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Providers for Zip Code 53188

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ObamacareByZipCode.com

Obamacare 2018 Marketplace Rates For Waukesha County, Wisconsin

Wednesday, April 24th, 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 Waukesha County, Wisconsin.

Obamacare Providers, Plans and 2018 Rates for Waukesha County

Waukesha County is in “Rating Area 12” of Wisconsin.

Currently, there are 53 plans offered in Rating Area 12.

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 Waukesha, WI area accept this insurance coverage as within the plan's "network".
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Children's Community Health Plan

Local: 1-844-201-4672 | Toll Free: 1-844-201-4672

TTY: 1-844-531-4856

Plan: (EPO) Together Bronze HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan )

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		 $364.22
$413.38
$465.46
$650.47
$988.46		 $728.44
$826.76
$930.92
$1,300.94
$1,976.92		 $1,007.06
$1,105.38
$1,209.54
$1,579.56		 $1,285.68
$1,384.00
$1,488.16
$1,858.18		 $1,564.30
$1,662.62
$1,766.78
$2,136.80		 $642.84
$692.00
$744.08
$929.09		 $921.46
$970.62
$1,022.70
$1,207.71		 $1,200.08
$1,249.24
$1,301.32
$1,486.33		 $278.62
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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) ProHealth 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		 $354.57
$402.43
$453.13
$633.25
$962.28		 $709.14
$804.86
$906.26
$1,266.50
$1,924.56		 $980.38
$1,076.10
$1,177.50
$1,537.74		 $1,251.62
$1,347.34
$1,448.74
$1,808.98		 $1,522.86
$1,618.58
$1,719.98
$2,080.22		 $625.81
$673.67
$724.37
$904.49		 $897.05
$944.91
$995.61
$1,175.73		 $1,168.29
$1,216.15
$1,266.85
$1,446.97		 $271.24

Plan: (HMO) ProHealth 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		 $346.89
$393.72
$443.32
$619.54
$941.45		 $693.78
$787.44
$886.64
$1,239.08
$1,882.90		 $959.15
$1,052.81
$1,152.01
$1,504.45		 $1,224.52
$1,318.18
$1,417.38
$1,769.82		 $1,489.89
$1,583.55
$1,682.75
$2,035.19		 $612.26
$659.09
$708.69
$884.91		 $877.63
$924.46
$974.06
$1,150.28		 $1,143.00
$1,189.83
$1,239.43
$1,415.65		 $265.37
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Children's Community Health Plan

Local: 1-844-201-4672 | Toll Free: 1-844-201-4672

TTY: 1-844-531-4856

Plan: (EPO) Together Bronze

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan )

Deductible: Individual: $6,250 : Family: $12,500
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
Bronze 21
30
40
50
60		 $344.12
$390.57
$439.78
$614.59
$933.92		 $688.24
$781.14
$879.56
$1,229.18
$1,867.84		 $951.49
$1,044.39
$1,142.81
$1,492.43		 $1,214.74
$1,307.64
$1,406.06
$1,755.68		 $1,477.99
$1,570.89
$1,669.31
$2,018.93		 $607.37
$653.82
$703.03
$877.84		 $870.62
$917.07
$966.28
$1,141.09		 $1,133.87
$1,180.32
$1,229.53
$1,404.34		 $263.25

Plan: (EPO) Together Standard Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan )

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		 $502.37
$570.17
$642.01
$897.21
$1,363.39		 $1,004.74
$1,140.34
$1,284.02
$1,794.42
$2,726.78		 $1,389.04
$1,524.64
$1,668.32
$2,178.72		 $1,773.34
$1,908.94
$2,052.62
$2,563.02		 $2,157.64
$2,293.24
$2,436.92
$2,947.32		 $886.67
$954.47
$1,026.31
$1,281.51		 $1,270.97
$1,338.77
$1,410.61
$1,665.81		 $1,655.27
$1,723.07
$1,794.91
$2,050.11		 $384.30

Plan: (EPO) Together Silver

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan )

Deductible: Individual: $4,250 : Family: $8,500
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		 $435.05
$493.77
$555.98
$776.98
$1,180.70		 $870.10
$987.54
$1,111.96
$1,553.96
$2,361.40		 $1,202.91
$1,320.35
$1,444.77
$1,886.77		 $1,535.72
$1,653.16
$1,777.58
$2,219.58		 $1,868.53
$1,985.97
$2,110.39
$2,552.39		 $767.86
$826.58
$888.79
$1,109.79		 $1,100.67
$1,159.39
$1,221.60
$1,442.60		 $1,433.48
$1,492.20
$1,554.41
$1,775.41		 $332.81

Plan: (EPO) Together Gold

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan )

Deductible: Individual: $1,000 : Family: $2,000
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
Gold 21
30
40
50
60		 $528.49
$599.82
$675.39
$943.86
$1,434.29		 $1,056.98
$1,199.64
$1,350.78
$1,887.72
$2,868.58		 $1,461.27
$1,603.93
$1,755.07
$2,292.01		 $1,865.56
$2,008.22
$2,159.36
$2,696.30		 $2,269.85
$2,412.51
$2,563.65
$3,100.59		 $932.78
$1,004.11
$1,079.68
$1,348.15		 $1,337.07
$1,408.40
$1,483.97
$1,752.44		 $1,741.36
$1,812.69
$1,888.26
$2,156.73		 $404.29

Plan: (EPO) Together Silver HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan )

Deductible: Individual: $4,000 : Family: $8,000
Out of Pocket Maximum per year: Individual: $5,700 : Family: $11,400

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $490.81
$557.06
$627.24
$876.57
$1,332.03		 $981.62
$1,114.12
$1,254.48
$1,753.14
$2,664.06		 $1,357.08
$1,489.58
$1,629.94
$2,128.60		 $1,732.54
$1,865.04
$2,005.40
$2,504.06		 $2,108.00
$2,240.50
$2,380.86
$2,879.52		 $866.27
$932.52
$1,002.70
$1,252.03		 $1,241.73
$1,307.98
$1,378.16
$1,627.49		 $1,617.19
$1,683.44
$1,753.62
$2,002.95		 $375.46

Plan: (EPO) Together Silver Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community Health Plan )

Deductible: Individual: $2,500 : Family: $5,000
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		 $499.85
$567.32
$638.80
$892.72
$1,356.58		 $999.70
$1,134.64
$1,277.60
$1,785.44
$2,713.16		 $1,382.08
$1,517.02
$1,659.98
$2,167.82		 $1,764.46
$1,899.40
$2,042.36
$2,550.20		 $2,146.84
$2,281.78
$2,424.74
$2,932.58		 $882.23
$949.70
$1,021.18
$1,275.10		 $1,264.61
$1,332.08
$1,403.56
$1,657.48		 $1,646.99
$1,714.46
$1,785.94
$2,039.86		 $382.38

Plan: (EPO) Together Catastrophic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-844-201-4672 - Provider Directory for This Plan: (Children's Community 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		 $285.35
$323.86
$364.66
$509.61
$774.41		 $570.70
$647.72
$729.32
$1,019.22
$1,548.82		 $788.98
$866.00
$947.60
$1,237.50		 $1,007.26
$1,084.28
$1,165.88
$1,455.78		 $1,225.54
$1,302.56
$1,384.16
$1,674.06		 $503.63
$542.14
$582.94
$727.89		 $721.91
$760.42
$801.22
$946.17		 $940.19
$978.70
$1,019.50
$1,164.45		 $218.28
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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) ProHealth 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		 $481.86
$546.90
$615.81
$860.59
$1,307.75		 $963.72
$1,093.80
$1,231.62
$1,721.18
$2,615.50		 $1,332.34
$1,462.42
$1,600.24
$2,089.80		 $1,700.96
$1,831.04
$1,968.86
$2,458.42		 $2,069.58
$2,199.66
$2,337.48
$2,827.04		 $850.48
$915.52
$984.43
$1,229.21		 $1,219.10
$1,284.14
$1,353.05
$1,597.83		 $1,587.72
$1,652.76
$1,721.67
$1,966.45		 $368.62

Plan: (HMO) ProHealth 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		 $522.72
$593.28
$668.03
$933.57
$1,418.65		 $1,045.44
$1,186.56
$1,336.06
$1,867.14
$2,837.30		 $1,445.32
$1,586.44
$1,735.94
$2,267.02		 $1,845.20
$1,986.32
$2,135.82
$2,666.90		 $2,245.08
$2,386.20
$2,535.70
$3,066.78		 $922.60
$993.16
$1,067.91
$1,333.45		 $1,322.48
$1,393.04
$1,467.79
$1,733.33		 $1,722.36
$1,792.92
$1,867.67
$2,133.21		 $399.88

Plan: (HMO) ProHealth 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		 $471.45
$535.09
$602.51
$842.00
$1,279.51		 $942.90
$1,070.18
$1,205.02
$1,684.00
$2,559.02		 $1,303.56
$1,430.84
$1,565.68
$2,044.66		 $1,664.22
$1,791.50
$1,926.34
$2,405.32		 $2,024.88
$2,152.16
$2,287.00
$2,765.98		 $832.11
$895.75
$963.17
$1,202.66		 $1,192.77
$1,256.41
$1,323.83
$1,563.32		 $1,553.43
$1,617.07
$1,684.49
$1,923.98		 $360.66

Plan: (HMO) ProHealth 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		 $462.00
$524.37
$590.43
$825.12
$1,253.86		 $924.00
$1,048.74
$1,180.86
$1,650.24
$2,507.72		 $1,277.43
$1,402.17
$1,534.29
$2,003.67		 $1,630.86
$1,755.60
$1,887.72
$2,357.10		 $1,984.29
$2,109.03
$2,241.15
$2,710.53		 $815.43
$877.80
$943.86
$1,178.55		 $1,168.86
$1,231.23
$1,297.29
$1,531.98		 $1,522.29
$1,584.66
$1,650.72
$1,885.41		 $353.43

Plan: (HMO) ProHealth 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		 $361.41
$410.20
$461.88
$645.47
$980.86		 $722.82
$820.40
$923.76
$1,290.94
$1,961.72		 $999.30
$1,096.88
$1,200.24
$1,567.42		 $1,275.78
$1,373.36
$1,476.72
$1,843.90		 $1,552.26
$1,649.84
$1,753.20
$2,120.38		 $637.89
$686.68
$738.36
$921.95		 $914.37
$963.16
$1,014.84
$1,198.43		 $1,190.85
$1,239.64
$1,291.32
$1,474.91		 $276.48

Plan: (HMO) ProHealth 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		 $515.02
$584.54
$658.19
$919.82
$1,397.76		 $1,030.04
$1,169.08
$1,316.38
$1,839.64
$2,795.52		 $1,424.03
$1,563.07
$1,710.37
$2,233.63		 $1,818.02
$1,957.06
$2,104.36
$2,627.62		 $2,212.01
$2,351.05
$2,498.35
$3,021.61		 $909.01
$978.53
$1,052.18
$1,313.81		 $1,303.00
$1,372.52
$1,446.17
$1,707.80		 $1,696.99
$1,766.51
$1,840.16
$2,101.79		 $393.99

Plan: (HMO) ProHealth 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		 $462.50
$524.93
$591.07
$826.01
$1,255.21		 $925.00
$1,049.86
$1,182.14
$1,652.02
$2,510.42		 $1,278.81
$1,403.67
$1,535.95
$2,005.83		 $1,632.62
$1,757.48
$1,889.76
$2,359.64		 $1,986.43
$2,111.29
$2,243.57
$2,713.45		 $816.31
$878.74
$944.88
$1,179.82		 $1,170.12
$1,232.55
$1,298.69
$1,533.63		 $1,523.93
$1,586.36
$1,652.50
$1,887.44		 $353.81

Plan: (HMO) ProHealth 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		 $494.33
$561.06
$631.75
$882.87
$1,341.60		 $988.66
$1,122.12
$1,263.50
$1,765.74
$2,683.20		 $1,366.82
$1,500.28
$1,641.66
$2,143.90		 $1,744.98
$1,878.44
$2,019.82
$2,522.06		 $2,123.14
$2,256.60
$2,397.98
$2,900.22		 $872.49
$939.22
$1,009.91
$1,261.03		 $1,250.65
$1,317.38
$1,388.07
$1,639.19		 $1,628.81
$1,695.54
$1,766.23
$2,017.35		 $378.16

Plan: (HMO) ProHealth 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		 $452.51
$513.59
$578.30
$808.18
$1,228.10		 $905.02
$1,027.18
$1,156.60
$1,616.36
$2,456.20		 $1,251.19
$1,373.35
$1,502.77
$1,962.53		 $1,597.36
$1,719.52
$1,848.94
$2,308.70		 $1,943.53
$2,065.69
$2,195.11
$2,654.87		 $798.68
$859.76
$924.47
$1,154.35		 $1,144.85
$1,205.93
$1,270.64
$1,500.52		 $1,491.02
$1,552.10
$1,616.81
$1,846.69		 $346.17

Plan: (HMO) ProHealth 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		 $443.44
$503.30
$566.71
$791.97
$1,203.48		 $886.88
$1,006.60
$1,133.42
$1,583.94
$2,406.96		 $1,226.11
$1,345.83
$1,472.65
$1,923.17		 $1,565.34
$1,685.06
$1,811.88
$2,262.40		 $1,904.57
$2,024.29
$2,151.11
$2,601.63		 $782.67
$842.53
$905.94
$1,131.20		 $1,121.90
$1,181.76
$1,245.17
$1,470.43		 $1,461.13
$1,520.99
$1,584.40
$1,809.66		 $339.23

Plan: (HMO) ProHealth 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		 $501.72
$569.45
$641.19
$896.06
$1,361.66		 $1,003.44
$1,138.90
$1,282.38
$1,792.12
$2,723.32		 $1,387.25
$1,522.71
$1,666.19
$2,175.93		 $1,771.06
$1,906.52
$2,050.00
$2,559.74		 $2,154.87
$2,290.33
$2,433.81
$2,943.55		 $885.53
$953.26
$1,025.00
$1,279.87		 $1,269.34
$1,337.07
$1,408.81
$1,663.68		 $1,653.15
$1,720.88
$1,792.62
$2,047.49		 $383.81

Plan: (HMO) ProHealth 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		 $503.35
$571.30
$643.28
$898.98
$1,366.09		 $1,006.70
$1,142.60
$1,286.56
$1,797.96
$2,732.18		 $1,391.76
$1,527.66
$1,671.62
$2,183.02		 $1,776.82
$1,912.72
$2,056.68
$2,568.08		 $2,161.88
$2,297.78
$2,441.74
$2,953.14		 $888.41
$956.36
$1,028.34
$1,284.04		 $1,273.47
$1,341.42
$1,413.40
$1,669.10		 $1,658.53
$1,726.48
$1,798.46
$2,054.16		 $385.06

Plan: (HMO) ProHealth 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		 $451.09
$511.98
$576.49
$805.64
$1,224.25		 $902.18
$1,023.96
$1,152.98
$1,611.28
$2,448.50		 $1,247.26
$1,369.04
$1,498.06
$1,956.36		 $1,592.34
$1,714.12
$1,843.14
$2,301.44		 $1,937.42
$2,059.20
$2,188.22
$2,646.52		 $796.17
$857.06
$921.57
$1,150.72		 $1,141.25
$1,202.14
$1,266.65
$1,495.80		 $1,486.33
$1,547.22
$1,611.73
$1,840.88		 $345.08

Plan: (HMO) ProHealth 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		 $497.88
$565.09
$636.29
$889.21
$1,351.24		 $995.76
$1,130.18
$1,272.58
$1,778.42
$2,702.48		 $1,376.64
$1,511.06
$1,653.46
$2,159.30		 $1,757.52
$1,891.94
$2,034.34
$2,540.18		 $2,138.40
$2,272.82
$2,415.22
$2,921.06		 $878.76
$945.97
$1,017.17
$1,270.09		 $1,259.64
$1,326.85
$1,398.05
$1,650.97		 $1,640.52
$1,707.73
$1,778.93
$2,031.85		 $380.88

Plan: (HMO) ProHealth 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		 $459.61
$521.65
$587.37
$820.85
$1,247.37		 $919.22
$1,043.30
$1,174.74
$1,641.70
$2,494.74		 $1,270.82
$1,394.90
$1,526.34
$1,993.30		 $1,622.42
$1,746.50
$1,877.94
$2,344.90		 $1,974.02
$2,098.10
$2,229.54
$2,696.50		 $811.21
$873.25
$938.97
$1,172.45		 $1,162.81
$1,224.85
$1,290.57
$1,524.05		 $1,514.41
$1,576.45
$1,642.17
$1,875.65		 $351.60

Plan: (HMO) ProHealth 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		 $354.07
$401.86
$452.49
$632.36
$960.93		 $708.14
$803.72
$904.98
$1,264.72
$1,921.86		 $979.00
$1,074.58
$1,175.84
$1,535.58		 $1,249.86
$1,345.44
$1,446.70
$1,806.44		 $1,520.72
$1,616.30
$1,717.56
$2,077.30		 $624.93
$672.72
$723.35
$903.22		 $895.79
$943.58
$994.21
$1,174.08		 $1,166.65
$1,214.44
$1,265.07
$1,444.94		 $270.86

Plan: (HMO) ProHealth 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		 $253.24
$287.43
$323.64
$452.28
$687.29		 $506.48
$574.86
$647.28
$904.56
$1,374.58		 $700.21
$768.59
$841.01
$1,098.29		 $893.94
$962.32
$1,034.74
$1,292.02		 $1,087.67
$1,156.05
$1,228.47
$1,485.75		 $446.97
$481.16
$517.37
$646.01		 $640.70
$674.89
$711.10
$839.74		 $834.43
$868.62
$904.83
$1,033.47

Plan: (HMO) ProHealth 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		 $358.26
$406.62
$457.85
$639.85
$972.31		 $716.52
$813.24
$915.70
$1,279.70
$1,944.62		 $990.59
$1,087.31
$1,189.77
$1,553.77		 $1,264.66
$1,361.38
$1,463.84
$1,827.84		 $1,538.73
$1,635.45
$1,737.91
$2,101.91		 $632.33
$680.69
$731.92
$913.92		 $906.40
$954.76
$1,005.99
$1,187.99		 $1,180.47
$1,228.83
$1,280.06
$1,462.06		 $274.07

Plan: (HMO) ProHealth 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		 $361.96
$410.82
$462.57
$646.45
$982.34		 $723.92
$821.64
$925.14
$1,292.90
$1,964.68		 $1,000.81
$1,098.53
$1,202.03
$1,569.79		 $1,277.70
$1,375.42
$1,478.92
$1,846.68		 $1,554.59
$1,652.31
$1,755.81
$2,123.57		 $638.85
$687.71
$739.46
$923.34		 $915.74
$964.60
$1,016.35
$1,200.23		 $1,192.63
$1,241.49
$1,293.24
$1,477.12		 $276.89

Plan: (HMO) ProHealth 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		 $462.45
$524.87
$591.00
$825.92
$1,255.07		 $924.90
$1,049.74
$1,182.00
$1,651.84
$2,510.14		 $1,278.67
$1,403.51
$1,535.77
$2,005.61		 $1,632.44
$1,757.28
$1,889.54
$2,359.38		 $1,986.21
$2,111.05
$2,243.31
$2,713.15		 $816.22
$878.64
$944.77
$1,179.69		 $1,169.99
$1,232.41
$1,298.54
$1,533.46		 $1,523.76
$1,586.18
$1,652.31
$1,887.23		 $353.77
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		 $258.27
$293.14
$330.07
$461.27
$700.95		 $516.54
$586.28
$660.14
$922.54
$1,401.90		 $714.12
$783.86
$857.72
$1,120.12		 $911.70
$981.44
$1,055.30
$1,317.70		 $1,109.28
$1,179.02
$1,252.88
$1,515.28		 $455.85
$490.72
$527.65
$658.85		 $653.43
$688.30
$725.23
$856.43		 $851.01
$885.88
$922.81
$1,054.01		 $197.58

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		 $507.60
$576.12
$648.71
$906.57
$1,377.62		 $1,015.20
$1,152.24
$1,297.42
$1,813.14
$2,755.24		 $1,403.51
$1,540.55
$1,685.73
$2,201.45		 $1,791.82
$1,928.86
$2,074.04
$2,589.76		 $2,180.13
$2,317.17
$2,462.35
$2,978.07		 $895.91
$964.43
$1,037.02
$1,294.88		 $1,284.22
$1,352.74
$1,425.33
$1,683.19		 $1,672.53
$1,741.05
$1,813.64
$2,071.50		 $388.31

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		 $508.86
$577.55
$650.32
$908.82
$1,381.04		 $1,017.72
$1,155.10
$1,300.64
$1,817.64
$2,762.08		 $1,407.00
$1,544.38
$1,689.92
$2,206.92		 $1,796.28
$1,933.66
$2,079.20
$2,596.20		 $2,185.56
$2,322.94
$2,468.48
$2,985.48		 $898.14
$966.83
$1,039.60
$1,298.10		 $1,287.42
$1,356.11
$1,428.88
$1,687.38		 $1,676.70
$1,745.39
$1,818.16
$2,076.66		 $389.28

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		 $531.17
$602.88
$678.84
$948.67
$1,441.60		 $1,062.34
$1,205.76
$1,357.68
$1,897.34
$2,883.20		 $1,468.69
$1,612.11
$1,764.03
$2,303.69		 $1,875.04
$2,018.46
$2,170.38
$2,710.04		 $2,281.39
$2,424.81
$2,576.73
$3,116.39		 $937.52
$1,009.23
$1,085.19
$1,355.02		 $1,343.87
$1,415.58
$1,491.54
$1,761.37		 $1,750.22
$1,821.93
$1,897.89
$2,167.72		 $406.35

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		 $448.60
$509.16
$573.31
$801.20
$1,217.50		 $897.20
$1,018.32
$1,146.62
$1,602.40
$2,435.00		 $1,240.38
$1,361.50
$1,489.80
$1,945.58		 $1,583.56
$1,704.68
$1,832.98
$2,288.76		 $1,926.74
$2,047.86
$2,176.16
$2,631.94		 $791.78
$852.34
$916.49
$1,144.38		 $1,134.96
$1,195.52
$1,259.67
$1,487.56		 $1,478.14
$1,538.70
$1,602.85
$1,830.74		 $343.18

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		 $374.88
$425.49
$479.10
$669.54
$1,017.43		 $749.76
$850.98
$958.20
$1,339.08
$2,034.86		 $1,036.54
$1,137.76
$1,244.98
$1,625.86		 $1,323.32
$1,424.54
$1,531.76
$1,912.64		 $1,610.10
$1,711.32
$1,818.54
$2,199.42		 $661.66
$712.27
$765.88
$956.32		 $948.44
$999.05
$1,052.66
$1,243.10		 $1,235.22
$1,285.83
$1,339.44
$1,529.88		 $286.78

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		 $535.86
$608.20
$684.83
$957.05
$1,454.33		 $1,071.72
$1,216.40
$1,369.66
$1,914.10
$2,908.66		 $1,481.65
$1,626.33
$1,779.59
$2,324.03		 $1,891.58
$2,036.26
$2,189.52
$2,733.96		 $2,301.51
$2,446.19
$2,599.45
$3,143.89		 $945.79
$1,018.13
$1,094.76
$1,366.98		 $1,355.72
$1,428.06
$1,504.69
$1,776.91		 $1,765.65
$1,837.99
$1,914.62
$2,186.84		 $409.93

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		 $460.49
$522.66
$588.51
$822.44
$1,249.78		 $920.98
$1,045.32
$1,177.02
$1,644.88
$2,499.56		 $1,273.26
$1,397.60
$1,529.30
$1,997.16		 $1,625.54
$1,749.88
$1,881.58
$2,349.44		 $1,977.82
$2,102.16
$2,233.86
$2,701.72		 $812.77
$874.94
$940.79
$1,174.72		 $1,165.05
$1,227.22
$1,293.07
$1,527.00		 $1,517.33
$1,579.50
$1,645.35
$1,879.28		 $352.28

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		 $358.47
$406.86
$458.13
$640.23
$972.89		 $716.94
$813.72
$916.26
$1,280.46
$1,945.78		 $991.17
$1,087.95
$1,190.49
$1,554.69		 $1,265.40
$1,362.18
$1,464.72
$1,828.92		 $1,539.63
$1,636.41
$1,738.95
$2,103.15		 $632.70
$681.09
$732.36
$914.46		 $906.93
$955.32
$1,006.59
$1,188.69		 $1,181.16
$1,229.55
$1,280.82
$1,462.92		 $274.23
ADVERTISEMENT

Network Health Plan

Local: 1-920-720-1400 x1400 | Toll Free: 1-855-275-1400

TTY: 1-800-947-3529

Plan: (HMO) Prestige Silver 0

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

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		 $558.44
$633.83
$713.69
$997.37
$1,515.61		 $1,116.88
$1,267.66
$1,427.38
$1,994.74
$3,031.22		 $1,544.09
$1,694.87
$1,854.59
$2,421.95		 $1,971.30
$2,122.08
$2,281.80
$2,849.16		 $2,398.51
$2,549.29
$2,709.01
$3,276.37		 $985.65
$1,061.04
$1,140.90
$1,424.58		 $1,412.86
$1,488.25
$1,568.11
$1,851.79		 $1,840.07
$1,915.46
$1,995.32
$2,279.00		 $427.21

Plan: (HMO) Prestige Bronze 20 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $5,500 : Family: $11,000
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		 $411.20
$466.71
$525.51
$734.40
$1,115.99		 $822.40
$933.42
$1,051.02
$1,468.80
$2,231.98		 $1,136.97
$1,247.99
$1,365.59
$1,783.37		 $1,451.54
$1,562.56
$1,680.16
$2,097.94		 $1,766.11
$1,877.13
$1,994.73
$2,412.51		 $725.77
$781.28
$840.08
$1,048.97		 $1,040.34
$1,095.85
$1,154.65
$1,363.54		 $1,354.91
$1,410.42
$1,469.22
$1,678.11		 $314.57

Plan: (HMO) Prestige Silver 20 HDHP

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $2,700 : Family: $5,400
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
Silver 21
30
40
50
60		 $548.71
$622.79
$701.25
$980.00
$1,489.20		 $1,097.42
$1,245.58
$1,402.50
$1,960.00
$2,978.40		 $1,517.19
$1,665.35
$1,822.27
$2,379.77		 $1,936.96
$2,085.12
$2,242.04
$2,799.54		 $2,356.73
$2,504.89
$2,661.81
$3,219.31		 $968.48
$1,042.56
$1,121.02
$1,399.77		 $1,388.25
$1,462.33
$1,540.79
$1,819.54		 $1,808.02
$1,882.10
$1,960.56
$2,239.31		 $419.77

Plan: (HMO) Prestige Bronze Essential

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

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
Expanded Bronze 21
30
40
50
60		 $417.61
$473.98
$533.70
$745.84
$1,133.37		 $835.22
$947.96
$1,067.40
$1,491.68
$2,266.74		 $1,154.69
$1,267.43
$1,386.87
$1,811.15		 $1,474.16
$1,586.90
$1,706.34
$2,130.62		 $1,793.63
$1,906.37
$2,025.81
$2,450.09		 $737.08
$793.45
$853.17
$1,065.31		 $1,056.55
$1,112.92
$1,172.64
$1,384.78		 $1,376.02
$1,432.39
$1,492.11
$1,704.25		 $319.47

Plan: (HMO) Prestige Silver Essential

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

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		 $562.25
$638.15
$718.55
$1,004.17
$1,525.93		 $1,124.50
$1,276.30
$1,437.10
$2,008.34
$3,051.86		 $1,554.62
$1,706.42
$1,867.22
$2,438.46		 $1,984.74
$2,136.54
$2,297.34
$2,868.58		 $2,414.86
$2,566.66
$2,727.46
$3,298.70		 $992.37
$1,068.27
$1,148.67
$1,434.29		 $1,422.49
$1,498.39
$1,578.79
$1,864.41		 $1,852.61
$1,928.51
$2,008.91
$2,294.53		 $430.12

Plan: (HMO) Prestige Gold Essential

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-275-1400 - Provider Directory for This Plan: (Network Health Plan)

Deductible: Individual: $1,500 : Family: $3,000
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		 $545.63
$619.29
$697.31
$974.49
$1,480.83		 $1,091.26
$1,238.58
$1,394.62
$1,948.98
$2,961.66		 $1,508.67
$1,655.99
$1,812.03
$2,366.39		 $1,926.08
$2,073.40
$2,229.44
$2,783.80		 $2,343.49
$2,490.81
$2,646.85
$3,201.21		 $963.04
$1,036.70
$1,114.72
$1,391.90		 $1,380.45
$1,454.11
$1,532.13
$1,809.31		 $1,797.86
$1,871.52
$1,949.54
$2,226.72		 $417.41
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		 $551.78
$626.26
$705.16
$985.46
$1,497.51		 $1,103.56
$1,252.52
$1,410.32
$1,970.92
$2,995.02		 $1,525.66
$1,674.62
$1,832.42
$2,393.02		 $1,947.76
$2,096.72
$2,254.52
$2,815.12		 $2,369.86
$2,518.82
$2,676.62
$3,237.22		 $973.88
$1,048.36
$1,127.26
$1,407.56		 $1,395.98
$1,470.46
$1,549.36
$1,829.66		 $1,818.08
$1,892.56
$1,971.46
$2,251.76		 $422.10

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		 $549.25
$623.38
$701.92
$980.94
$1,490.63		 $1,098.50
$1,246.76
$1,403.84
$1,961.88
$2,981.26		 $1,518.67
$1,666.93
$1,824.01
$2,382.05		 $1,938.84
$2,087.10
$2,244.18
$2,802.22		 $2,359.01
$2,507.27
$2,664.35
$3,222.39		 $969.42
$1,043.55
$1,122.09
$1,401.11		 $1,389.59
$1,463.72
$1,542.26
$1,821.28		 $1,809.76
$1,883.89
$1,962.43
$2,241.45		 $420.17

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		 $571.56
$648.71
$730.44
$1,020.79
$1,551.19		 $1,143.12
$1,297.42
$1,460.88
$2,041.58
$3,102.38		 $1,580.36
$1,734.66
$1,898.12
$2,478.82		 $2,017.60
$2,171.90
$2,335.36
$2,916.06		 $2,454.84
$2,609.14
$2,772.60
$3,353.30		 $1,008.80
$1,085.95
$1,167.68
$1,458.03		 $1,446.04
$1,523.19
$1,604.92
$1,895.27		 $1,883.28
$1,960.43
$2,042.16
$2,332.51		 $437.24

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		 $292.91
$332.44
$374.33
$523.12
$794.94		 $585.82
$664.88
$748.66
$1,046.24
$1,589.88		 $809.89
$888.95
$972.73
$1,270.31		 $1,033.96
$1,113.02
$1,196.80
$1,494.38		 $1,258.03
$1,337.09
$1,420.87
$1,718.45		 $516.98
$556.51
$598.40
$747.19		 $741.05
$780.58
$822.47
$971.26		 $965.12
$1,004.65
$1,046.54
$1,195.33		 $224.07

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		 $369.57
$419.45
$472.30
$660.04
$1,002.99		 $739.14
$838.90
$944.60
$1,320.08
$2,005.98		 $1,021.86
$1,121.62
$1,227.32
$1,602.80		 $1,304.58
$1,404.34
$1,510.04
$1,885.52		 $1,587.30
$1,687.06
$1,792.76
$2,168.24		 $652.29
$702.17
$755.02
$942.76		 $935.01
$984.89
$1,037.74
$1,225.48		 $1,217.73
$1,267.61
$1,320.46
$1,508.20		 $282.72

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		 $596.42
$676.92
$762.21
$1,065.18
$1,618.65		 $1,192.84
$1,353.84
$1,524.42
$2,130.36
$3,237.30		 $1,649.09
$1,810.09
$1,980.67
$2,586.61		 $2,105.34
$2,266.34
$2,436.92
$3,042.86		 $2,561.59
$2,722.59
$2,893.17
$3,499.11		 $1,052.67
$1,133.17
$1,218.46
$1,521.43		 $1,508.92
$1,589.42
$1,674.71
$1,977.68		 $1,965.17
$2,045.67
$2,130.96
$2,433.93		 $456.25

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		 $378.34
$429.41
$483.51
$675.70
$1,026.79		 $756.68
$858.82
$967.02
$1,351.40
$2,053.58		 $1,046.10
$1,148.24
$1,256.44
$1,640.82		 $1,335.52
$1,437.66
$1,545.86
$1,930.24		 $1,624.94
$1,727.08
$1,835.28
$2,219.66		 $667.76
$718.83
$772.93
$965.12		 $957.18
$1,008.25
$1,062.35
$1,254.54		 $1,246.60
$1,297.67
$1,351.77
$1,543.96		 $289.42

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		 $462.80
$525.26
$591.44
$826.54
$1,256.01		 $925.60
$1,050.52
$1,182.88
$1,653.08
$2,512.02		 $1,279.63
$1,404.55
$1,536.91
$2,007.11		 $1,633.66
$1,758.58
$1,890.94
$2,361.14		 $1,987.69
$2,112.61
$2,244.97
$2,715.17		 $816.83
$879.29
$945.47
$1,180.57		 $1,170.86
$1,233.32
$1,299.50
$1,534.60		 $1,524.89
$1,587.35
$1,653.53
$1,888.63		 $354.03

‡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 Waukesha County here.

 

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