$1,187.68
$1,278.50
$1,374.72
$1,716.56
$1,445.06
$1,535.88
$1,632.10
$1,973.94
$593.84
$639.25
$687.36
$858.28
$851.22
$896.63
$944.74
$1,115.66
$1,108.60
$1,154.01
$1,202.12
$1,373.04
$257.38

Plan: (EPO) Envision Aurora Bellin - HSA Silver 3200/75

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $3,200 : Family: $6,400
Out of Pocket Maximum per year: Individual: $6,550 : Family: $13,100

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$542.98
$616.27
$693.92
$969.75
$1,473.62
$1,085.96
$1,232.54
$1,387.84
$1,939.50
$2,947.24
$1,501.33
$1,647.91
$1,803.21
$2,354.87
$1,916.70
$2,063.28
$2,218.58
$2,770.24
$2,332.07
$2,478.65
$2,633.95
$3,185.61
$958.35
$1,031.64
$1,109.29
$1,385.12
$1,373.72
$1,447.01
$1,524.66
$1,800.49
$1,789.09
$1,862.38
$1,940.03
$2,215.86
$415.37

Plan: (EPO) Envision Aurora Bellin - HSA Bronze 6650/100

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: 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
$344.44
$390.93
$440.19
$615.16
$934.79
$688.88
$781.86
$880.38
$1,230.32
$1,869.58
$952.37
$1,045.35
$1,143.87
$1,493.81
$1,215.86
$1,308.84
$1,407.36
$1,757.30
$1,479.35
$1,572.33
$1,670.85
$2,020.79
$607.93
$654.42
$703.68
$878.65
$871.42
$917.91
$967.17
$1,142.14
$1,134.91
$1,181.40
$1,230.66
$1,405.63
$263.49

Plan: (EPO) Envision Aurora Bellin - Silver 5500/80

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-877-514-2442 - Provider Directory for This Plan: (Common Ground Healthcare Cooperative)

Deductible: Individual: $5,500 : Family: $11,000
Out of Pocket Maximum per year: Individual: $7,350 : Family: $14,700

Monthly Premiums:

Metal level Age Individual
Couple
Couple
w 1 Kid
Couple
w 2 Kids
Couple
w3+Kids
Single
w 1 Kid
Single
w 2 Kids
Single
w3+Kids
Child
any age
Silver 21
30
40
50
60
$421.33
$478.20
$538.45
$752.48
$1,143.47
$842.66
$956.40
$1,076.90
$1,504.96
$2,286.94
$1,164.97
$1,278.71
$1,399.21
$1,827.27
$1,487.28
$1,601.02
$1,721.52
$2,149.58
$1,809.59
$1,923.33
$2,043.83
$2,471.89
$743.64
$800.51
$860.76
$1,074.79
$1,065.95
$1,122.82
$1,183.07
$1,397.10
$1,388.26
$1,445.13
$1,505.38
$1,719.41
$322.31

‡Source: HealthCare.gov has released sample rates for all counties in the 36 states served by HealthCare.gov. We have integrated that data into our tables and provide you that information for Fond Du Lac County here.

 

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