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 Walworth County, Wisconsin.
Obamacare Providers, Plans and 2018 Rates for Walworth County
Walworth County is in “Rating Area 14” of Wisconsin.
Currently, there are 49 plans offered in Rating Area 14.
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 Whitewater, WI area accept this insurance coverage as within the plan's "network".
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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) Elite Gold Healthy You - PCP Copay $30 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:
$2,900
: Family:
$5,800 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 |
Gold | 21 30 40 50 60 |
$487.40 $553.20 $622.90 $870.49 $1,322.80 |
$974.80 $1,106.40 $1,245.80 $1,740.98 $2,645.60 |
$1,347.66 $1,479.26 $1,618.66 $2,113.84 |
$1,720.52 $1,852.12 $1,991.52 $2,486.70 |
$2,093.38 $2,224.98 $2,364.38 $2,859.56 |
$860.26 $926.06 $995.76 $1,243.35 |
$1,233.12 $1,298.92 $1,368.62 $1,616.21 |
$1,605.98 $1,671.78 $1,741.48 $1,989.07 |
$372.86 |
Plan: (HMO) Elite Silver 5000 Value - PCP Copay $35 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:
$5,000
: Family:
$10,000 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 |
$476.88 $541.25 $609.44 $851.70 $1,294.23 |
$953.76 $1,082.50 $1,218.88 $1,703.40 $2,588.46 |
$1,318.57 $1,447.31 $1,583.69 $2,068.21 |
$1,683.38 $1,812.12 $1,948.50 $2,433.02 |
$2,048.19 $2,176.93 $2,313.31 $2,797.83 |
$841.69 $906.06 $974.25 $1,216.51 |
$1,206.50 $1,270.87 $1,339.06 $1,581.32 |
$1,571.31 $1,635.68 $1,703.87 $1,946.13 |
$364.81 |
Plan: (HMO) Elite Silver 7100 Value - PCP Copay $75 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:
$7,100
: Family:
$14,200 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 |
$467.32 $530.40 $597.23 $834.62 $1,268.29 |
$934.64 $1,060.80 $1,194.46 $1,669.24 $2,536.58 |
$1,292.14 $1,418.30 $1,551.96 $2,026.74 |
$1,649.64 $1,775.80 $1,909.46 $2,384.24 |
$2,007.14 $2,133.30 $2,266.96 $2,741.74 |
$824.82 $887.90 $954.73 $1,192.12 |
$1,182.32 $1,245.40 $1,312.23 $1,549.62 |
$1,539.82 $1,602.90 $1,669.73 $1,907.12 |
$357.50 |
Plan: (HMO) Elite Gold First $500 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:
$3,500
: 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 |
$528.74 $600.11 $675.72 $944.32 $1,434.98 |
$1,057.48 $1,200.22 $1,351.44 $1,888.64 $2,869.96 |
$1,461.96 $1,604.70 $1,755.92 $2,293.12 |
$1,866.44 $2,009.18 $2,160.40 $2,697.60 |
$2,270.92 $2,413.66 $2,564.88 $3,102.08 |
$933.22 $1,004.59 $1,080.20 $1,348.80 |
$1,337.70 $1,409.07 $1,484.68 $1,753.28 |
$1,742.18 $1,813.55 $1,889.16 $2,157.76 |
$404.48 |
Plan: (HMO) Elite Bronze Deductible $6500 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:
$6,500
: Family:
$13,000 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 |
Bronze | 21 30 40 50 60 |
$365.57 $414.92 $467.20 $652.90 $992.15 |
$731.14 $829.84 $934.40 $1,305.80 $1,984.30 |
$1,010.80 $1,109.50 $1,214.06 $1,585.46 |
$1,290.46 $1,389.16 $1,493.72 $1,865.12 |
$1,570.12 $1,668.82 $1,773.38 $2,144.78 |
$645.23 $694.58 $746.86 $932.56 |
$924.89 $974.24 $1,026.52 $1,212.22 |
$1,204.55 $1,253.90 $1,306.18 $1,491.88 |
$279.66 |
Plan: (HMO) Elite Gold Maintenance - PCP Copay $20 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:
$1,700
: Family:
$3,400 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 |
$520.95 $591.27 $665.77 $930.41 $1,413.85 |
$1,041.90 $1,182.54 $1,331.54 $1,860.82 $2,827.70 |
$1,440.42 $1,581.06 $1,730.06 $2,259.34 |
$1,838.94 $1,979.58 $2,128.58 $2,657.86 |
$2,237.46 $2,378.10 $2,527.10 $3,056.38 |
$919.47 $989.79 $1,064.29 $1,328.93 |
$1,317.99 $1,388.31 $1,462.81 $1,727.45 |
$1,716.51 $1,786.83 $1,861.33 $2,125.97 |
$398.52 |
Plan: (HMO) Elite Gold Healthy You - PCP Copay $30Summary 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 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 |
$467.82 $530.97 $597.87 $835.52 $1,269.66 |
$935.64 $1,061.94 $1,195.74 $1,671.04 $2,539.32 |
$1,293.52 $1,419.82 $1,553.62 $2,028.92 |
$1,651.40 $1,777.70 $1,911.50 $2,386.80 |
$2,009.28 $2,135.58 $2,269.38 $2,744.68 |
$825.70 $888.85 $955.75 $1,193.40 |
$1,183.58 $1,246.73 $1,313.63 $1,551.28 |
$1,541.46 $1,604.61 $1,671.51 $1,909.16 |
$357.88 |
Plan: (HMO) Elite Silver 5000 Value - PCP Copay $35Summary 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 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 |
$457.72 $519.51 $584.96 $817.48 $1,242.24 |
$915.44 $1,039.02 $1,169.92 $1,634.96 $2,484.48 |
$1,265.59 $1,389.17 $1,520.07 $1,985.11 |
$1,615.74 $1,739.32 $1,870.22 $2,335.26 |
$1,965.89 $2,089.47 $2,220.37 $2,685.41 |
$807.87 $869.66 $935.11 $1,167.63 |
$1,158.02 $1,219.81 $1,285.26 $1,517.78 |
$1,508.17 $1,569.96 $1,635.41 $1,867.93 |
$350.15 |
Plan: (HMO) Elite Silver 7100 Value - PCP Copay $75Summary 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 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 |
$448.54 $509.09 $573.23 $801.09 $1,217.34 |
$897.08 $1,018.18 $1,146.46 $1,602.18 $2,434.68 |
$1,240.21 $1,361.31 $1,489.59 $1,945.31 |
$1,583.34 $1,704.44 $1,832.72 $2,288.44 |
$1,926.47 $2,047.57 $2,175.85 $2,631.57 |
$791.67 $852.22 $916.36 $1,144.22 |
$1,134.80 $1,195.35 $1,259.49 $1,487.35 |
$1,477.93 $1,538.48 $1,602.62 $1,830.48 |
$343.13 |
Plan: (HMO) Elite Gold First $500Summary 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 |
Gold | 21 30 40 50 60 |
$507.50 $576.00 $648.57 $906.38 $1,377.33 |
$1,015.00 $1,152.00 $1,297.14 $1,812.76 $2,754.66 |
$1,403.23 $1,540.23 $1,685.37 $2,200.99 |
$1,791.46 $1,928.46 $2,073.60 $2,589.22 |
$2,179.69 $2,316.69 $2,461.83 $2,977.45 |
$895.73 $964.23 $1,036.80 $1,294.61 |
$1,283.96 $1,352.46 $1,425.03 $1,682.84 |
$1,672.19 $1,740.69 $1,813.26 $2,071.07 |
$388.23 |
Plan: (HMO) Elite Gold Standard - PCP Copay $20Summary 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 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 |
$509.15 $577.88 $650.69 $909.33 $1,381.82 |
$1,018.30 $1,155.76 $1,301.38 $1,818.66 $2,763.64 |
$1,407.80 $1,545.26 $1,690.88 $2,208.16 |
$1,797.30 $1,934.76 $2,080.38 $2,597.66 |
$2,186.80 $2,324.26 $2,469.88 $2,987.16 |
$898.65 $967.38 $1,040.19 $1,298.83 |
$1,288.15 $1,356.88 $1,429.69 $1,688.33 |
$1,677.65 $1,746.38 $1,819.19 $2,077.83 |
$389.50 |
Plan: (HMO) Elite Silver Standard - PCP Copay $30Summary 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 |
$456.28 $517.88 $583.12 $814.91 $1,238.34 |
$912.56 $1,035.76 $1,166.24 $1,629.82 $2,476.68 |
$1,261.61 $1,384.81 $1,515.29 $1,978.87 |
$1,610.66 $1,733.86 $1,864.34 $2,327.92 |
$1,959.71 $2,082.91 $2,213.39 $2,676.97 |
$805.33 $866.93 $932.17 $1,163.96 |
$1,154.38 $1,215.98 $1,281.22 $1,513.01 |
$1,503.43 $1,565.03 $1,630.27 $1,862.06 |
$349.05 |
Plan: (HMO) Elite Bronze Standard - PCP Copay $35Summary 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 |
Expanded Bronze | 21 30 40 50 60 |
$358.65 $407.06 $458.35 $640.54 $973.36 |
$717.30 $814.12 $916.70 $1,281.08 $1,946.72 |
$991.66 $1,088.48 $1,191.06 $1,555.44 |
$1,266.02 $1,362.84 $1,465.42 $1,829.80 |
$1,540.38 $1,637.20 $1,739.78 $2,104.16 |
$633.01 $681.42 $732.71 $914.90 |
$907.37 $955.78 $1,007.07 $1,189.26 |
$1,181.73 $1,230.14 $1,281.43 $1,463.62 |
$274.36 |
Plan: (HMO) Elite Bronze Deductible $6500Summary 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 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 |
$350.89 $398.25 $448.43 $626.67 $952.29 |
$701.78 $796.50 $896.86 $1,253.34 $1,904.58 |
$970.20 $1,064.92 $1,165.28 $1,521.76 |
$1,238.62 $1,333.34 $1,433.70 $1,790.18 |
$1,507.04 $1,601.76 $1,702.12 $2,058.60 |
$619.31 $666.67 $716.85 $895.09 |
$887.73 $935.09 $985.27 $1,163.51 |
$1,156.15 $1,203.51 $1,253.69 $1,431.93 |
$268.42 |
Plan: (HMO) Elite Gold Maintenance - PCP Copay $20Summary 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 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 |
$500.02 $567.52 $639.02 $893.03 $1,357.04 |
$1,000.04 $1,135.04 $1,278.04 $1,786.06 $2,714.08 |
$1,382.55 $1,517.55 $1,660.55 $2,168.57 |
$1,765.06 $1,900.06 $2,043.06 $2,551.08 |
$2,147.57 $2,282.57 $2,425.57 $2,933.59 |
$882.53 $950.03 $1,021.53 $1,275.54 |
$1,265.04 $1,332.54 $1,404.04 $1,658.05 |
$1,647.55 $1,715.05 $1,786.55 $2,040.56 |
$382.51 |
Plan: (HMO) Elite Gold HSA $1800Summary 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 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 |
$503.61 $571.60 $643.61 $899.45 $1,366.80 |
$1,007.22 $1,143.20 $1,287.22 $1,798.90 $2,733.60 |
$1,392.48 $1,528.46 $1,672.48 $2,184.16 |
$1,777.74 $1,913.72 $2,057.74 $2,569.42 |
$2,163.00 $2,298.98 $2,443.00 $2,954.68 |
$888.87 $956.86 $1,028.87 $1,284.71 |
$1,274.13 $1,342.12 $1,414.13 $1,669.97 |
$1,659.39 $1,727.38 $1,799.39 $2,055.23 |
$385.26 |
Plan: (HMO) Elite Silver HSA $3000Summary 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: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$464.90 $527.66 $594.14 $830.30 $1,261.72 |
$929.80 $1,055.32 $1,188.28 $1,660.60 $2,523.44 |
$1,285.44 $1,410.96 $1,543.92 $2,016.24 |
$1,641.08 $1,766.60 $1,899.56 $2,371.88 |
$1,996.72 $2,122.24 $2,255.20 $2,727.52 |
$820.54 $883.30 $949.78 $1,185.94 |
$1,176.18 $1,238.94 $1,305.42 $1,541.58 |
$1,531.82 $1,594.58 $1,661.06 $1,897.22 |
$355.64 |
Plan: (HMO) Elite Bronze HSA $6550Summary 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 |
$358.15 $406.49 $457.70 $639.64 $971.99 |
$716.30 $812.98 $915.40 $1,279.28 $1,943.98 |
$990.28 $1,086.96 $1,189.38 $1,553.26 |
$1,264.26 $1,360.94 $1,463.36 $1,827.24 |
$1,538.24 $1,634.92 $1,737.34 $2,101.22 |
$632.13 $680.47 $731.68 $913.62 |
$906.11 $954.45 $1,005.66 $1,187.60 |
$1,180.09 $1,228.43 $1,279.64 $1,461.58 |
$273.98 |
Plan: (HMO) Elite 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:
$7,350
: 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 |
$256.16 $290.73 $327.36 $457.49 $695.20 |
$512.32 $581.46 $654.72 $914.98 $1,390.40 |
$708.28 $777.42 $850.68 $1,110.94 |
$904.24 $973.38 $1,046.64 $1,306.90 |
$1,100.20 $1,169.34 $1,242.60 $1,502.86 |
$452.12 $486.69 $523.32 $653.45 |
$648.08 $682.65 $719.28 $849.41 |
$844.04 $878.61 $915.24 $1,045.37 |
|
Plan: (HMO) Elite Bronze HSA $5000Summary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$362.39 $411.30 $463.12 $647.21 $983.50 |
$724.78 $822.60 $926.24 $1,294.42 $1,967.00 |
$1,002.00 $1,099.82 $1,203.46 $1,571.64 |
$1,279.22 $1,377.04 $1,480.68 $1,848.86 |
$1,556.44 $1,654.26 $1,757.90 $2,126.08 |
$639.61 $688.52 $740.34 $924.43 |
$916.83 $965.74 $1,017.56 $1,201.65 |
$1,194.05 $1,242.96 $1,294.78 $1,478.87 |
$277.22 |
Plan: (HMO) Elite Bronze Standard HSA $6000Summary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$366.12 $415.54 $467.90 $653.89 $993.64 |
$732.24 $831.08 $935.80 $1,307.78 $1,987.28 |
$1,012.32 $1,111.16 $1,215.88 $1,587.86 |
$1,292.40 $1,391.24 $1,495.96 $1,867.94 |
$1,572.48 $1,671.32 $1,776.04 $2,148.02 |
$646.20 $695.62 $747.98 $933.97 |
$926.28 $975.70 $1,028.06 $1,214.05 |
$1,206.36 $1,255.78 $1,308.14 $1,494.13 |
$280.08 |
Plan: (HMO) Elite Silver HSA $5050Summary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$467.77 $530.92 $597.81 $835.43 $1,269.52 |
$935.54 $1,061.84 $1,195.62 $1,670.86 $2,539.04 |
$1,293.38 $1,419.68 $1,553.46 $2,028.70 |
$1,651.22 $1,777.52 $1,911.30 $2,386.54 |
$2,009.06 $2,135.36 $2,269.14 $2,744.38 |
$825.61 $888.76 $955.65 $1,193.27 |
$1,183.45 $1,246.60 $1,313.49 $1,551.11 |
$1,541.29 $1,604.44 $1,671.33 $1,908.95 |
$357.84 |
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:
$7,350
: 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 |
$198.47 $225.27 $253.65 $354.47 $538.65 |
$396.94 $450.54 $507.30 $708.94 $1,077.30 |
$548.77 $602.37 $659.13 $860.77 |
$700.60 $754.20 $810.96 $1,012.60 |
$852.43 $906.03 $962.79 $1,164.43 |
$350.30 $377.10 $405.48 $506.30 |
$502.13 $528.93 $557.31 $658.13 |
$653.96 $680.76 $709.14 $809.96 |
$151.83 |
Plan: (HMO) Dean Silver Copay Plus 3250XSummary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple w 1 Kid |
Couple w 2 Kids |
Couple w3+Kids |
Single w 1 Kid |
Single w 2 Kids |
Single w3+Kids |
Child any age |
Silver | 21 30 40 50 60 |
$390.07 $442.73 $498.51 $696.67 $1,058.66 |
$780.14 $885.46 $997.02 $1,393.34 $2,117.32 |
$1,078.55 $1,183.87 $1,295.43 $1,691.75 |
$1,376.96 $1,482.28 $1,593.84 $1,990.16 |
$1,675.37 $1,780.69 $1,892.25 $2,288.57 |
$688.48 $741.14 $796.92 $995.08 |
$986.89 $1,039.55 $1,095.33 $1,293.49 |
$1,285.30 $1,337.96 $1,393.74 $1,591.90 |
$298.41 |
Plan: (HMO) Dean Silver Classic 4750XSummary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$391.04 $443.83 $499.75 $698.40 $1,061.28 |
$782.08 $887.66 $999.50 $1,396.80 $2,122.56 |
$1,081.23 $1,186.81 $1,298.65 $1,695.95 |
$1,380.38 $1,485.96 $1,597.80 $1,995.10 |
$1,679.53 $1,785.11 $1,896.95 $2,294.25 |
$690.19 $742.98 $798.90 $997.55 |
$989.34 $1,042.13 $1,098.05 $1,296.70 |
$1,288.49 $1,341.28 $1,397.20 $1,595.85 |
$299.15 |
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 |
$408.19 $463.29 $521.66 $729.02 $1,107.82 |
$816.38 $926.58 $1,043.32 $1,458.04 $2,215.64 |
$1,128.64 $1,238.84 $1,355.58 $1,770.30 |
$1,440.90 $1,551.10 $1,667.84 $2,082.56 |
$1,753.16 $1,863.36 $1,980.10 $2,394.82 |
$720.45 $775.55 $833.92 $1,041.28 |
$1,032.71 $1,087.81 $1,146.18 $1,353.54 |
$1,344.97 $1,400.07 $1,458.44 $1,665.80 |
$312.26 |
Plan: (HMO) Dean Gold Value Copay 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 |
Gold | 21 30 40 50 60 |
$344.73 $391.27 $440.57 $615.69 $935.60 |
$689.46 $782.54 $881.14 $1,231.38 $1,871.20 |
$953.18 $1,046.26 $1,144.86 $1,495.10 |
$1,216.90 $1,309.98 $1,408.58 $1,758.82 |
$1,480.62 $1,573.70 $1,672.30 $2,022.54 |
$608.45 $654.99 $704.29 $879.41 |
$872.17 $918.71 $968.01 $1,143.13 |
$1,135.89 $1,182.43 $1,231.73 $1,406.85 |
$263.72 |
Plan: (HMO) Dean Bronze Value Copay 7350XSummary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$288.08 $326.97 $368.17 $514.52 $781.86 |
$576.16 $653.94 $736.34 $1,029.04 $1,563.72 |
$796.54 $874.32 $956.72 $1,249.42 |
$1,016.92 $1,094.70 $1,177.10 $1,469.80 |
$1,237.30 $1,315.08 $1,397.48 $1,690.18 |
$508.46 $547.35 $588.55 $734.90 |
$728.84 $767.73 $808.93 $955.28 |
$949.22 $988.11 $1,029.31 $1,175.66 |
$220.38 |
Plan: (HMO) Dean Silver HSA-E 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 |
$411.79 $467.38 $526.27 $735.46 $1,117.60 |
$823.58 $934.76 $1,052.54 $1,470.92 $2,235.20 |
$1,138.60 $1,249.78 $1,367.56 $1,785.94 |
$1,453.62 $1,564.80 $1,682.58 $2,100.96 |
$1,768.64 $1,879.82 $1,997.60 $2,415.98 |
$726.81 $782.40 $841.29 $1,050.48 |
$1,041.83 $1,097.42 $1,156.31 $1,365.50 |
$1,356.85 $1,412.44 $1,471.33 $1,680.52 |
$315.02 |
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 |
$353.87 $401.65 $452.25 $632.02 $960.41 |
$707.74 $803.30 $904.50 $1,264.04 $1,920.82 |
$978.45 $1,074.01 $1,175.21 $1,534.75 |
$1,249.16 $1,344.72 $1,445.92 $1,805.46 |
$1,519.87 $1,615.43 $1,716.63 $2,076.17 |
$624.58 $672.36 $722.96 $902.73 |
$895.29 $943.07 $993.67 $1,173.44 |
$1,166.00 $1,213.78 $1,264.38 $1,444.15 |
$270.71 |
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 |
$275.47 $312.66 $352.05 $491.99 $747.63 |
$550.94 $625.32 $704.10 $983.98 $1,495.26 |
$761.68 $836.06 $914.84 $1,194.72 |
$972.42 $1,046.80 $1,125.58 $1,405.46 |
$1,183.16 $1,257.54 $1,336.32 $1,616.20 |
$486.21 $523.40 $562.79 $702.73 |
$696.95 $734.14 $773.53 $913.47 |
$907.69 $944.88 $984.27 $1,124.21 |
$210.74 |
ADVERTISEMENT
|
||||||||||
MercyCare HMO, Inc.Local: 1-800-895-2421 | Toll Free: 1-800-895-2421 |
||||||||||
Plan: (HMO) MercyCare HMO Gold Option ASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
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 |
$294.93 $334.75 $376.92 $526.74 $800.44 |
$589.86 $669.50 $753.84 $1,053.48 $1,600.88 |
$815.48 $895.12 $979.46 $1,279.10 |
$1,041.10 $1,120.74 $1,205.08 $1,504.72 |
$1,266.72 $1,346.36 $1,430.70 $1,730.34 |
$520.55 $560.37 $602.54 $752.36 |
$746.17 $785.99 $828.16 $977.98 |
$971.79 $1,011.61 $1,053.78 $1,203.60 |
$225.62 |
Plan: (HMO) MercyCare HMO Silver Option ASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, 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 |
Silver | 21 30 40 50 60 |
$302.80 $343.68 $386.98 $540.80 $821.80 |
$605.60 $687.36 $773.96 $1,081.60 $1,643.60 |
$837.24 $919.00 $1,005.60 $1,313.24 |
$1,068.88 $1,150.64 $1,237.24 $1,544.88 |
$1,300.52 $1,382.28 $1,468.88 $1,776.52 |
$534.44 $575.32 $618.62 $772.44 |
$766.08 $806.96 $850.26 $1,004.08 |
$997.72 $1,038.60 $1,081.90 $1,235.72 |
$231.64 |
Plan: (HMO) MercyCare HMO Bronze Option ASummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, 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 |
$206.49 $234.37 $263.89 $368.79 $560.41 |
$412.98 $468.74 $527.78 $737.58 $1,120.82 |
$570.94 $626.70 $685.74 $895.54 |
$728.90 $784.66 $843.70 $1,053.50 |
$886.86 $942.62 $1,001.66 $1,211.46 |
$364.45 $392.33 $421.85 $526.75 |
$522.41 $550.29 $579.81 $684.71 |
$680.37 $708.25 $737.77 $842.67 |
$157.96 |
Plan: (HMO) MercyCare HMO Gold Option B Simple Choice PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
Deductible: Individual:
$1,400
: Family:
$2,800 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 |
Gold | 21 30 40 50 60 |
$295.76 $335.69 $377.98 $528.23 $802.69 |
$591.52 $671.38 $755.96 $1,056.46 $1,605.38 |
$817.78 $897.64 $982.22 $1,282.72 |
$1,044.04 $1,123.90 $1,208.48 $1,508.98 |
$1,270.30 $1,350.16 $1,434.74 $1,735.24 |
$522.02 $561.95 $604.24 $754.49 |
$748.28 $788.21 $830.50 $980.75 |
$974.54 $1,014.47 $1,056.76 $1,207.01 |
$226.26 |
Plan: (HMO) MercyCare HMO Gold Option CSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, 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 |
Gold | 21 30 40 50 60 |
$303.85 $344.87 $388.32 $542.68 $824.65 |
$607.70 $689.74 $776.64 $1,085.36 $1,649.30 |
$840.15 $922.19 $1,009.09 $1,317.81 |
$1,072.60 $1,154.64 $1,241.54 $1,550.26 |
$1,305.05 $1,387.09 $1,473.99 $1,782.71 |
$536.30 $577.32 $620.77 $775.13 |
$768.75 $809.77 $853.22 $1,007.58 |
$1,001.20 $1,042.22 $1,085.67 $1,240.03 |
$232.45 |
Plan: (HMO) MercyCare HMO Silver Option B Simple Choice PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
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 |
$303.28 $344.22 $387.59 $541.66 $823.10 |
$606.56 $688.44 $775.18 $1,083.32 $1,646.20 |
$838.57 $920.45 $1,007.19 $1,315.33 |
$1,070.58 $1,152.46 $1,239.20 $1,547.34 |
$1,302.59 $1,384.47 $1,471.21 $1,779.35 |
$535.29 $576.23 $619.60 $773.67 |
$767.30 $808.24 $851.61 $1,005.68 |
$999.31 $1,040.25 $1,083.62 $1,237.69 |
$232.01 |
Plan: (HMO) MercyCare HMO Silver Option CSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, 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 |
$300.87 $341.49 $384.51 $537.35 $816.56 |
$601.74 $682.98 $769.02 $1,074.70 $1,633.12 |
$831.91 $913.15 $999.19 $1,304.87 |
$1,062.08 $1,143.32 $1,229.36 $1,535.04 |
$1,292.25 $1,373.49 $1,459.53 $1,765.21 |
$531.04 $571.66 $614.68 $767.52 |
$761.21 $801.83 $844.85 $997.69 |
$991.38 $1,032.00 $1,075.02 $1,227.86 |
$230.17 |
Plan: (HMO) MercyCare HMO Bronze Option B Simple Choice PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
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 |
Expanded Bronze | 21 30 40 50 60 |
$207.46 $235.47 $265.13 $370.52 $563.05 |
$414.92 $470.94 $530.26 $741.04 $1,126.10 |
$573.63 $629.65 $688.97 $899.75 |
$732.34 $788.36 $847.68 $1,058.46 |
$891.05 $947.07 $1,006.39 $1,217.17 |
$366.17 $394.18 $423.84 $529.23 |
$524.88 $552.89 $582.55 $687.94 |
$683.59 $711.60 $741.26 $846.65 |
$158.71 |
Plan: (HMO) MercyCare HMO Bronze Option CSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, 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 |
$195.68 $222.10 $250.08 $349.48 $531.08 |
$391.36 $444.20 $500.16 $698.96 $1,062.16 |
$541.06 $593.90 $649.86 $848.66 |
$690.76 $743.60 $799.56 $998.36 |
$840.46 $893.30 $949.26 $1,148.06 |
$345.38 $371.80 $399.78 $499.18 |
$495.08 $521.50 $549.48 $648.88 |
$644.78 $671.20 $699.18 $798.58 |
$149.70 |
Plan: (HMO) MercyCare HMO Bronze Option D Simple Choice PlanSummary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-895-2421 - Provider Directory for This Plan: (MercyCare HMO, Inc.)
Deductible: 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 |
$205.35 $233.07 $262.44 $366.76 $557.32 |
$410.70 $466.14 $524.88 $733.52 $1,114.64 |
$567.79 $623.23 $681.97 $890.61 |
$724.88 $780.32 $839.06 $1,047.70 |
$881.97 $937.41 $996.15 $1,204.79 |
$362.44 $390.16 $419.53 $523.85 |
$519.53 $547.25 $576.62 $680.94 |
$676.62 $704.34 $733.71 $838.03 |
$157.09 |
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Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 TTY: 1-855-643-5001 |
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Plan: (EPO) Envision Aurora Bellin - Gold 2000/80Summary 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 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 |
$601.22 $682.37 $768.34 $1,073.76 $1,631.68 |
$1,202.44 $1,364.74 $1,536.68 $2,147.52 $3,263.36 |
$1,662.36 $1,824.66 $1,996.60 $2,607.44 |
$2,122.28 $2,284.58 $2,456.52 $3,067.36 |
$2,582.20 $2,744.50 $2,916.44 $3,527.28 |
$1,061.14 $1,142.29 $1,228.26 $1,533.68 |
$1,521.06 $1,602.21 $1,688.18 $1,993.60 |
$1,980.98 $2,062.13 $2,148.10 $2,453.52 |
$459.92 |
Plan: (EPO) Envision Aurora Bellin - Silver 4000/75Summary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$598.46 $679.24 $764.82 $1,068.83 $1,624.19 |
$1,196.92 $1,358.48 $1,529.64 $2,137.66 $3,248.38 |
$1,654.73 $1,816.29 $1,987.45 $2,595.47 |
$2,112.54 $2,274.10 $2,445.26 $3,053.28 |
$2,570.35 $2,731.91 $2,903.07 $3,511.09 |
$1,056.27 $1,137.05 $1,222.63 $1,526.64 |
$1,514.08 $1,594.86 $1,680.44 $1,984.45 |
$1,971.89 $2,052.67 $2,138.25 $2,442.26 |
$457.81 |
Plan: (EPO) Envision Aurora Bellin - Silver 3000/75/Copay40Summary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$622.77 $706.83 $795.89 $1,112.25 $1,690.17 |
$1,245.54 $1,413.66 $1,591.78 $2,224.50 $3,380.34 |
$1,721.95 $1,890.07 $2,068.19 $2,700.91 |
$2,198.36 $2,366.48 $2,544.60 $3,177.32 |
$2,674.77 $2,842.89 $3,021.01 $3,653.73 |
$1,099.18 $1,183.24 $1,272.30 $1,588.66 |
$1,575.59 $1,659.65 $1,748.71 $2,065.07 |
$2,052.00 $2,136.06 $2,225.12 $2,541.48 |
$476.41 |
Plan: (EPO) Envision Aurora Bellin - Catastrophic 7350/100Summary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$319.16 $362.23 $407.87 $569.99 $866.16 |
$638.32 $724.46 $815.74 $1,139.98 $1,732.32 |
$882.47 $968.61 $1,059.89 $1,384.13 |
$1,126.62 $1,212.76 $1,304.04 $1,628.28 |
$1,370.77 $1,456.91 $1,548.19 $1,872.43 |
$563.31 $606.38 $652.02 $814.14 |
$807.46 $850.53 $896.17 $1,058.29 |
$1,051.61 $1,094.68 $1,140.32 $1,302.44 |
$244.15 |
Plan: (EPO) Envision Aurora Bellin - Bronze 7350/100Summary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$402.68 $457.04 $514.62 $719.18 $1,092.86 |
$805.36 $914.08 $1,029.24 $1,438.36 $2,185.72 |
$1,113.41 $1,222.13 $1,337.29 $1,746.41 |
$1,421.46 $1,530.18 $1,645.34 $2,054.46 |
$1,729.51 $1,838.23 $1,953.39 $2,362.51 |
$710.73 $765.09 $822.67 $1,027.23 |
$1,018.78 $1,073.14 $1,130.72 $1,335.28 |
$1,326.83 $1,381.19 $1,438.77 $1,643.33 |
$308.05 |
Plan: (EPO) Envision Aurora Bellin - HSA Silver 3200/75Summary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$649.85 $737.57 $830.50 $1,160.62 $1,763.68 |
$1,299.70 $1,475.14 $1,661.00 $2,321.24 $3,527.36 |
$1,796.83 $1,972.27 $2,158.13 $2,818.37 |
$2,293.96 $2,469.40 $2,655.26 $3,315.50 |
$2,791.09 $2,966.53 $3,152.39 $3,812.63 |
$1,146.98 $1,234.70 $1,327.63 $1,657.75 |
$1,644.11 $1,731.83 $1,824.76 $2,154.88 |
$2,141.24 $2,228.96 $2,321.89 $2,652.01 |
$497.13 |
Plan: (EPO) Envision Aurora Bellin - HSA Bronze 6650/100Summary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$412.24 $467.88 $526.83 $736.24 $1,118.79 |
$824.48 $935.76 $1,053.66 $1,472.48 $2,237.58 |
$1,139.83 $1,251.11 $1,369.01 $1,787.83 |
$1,455.18 $1,566.46 $1,684.36 $2,103.18 |
$1,770.53 $1,881.81 $1,999.71 $2,418.53 |
$727.59 $783.23 $842.18 $1,051.59 |
$1,042.94 $1,098.58 $1,157.53 $1,366.94 |
$1,358.29 $1,413.93 $1,472.88 $1,682.29 |
$315.35 |
Plan: (EPO) Envision Aurora Bellin - Silver 5500/80Summary 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 Monthly Premiums: |
||||||||||
Metal level | Age | Individual |
Couple |
Couple 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 |
$504.26 $572.33 $644.44 $900.60 $1,368.54 |
$1,008.52 $1,144.66 $1,288.88 $1,801.20 $2,737.08 |
$1,394.27 $1,530.41 $1,674.63 $2,186.95 |
$1,780.02 $1,916.16 $2,060.38 $2,572.70 |
$2,165.77 $2,301.91 $2,446.13 $2,958.45 |
$890.01 $958.08 $1,030.19 $1,286.35 |
$1,275.76 $1,343.83 $1,415.94 $1,672.10 |
$1,661.51 $1,729.58 $1,801.69 $2,057.85 |
$385.75 |
‡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 Walworth County here.