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Providers for Zip Code 32935

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ObamacareByZipCode.com

Obamacare 2019 Marketplace Rates For Brevard County, Florida

Friday, April 26th, 2024


The health insurance rates listed below are for calendar year 2019.

2019 Rates and Providers

(click here for 2014)

(click here for 2015)

(click here for 2016)

(click here for 2017)

(click here for 2018)

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

Obamacare Providers, Plans and 2019 Rates for Brevard County

Brevard County is in “Rating Area 5” of Florida.

Currently, there are 92 plans offered in Rating Area 5.

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 Melbourne, FL area accept this insurance coverage as within the plan's "network".
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Blue Cross and Blue Shield of Florida

Local: 1-800-352-2583 | Toll Free: 1-800-352-2583

TTY: 1-800-955-8771

Plan: (EPO) BlueOptions Silver 1423

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $5,950 : Family: $11,900
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $581.60
$660.12
$743.28
$1,038.74
$1,578.46		 $1,163.20
$1,320.24
$1,486.56
$2,077.48
$3,156.92		 $1,608.12
$1,765.16
$1,931.48
$2,522.40		 $2,053.04
$2,210.08
$2,376.40
$2,967.32		 $2,497.96
$2,655.00
$2,821.32
$3,412.24		 $1,026.52
$1,105.04
$1,188.20
$1,483.66		 $1,471.44
$1,549.96
$1,633.12
$1,928.58		 $1,916.36
$1,994.88
$2,078.04
$2,373.50		 $531.00

Plan: (EPO) BlueOptions Bronze 1419

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $7,900 : Family: $15,800
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $368.30
$418.02
$470.69
$657.78
$999.57		 $736.60
$836.04
$941.38
$1,315.56
$1,999.14		 $1,018.35
$1,117.79
$1,223.13
$1,597.31		 $1,300.10
$1,399.54
$1,504.88
$1,879.06		 $1,581.85
$1,681.29
$1,786.63
$2,160.81		 $650.05
$699.77
$752.44
$939.53		 $931.80
$981.52
$1,034.19
$1,221.28		 $1,213.55
$1,263.27
$1,315.94
$1,503.03		 $336.26

Plan: (EPO) BlueOptions Silver 1431

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $5,650 : Family: $11,300
Out of Pocket Maximum per year: Individual: $7,000 : Family: $14,000

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		 $599.35
$680.26
$765.97
$1,070.44
$1,626.64		 $1,198.70
$1,360.52
$1,531.94
$2,140.88
$3,253.28		 $1,657.20
$1,819.02
$1,990.44
$2,599.38		 $2,115.70
$2,277.52
$2,448.94
$3,057.88		 $2,574.20
$2,736.02
$2,907.44
$3,516.38		 $1,057.85
$1,138.76
$1,224.47
$1,528.94		 $1,516.35
$1,597.26
$1,682.97
$1,987.44		 $1,974.85
$2,055.76
$2,141.47
$2,445.94		 $547.21

Plan: (EPO) BlueOptions Platinum 1418

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $1,000 : Family: $2,000
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
Platinum 21
30
40
50
60		 $719.55
$816.69
$919.58
$1,285.12
$1,952.86		 $1,439.10
$1,633.38
$1,839.16
$2,570.24
$3,905.72		 $1,989.56
$2,183.84
$2,389.62
$3,120.70		 $2,540.02
$2,734.30
$2,940.08
$3,671.16		 $3,090.48
$3,284.76
$3,490.54
$4,221.62		 $1,270.01
$1,367.15
$1,470.04
$1,835.58		 $1,820.47
$1,917.61
$2,020.50
$2,386.04		 $2,370.93
$2,468.07
$2,570.96
$2,936.50		 $656.95

Plan: (EPO) BlueOptions Bronze 1416

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $6,200 : Family: $12,400
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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
Expanded Bronze 21
30
40
50
60		 $395.88
$449.32
$505.93
$707.04
$1,074.42		 $791.76
$898.64
$1,011.86
$1,414.08
$2,148.84		 $1,094.61
$1,201.49
$1,314.71
$1,716.93		 $1,397.46
$1,504.34
$1,617.56
$2,019.78		 $1,700.31
$1,807.19
$1,920.41
$2,322.63		 $698.73
$752.17
$808.78
$1,009.89		 $1,001.58
$1,055.02
$1,111.63
$1,312.74		 $1,304.43
$1,357.87
$1,414.48
$1,615.59		 $361.44

Plan: (EPO) BlueOptions Platinum 1424

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: 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
Platinum 21
30
40
50
60		 $756.40
$858.51
$966.68
$1,350.93
$2,052.87		 $1,512.80
$1,717.02
$1,933.36
$2,701.86
$4,105.74		 $2,091.45
$2,295.67
$2,512.01
$3,280.51		 $2,670.10
$2,874.32
$3,090.66
$3,859.16		 $3,248.75
$3,452.97
$3,669.31
$4,437.81		 $1,335.05
$1,437.16
$1,545.33
$1,929.58		 $1,913.70
$2,015.81
$2,123.98
$2,508.23		 $2,492.35
$2,594.46
$2,702.63
$3,086.88		 $690.59

Plan: (EPO) BlueOptions Silver 1410

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $538.05
$610.69
$687.63
$960.96
$1,460.27		 $1,076.10
$1,221.38
$1,375.26
$1,921.92
$2,920.54		 $1,487.71
$1,632.99
$1,786.87
$2,333.53		 $1,899.32
$2,044.60
$2,198.48
$2,745.14		 $2,310.93
$2,456.21
$2,610.09
$3,156.75		 $949.66
$1,022.30
$1,099.24
$1,372.57		 $1,361.27
$1,433.91
$1,510.85
$1,784.18		 $1,772.88
$1,845.52
$1,922.46
$2,195.79		 $491.24

Plan: (EPO) BlueOptions Gold 1505

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $0 : Family: $0
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		 $584.45
$663.35
$746.93
$1,043.83
$1,586.20		 $1,168.90
$1,326.70
$1,493.86
$2,087.66
$3,172.40		 $1,616.00
$1,773.80
$1,940.96
$2,534.76		 $2,063.10
$2,220.90
$2,388.06
$2,981.86		 $2,510.20
$2,668.00
$2,835.16
$3,428.96		 $1,031.55
$1,110.45
$1,194.03
$1,490.93		 $1,478.65
$1,557.55
$1,641.13
$1,938.03		 $1,925.75
$2,004.65
$2,088.23
$2,385.13		 $533.60

Plan: (EPO) BlueOptions Bronze (HSA) 1705

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

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		 $388.44
$440.88
$496.43
$693.75
$1,054.23		 $776.88
$881.76
$992.86
$1,387.50
$2,108.46		 $1,074.04
$1,178.92
$1,290.02
$1,684.66		 $1,371.20
$1,476.08
$1,587.18
$1,981.82		 $1,668.36
$1,773.24
$1,884.34
$2,278.98		 $685.60
$738.04
$793.59
$990.91		 $982.76
$1,035.20
$1,090.75
$1,288.07		 $1,279.92
$1,332.36
$1,387.91
$1,585.23		 $354.65

Plan: (EPO) BlueOptions Silver 1706S

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $591.87
$671.77
$756.41
$1,057.08
$1,606.34		 $1,183.74
$1,343.54
$1,512.82
$2,114.16
$3,212.68		 $1,636.52
$1,796.32
$1,965.60
$2,566.94		 $2,089.30
$2,249.10
$2,418.38
$3,019.72		 $2,542.08
$2,701.88
$2,871.16
$3,472.50		 $1,044.65
$1,124.55
$1,209.19
$1,509.86		 $1,497.43
$1,577.33
$1,661.97
$1,962.64		 $1,950.21
$2,030.11
$2,114.75
$2,415.42		 $540.38

Plan: (EPO) BlueOptions Bronze 1707S

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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
Expanded Bronze 21
30
40
50
60		 $389.83
$442.46
$498.20
$696.24
$1,058.00		 $779.66
$884.92
$996.40
$1,392.48
$2,116.00		 $1,077.88
$1,183.14
$1,294.62
$1,690.70		 $1,376.10
$1,481.36
$1,592.84
$1,988.92		 $1,674.32
$1,779.58
$1,891.06
$2,287.14		 $688.05
$740.68
$796.42
$994.46		 $986.27
$1,038.90
$1,094.64
$1,292.68		 $1,284.49
$1,337.12
$1,392.86
$1,590.90		 $355.91

Plan: (EPO) BlueOptions Gold 1805

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: 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
Gold 21
30
40
50
60		 $559.26
$634.76
$714.73
$998.84
$1,517.83		 $1,118.52
$1,269.52
$1,429.46
$1,997.68
$3,035.66		 $1,546.35
$1,697.35
$1,857.29
$2,425.51		 $1,974.18
$2,125.18
$2,285.12
$2,853.34		 $2,402.01
$2,553.01
$2,712.95
$3,281.17		 $987.09
$1,062.59
$1,142.56
$1,426.67		 $1,414.92
$1,490.42
$1,570.39
$1,854.50		 $1,842.75
$1,918.25
$1,998.22
$2,282.33		 $510.60

Plan: (EPO) BlueSelect Silver 1456

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $5,950 : Family: $11,900
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $361.76
$410.60
$462.33
$646.10
$981.82		 $723.52
$821.20
$924.66
$1,292.20
$1,963.64		 $1,000.27
$1,097.95
$1,201.41
$1,568.95		 $1,277.02
$1,374.70
$1,478.16
$1,845.70		 $1,553.77
$1,651.45
$1,754.91
$2,122.45		 $638.51
$687.35
$739.08
$922.85		 $915.26
$964.10
$1,015.83
$1,199.60		 $1,192.01
$1,240.85
$1,292.58
$1,476.35		 $330.29

Plan: (EPO) BlueSelect Bronze 1452

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $7,900 : Family: $15,800
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $262.09
$297.47
$334.95
$468.09
$711.31		 $524.18
$594.94
$669.90
$936.18
$1,422.62		 $724.68
$795.44
$870.40
$1,136.68		 $925.18
$995.94
$1,070.90
$1,337.18		 $1,125.68
$1,196.44
$1,271.40
$1,537.68		 $462.59
$497.97
$535.45
$668.59		 $663.09
$698.47
$735.95
$869.09		 $863.59
$898.97
$936.45
$1,069.59		 $239.29

Plan: (EPO) BlueSelect Silver 1464

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $5,650 : Family: $11,300
Out of Pocket Maximum per year: Individual: $7,000 : Family: $14,000

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		 $378.55
$429.65
$483.79
$676.09
$1,027.38		 $757.10
$859.30
$967.58
$1,352.18
$2,054.76		 $1,046.69
$1,148.89
$1,257.17
$1,641.77		 $1,336.28
$1,438.48
$1,546.76
$1,931.36		 $1,625.87
$1,728.07
$1,836.35
$2,220.95		 $668.14
$719.24
$773.38
$965.68		 $957.73
$1,008.83
$1,062.97
$1,255.27		 $1,247.32
$1,298.42
$1,352.56
$1,544.86		 $345.62

Plan: (EPO) BlueSelect Platinum 1451

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $1,000 : Family: $2,000
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
Platinum 21
30
40
50
60		 $451.81
$512.80
$577.41
$806.93
$1,226.21		 $903.62
$1,025.60
$1,154.82
$1,613.86
$2,452.42		 $1,249.25
$1,371.23
$1,500.45
$1,959.49		 $1,594.88
$1,716.86
$1,846.08
$2,305.12		 $1,940.51
$2,062.49
$2,191.71
$2,650.75		 $797.44
$858.43
$923.04
$1,152.56		 $1,143.07
$1,204.06
$1,268.67
$1,498.19		 $1,488.70
$1,549.69
$1,614.30
$1,843.82		 $412.50

Plan: (EPO) BlueSelect Bronze 1449

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $6,200 : Family: $12,400
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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
Expanded Bronze 21
30
40
50
60		 $281.24
$319.21
$359.42
$502.29
$763.29		 $562.48
$638.42
$718.84
$1,004.58
$1,526.58		 $777.63
$853.57
$933.99
$1,219.73		 $992.78
$1,068.72
$1,149.14
$1,434.88		 $1,207.93
$1,283.87
$1,364.29
$1,650.03		 $496.39
$534.36
$574.57
$717.44		 $711.54
$749.51
$789.72
$932.59		 $926.69
$964.66
$1,004.87
$1,147.74		 $256.77

Plan: (EPO) BlueSelect Platinum 1457

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: 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
Platinum 21
30
40
50
60		 $479.07
$543.74
$612.25
$855.62
$1,300.20		 $958.14
$1,087.48
$1,224.50
$1,711.24
$2,600.40		 $1,324.63
$1,453.97
$1,590.99
$2,077.73		 $1,691.12
$1,820.46
$1,957.48
$2,444.22		 $2,057.61
$2,186.95
$2,323.97
$2,810.71		 $845.56
$910.23
$978.74
$1,222.11		 $1,212.05
$1,276.72
$1,345.23
$1,588.60		 $1,578.54
$1,643.21
$1,711.72
$1,955.09		 $437.39

Plan: (EPO) BlueSelect Silver 1443

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $335.88
$381.22
$429.25
$599.88
$911.58		 $671.76
$762.44
$858.50
$1,199.76
$1,823.16		 $928.71
$1,019.39
$1,115.45
$1,456.71		 $1,185.66
$1,276.34
$1,372.40
$1,713.66		 $1,442.61
$1,533.29
$1,629.35
$1,970.61		 $592.83
$638.17
$686.20
$856.83		 $849.78
$895.12
$943.15
$1,113.78		 $1,106.73
$1,152.07
$1,200.10
$1,370.73		 $306.66

Plan: (EPO) BlueSelect Gold 1535

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $0 : Family: $0
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		 $392.09
$445.02
$501.09
$700.27
$1,064.13		 $784.18
$890.04
$1,002.18
$1,400.54
$2,128.26		 $1,084.13
$1,189.99
$1,302.13
$1,700.49		 $1,384.08
$1,489.94
$1,602.08
$2,000.44		 $1,684.03
$1,789.89
$1,902.03
$2,300.39		 $692.04
$744.97
$801.04
$1,000.22		 $991.99
$1,044.92
$1,100.99
$1,300.17		 $1,291.94
$1,344.87
$1,400.94
$1,600.12		 $357.98

Plan: (EPO) BlueSelect Bronze (HSA) 1735

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

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		 $276.00
$313.26
$352.73
$492.94
$749.06		 $552.00
$626.52
$705.46
$985.88
$1,498.12		 $763.14
$837.66
$916.60
$1,197.02		 $974.28
$1,048.80
$1,127.74
$1,408.16		 $1,185.42
$1,259.94
$1,338.88
$1,619.30		 $487.14
$524.40
$563.87
$704.08		 $698.28
$735.54
$775.01
$915.22		 $909.42
$946.68
$986.15
$1,126.36		 $251.99

Plan: (EPO) BlueSelect Silver 1736S

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $368.93
$418.74
$471.49
$658.91
$1,001.28		 $737.86
$837.48
$942.98
$1,317.82
$2,002.56		 $1,020.09
$1,119.71
$1,225.21
$1,600.05		 $1,302.32
$1,401.94
$1,507.44
$1,882.28		 $1,584.55
$1,684.17
$1,789.67
$2,164.51		 $651.16
$700.97
$753.72
$941.14		 $933.39
$983.20
$1,035.95
$1,223.37		 $1,215.62
$1,265.43
$1,318.18
$1,505.60		 $336.83

Plan: (EPO) BlueSelect Bronze 1737S

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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
Expanded Bronze 21
30
40
50
60		 $277.26
$314.69
$354.34
$495.19
$752.48		 $554.52
$629.38
$708.68
$990.38
$1,504.96		 $766.62
$841.48
$920.78
$1,202.48		 $978.72
$1,053.58
$1,132.88
$1,414.58		 $1,190.82
$1,265.68
$1,344.98
$1,626.68		 $489.36
$526.79
$566.44
$707.29		 $701.46
$738.89
$778.54
$919.39		 $913.56
$950.99
$990.64
$1,131.49		 $253.14

Plan: (EPO) BlueSelect Gold 1835

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Blue Cross and Blue Shield of Florida)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: 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
Gold 21
30
40
50
60		 $369.69
$419.60
$472.46
$660.27
$1,003.34		 $739.38
$839.20
$944.92
$1,320.54
$2,006.68		 $1,022.19
$1,122.01
$1,227.73
$1,603.35		 $1,305.00
$1,404.82
$1,510.54
$1,886.16		 $1,587.81
$1,687.63
$1,793.35
$2,168.97		 $652.50
$702.41
$755.27
$943.08		 $935.31
$985.22
$1,038.08
$1,225.89		 $1,218.12
$1,268.03
$1,320.89
$1,508.70		 $337.53
ADVERTISEMENT

Health Options, Inc.

Local: 1-800-352-2583 | Toll Free: 1-800-352-2583

TTY: 1-800-955-8771

Plan: (HMO) BlueCare Silver 1490

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Health Options, Inc.)

Deductible: Individual: $5,950 : Family: $11,900
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $530.37
$601.97
$677.81
$947.24
$1,439.42		 $1,060.74
$1,203.94
$1,355.62
$1,894.48
$2,878.84		 $1,466.47
$1,609.67
$1,761.35
$2,300.21		 $1,872.20
$2,015.40
$2,167.08
$2,705.94		 $2,277.93
$2,421.13
$2,572.81
$3,111.67		 $936.10
$1,007.70
$1,083.54
$1,352.97		 $1,341.83
$1,413.43
$1,489.27
$1,758.70		 $1,747.56
$1,819.16
$1,895.00
$2,164.43		 $484.23

Plan: (HMO) BlueCare Bronze 1486

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Health Options, Inc.)

Deductible: Individual: $7,900 : Family: $15,800
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $344.63
$391.16
$440.44
$615.51
$935.33		 $689.26
$782.32
$880.88
$1,231.02
$1,870.66		 $952.90
$1,045.96
$1,144.52
$1,494.66		 $1,216.54
$1,309.60
$1,408.16
$1,758.30		 $1,480.18
$1,573.24
$1,671.80
$2,021.94		 $608.27
$654.80
$704.08
$879.15		 $871.91
$918.44
$967.72
$1,142.79		 $1,135.55
$1,182.08
$1,231.36
$1,406.43		 $314.65

Plan: (HMO) BlueCare Silver 1498

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Health Options, Inc.)

Deductible: Individual: $5,650 : Family: $11,300
Out of Pocket Maximum per year: Individual: $7,000 : Family: $14,000

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		 $530.99
$602.67
$678.61
$948.35
$1,441.11		 $1,061.98
$1,205.34
$1,357.22
$1,896.70
$2,882.22		 $1,468.19
$1,611.55
$1,763.43
$2,302.91		 $1,874.40
$2,017.76
$2,169.64
$2,709.12		 $2,280.61
$2,423.97
$2,575.85
$3,115.33		 $937.20
$1,008.88
$1,084.82
$1,354.56		 $1,343.41
$1,415.09
$1,491.03
$1,760.77		 $1,749.62
$1,821.30
$1,897.24
$2,166.98		 $484.79

Plan: (HMO) BlueCare Platinum 1485

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Health Options, Inc.)

Deductible: Individual: $1,000 : Family: $2,000
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
Platinum 21
30
40
50
60		 $598.08
$678.82
$764.35
$1,068.17
$1,623.19		 $1,196.16
$1,357.64
$1,528.70
$2,136.34
$3,246.38		 $1,653.69
$1,815.17
$1,986.23
$2,593.87		 $2,111.22
$2,272.70
$2,443.76
$3,051.40		 $2,568.75
$2,730.23
$2,901.29
$3,508.93		 $1,055.61
$1,136.35
$1,221.88
$1,525.70		 $1,513.14
$1,593.88
$1,679.41
$1,983.23		 $1,970.67
$2,051.41
$2,136.94
$2,440.76		 $546.05

Plan: (HMO) BlueCare Bronze 1483

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Health Options, Inc.)

Deductible: Individual: $6,200 : Family: $12,400
Out of Pocket Maximum per year: Individual: $7,900 : Family: $14,800

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
Expanded Bronze 21
30
40
50
60		 $380.04
$431.35
$485.69
$678.75
$1,031.43		 $760.08
$862.70
$971.38
$1,357.50
$2,062.86		 $1,050.81
$1,153.43
$1,262.11
$1,648.23		 $1,341.54
$1,444.16
$1,552.84
$1,938.96		 $1,632.27
$1,734.89
$1,843.57
$2,229.69		 $670.77
$722.08
$776.42
$969.48		 $961.50
$1,012.81
$1,067.15
$1,260.21		 $1,252.23
$1,303.54
$1,357.88
$1,550.94		 $346.98

Plan: (HMO) BlueCare Platinum 1491

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Health Options, Inc.)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: 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
Platinum 21
30
40
50
60		 $637.48
$723.54
$814.70
$1,138.54
$1,730.12		 $1,274.96
$1,447.08
$1,629.40
$2,277.08
$3,460.24		 $1,762.63
$1,934.75
$2,117.07
$2,764.75		 $2,250.30
$2,422.42
$2,604.74
$3,252.42		 $2,737.97
$2,910.09
$3,092.41
$3,740.09		 $1,125.15
$1,211.21
$1,302.37
$1,626.21		 $1,612.82
$1,698.88
$1,790.04
$2,113.88		 $2,100.49
$2,186.55
$2,277.71
$2,601.55		 $582.02

Plan: (HMO) BlueCare Silver 1477

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Health Options, Inc.)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $463.72
$526.32
$592.63
$828.20
$1,258.54		 $927.44
$1,052.64
$1,185.26
$1,656.40
$2,517.08		 $1,282.19
$1,407.39
$1,540.01
$2,011.15		 $1,636.94
$1,762.14
$1,894.76
$2,365.90		 $1,991.69
$2,116.89
$2,249.51
$2,720.65		 $818.47
$881.07
$947.38
$1,182.95		 $1,173.22
$1,235.82
$1,302.13
$1,537.70		 $1,527.97
$1,590.57
$1,656.88
$1,892.45		 $423.38

Plan: (HMO) BlueCare Gold 1565

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Health Options, Inc.)

Deductible: Individual: $0 : Family: $0
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		 $546.00
$619.71
$697.79
$975.16
$1,481.84		 $1,092.00
$1,239.42
$1,395.58
$1,950.32
$2,963.68		 $1,509.69
$1,657.11
$1,813.27
$2,368.01		 $1,927.38
$2,074.80
$2,230.96
$2,785.70		 $2,345.07
$2,492.49
$2,648.65
$3,203.39		 $963.69
$1,037.40
$1,115.48
$1,392.85		 $1,381.38
$1,455.09
$1,533.17
$1,810.54		 $1,799.07
$1,872.78
$1,950.86
$2,228.23		 $498.50

Plan: (HMO) BlueCare Bronze (HSA) 1765

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Health Options, Inc.)

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		 $368.03
$417.71
$470.34
$657.30
$998.83		 $736.06
$835.42
$940.68
$1,314.60
$1,997.66		 $1,017.60
$1,116.96
$1,222.22
$1,596.14		 $1,299.14
$1,398.50
$1,503.76
$1,877.68		 $1,580.68
$1,680.04
$1,785.30
$2,159.22		 $649.57
$699.25
$751.88
$938.84		 $931.11
$980.79
$1,033.42
$1,220.38		 $1,212.65
$1,262.33
$1,314.96
$1,501.92		 $336.01

Plan: (HMO) BlueCare Silver 1766S

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Health Options, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $524.39
$595.18
$670.17
$936.56
$1,423.19		 $1,048.78
$1,190.36
$1,340.34
$1,873.12
$2,846.38		 $1,449.94
$1,591.52
$1,741.50
$2,274.28		 $1,851.10
$1,992.68
$2,142.66
$2,675.44		 $2,252.26
$2,393.84
$2,543.82
$3,076.60		 $925.55
$996.34
$1,071.33
$1,337.72		 $1,326.71
$1,397.50
$1,472.49
$1,738.88		 $1,727.87
$1,798.66
$1,873.65
$2,140.04		 $478.77

Plan: (HMO) BlueCare Bronze 1767S

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Health Options, Inc.)

Deductible: Individual: $6,650 : Family: $13,300
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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
Expanded Bronze 21
30
40
50
60		 $371.72
$421.90
$475.06
$663.89
$1,008.85		 $743.44
$843.80
$950.12
$1,327.78
$2,017.70		 $1,027.81
$1,128.17
$1,234.49
$1,612.15		 $1,312.18
$1,412.54
$1,518.86
$1,896.52		 $1,596.55
$1,696.91
$1,803.23
$2,180.89		 $656.09
$706.27
$759.43
$948.26		 $940.46
$990.64
$1,043.80
$1,232.63		 $1,224.83
$1,275.01
$1,328.17
$1,517.00		 $339.38

Plan: (HMO) BlueCare Gold 1865

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-352-2583 - Provider Directory for This Plan: (Health Options, Inc.)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: 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
Gold 21
30
40
50
60		 $518.06
$588.00
$662.08
$925.26
$1,406.01		 $1,036.12
$1,176.00
$1,324.16
$1,850.52
$2,812.02		 $1,432.44
$1,572.32
$1,720.48
$2,246.84		 $1,828.76
$1,968.64
$2,116.80
$2,643.16		 $2,225.08
$2,364.96
$2,513.12
$3,039.48		 $914.38
$984.32
$1,058.40
$1,321.58		 $1,310.70
$1,380.64
$1,454.72
$1,717.90		 $1,707.02
$1,776.96
$1,851.04
$2,114.22		 $472.99
ADVERTISEMENT

Health First Commercial Plans, Inc.

Local: 1-855-443-4735 | Toll Free: 1-855-443-4735

TTY: 1-800-955-8771

Plan: (HMO) Health First GYM ACCESS Bronze HMO 70 1656

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $7,400 : Family: $14,800
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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
Expanded Bronze 21
30
40
50
60		 $314.47
$356.93
$401.89
$561.65
$853.48		 $628.94
$713.86
$803.78
$1,123.30
$1,706.96		 $869.51
$954.43
$1,044.35
$1,363.87		 $1,110.08
$1,195.00
$1,284.92
$1,604.44		 $1,350.65
$1,435.57
$1,525.49
$1,845.01		 $555.04
$597.50
$642.46
$802.22		 $795.61
$838.07
$883.03
$1,042.79		 $1,036.18
$1,078.64
$1,123.60
$1,283.36		 $287.11

Plan: (HMO) Health First GYM ACCESS Bronze HMO 100 HSA 1658

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $6,450 : Family: $12,900
Out of Pocket Maximum per year: Individual: $6,450 : Family: $12,900

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		 $306.79
$348.21
$392.08
$547.93
$832.64		 $613.58
$696.42
$784.16
$1,095.86
$1,665.28		 $848.28
$931.12
$1,018.86
$1,330.56		 $1,082.98
$1,165.82
$1,253.56
$1,565.26		 $1,317.68
$1,400.52
$1,488.26
$1,799.96		 $541.49
$582.91
$626.78
$782.63		 $776.19
$817.61
$861.48
$1,017.33		 $1,010.89
$1,052.31
$1,096.18
$1,252.03		 $280.10

Plan: (HMO) Health First GYM ACCESS Bronze HMO 70 HSA 1662

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $5,500 : Family: $11,000
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		 $306.23
$347.57
$391.36
$546.92
$831.10		 $612.46
$695.14
$782.72
$1,093.84
$1,662.20		 $846.72
$929.40
$1,016.98
$1,328.10		 $1,080.98
$1,163.66
$1,251.24
$1,562.36		 $1,315.24
$1,397.92
$1,485.50
$1,796.62		 $540.49
$581.83
$625.62
$781.18		 $774.75
$816.09
$859.88
$1,015.44		 $1,009.01
$1,050.35
$1,094.14
$1,249.70		 $279.59

Plan: (HMO) Health First GYM ACCESS Silver HMO 100 1664

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $5,450 : Family: $10,900
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $448.27
$508.79
$572.89
$800.62
$1,216.62		 $896.54
$1,017.58
$1,145.78
$1,601.24
$2,433.24		 $1,239.47
$1,360.51
$1,488.71
$1,944.17		 $1,582.40
$1,703.44
$1,831.64
$2,287.10		 $1,925.33
$2,046.37
$2,174.57
$2,630.03		 $791.20
$851.72
$915.82
$1,143.55		 $1,134.13
$1,194.65
$1,258.75
$1,486.48		 $1,477.06
$1,537.58
$1,601.68
$1,829.41		 $409.27

Plan: (HMO) Health First GYM ACCESS Silver HMO 100 1672

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $4,200 : Family: $8,400
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $460.86
$523.08
$588.98
$823.10
$1,250.78		 $921.72
$1,046.16
$1,177.96
$1,646.20
$2,501.56		 $1,274.28
$1,398.72
$1,530.52
$1,998.76		 $1,626.84
$1,751.28
$1,883.08
$2,351.32		 $1,979.40
$2,103.84
$2,235.64
$2,703.88		 $813.42
$875.64
$941.54
$1,175.66		 $1,165.98
$1,228.20
$1,294.10
$1,528.22		 $1,518.54
$1,580.76
$1,646.66
$1,880.78		 $420.77

Plan: (HMO) Health First GYM ACCESS Silver HMO 90 1680

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $7,150 : Family: $14,300
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $470.83
$534.39
$601.72
$840.90
$1,277.83		 $941.66
$1,068.78
$1,203.44
$1,681.80
$2,555.66		 $1,301.85
$1,428.97
$1,563.63
$2,041.99		 $1,662.04
$1,789.16
$1,923.82
$2,402.18		 $2,022.23
$2,149.35
$2,284.01
$2,762.37		 $831.02
$894.58
$961.91
$1,201.09		 $1,191.21
$1,254.77
$1,322.10
$1,561.28		 $1,551.40
$1,614.96
$1,682.29
$1,921.47		 $429.87

Plan: (HMO) Health First GYM ACCESS Silver HMO 80 1688

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $4,950 : Family: $9,900
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $427.81
$485.56
$546.74
$764.07
$1,161.07		 $855.62
$971.12
$1,093.48
$1,528.14
$2,322.14		 $1,182.89
$1,298.39
$1,420.75
$1,855.41		 $1,510.16
$1,625.66
$1,748.02
$2,182.68		 $1,837.43
$1,952.93
$2,075.29
$2,509.95		 $755.08
$812.83
$874.01
$1,091.34		 $1,082.35
$1,140.10
$1,201.28
$1,418.61		 $1,409.62
$1,467.37
$1,528.55
$1,745.88		 $390.59

Plan: (HMO) Health First GYM ACCESS Silver HMO 70 1704

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,300 : Family: $14,600

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		 $453.34
$514.55
$579.37
$809.67
$1,230.38		 $906.68
$1,029.10
$1,158.74
$1,619.34
$2,460.76		 $1,253.49
$1,375.91
$1,505.55
$1,966.15		 $1,600.30
$1,722.72
$1,852.36
$2,312.96		 $1,947.11
$2,069.53
$2,199.17
$2,659.77		 $800.15
$861.36
$926.18
$1,156.48		 $1,146.96
$1,208.17
$1,272.99
$1,503.29		 $1,493.77
$1,554.98
$1,619.80
$1,850.10		 $413.90

Plan: (HMO) Health First GYM ACCESS Silver HMO 70 1720

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

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

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		 $453.96
$515.24
$580.16
$810.77
$1,232.04		 $907.92
$1,030.48
$1,160.32
$1,621.54
$2,464.08		 $1,255.20
$1,377.76
$1,507.60
$1,968.82		 $1,602.48
$1,725.04
$1,854.88
$2,316.10		 $1,949.76
$2,072.32
$2,202.16
$2,663.38		 $801.24
$862.52
$927.44
$1,158.05		 $1,148.52
$1,209.80
$1,274.72
$1,505.33		 $1,495.80
$1,557.08
$1,622.00
$1,852.61		 $414.46

Plan: (HMO) Health First GYM ACCESS Silver HMO 80 HSA 1728

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $2,500 : Family: $5,000
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
Silver 21
30
40
50
60		 $455.36
$516.84
$581.95
$813.28
$1,235.86		 $910.72
$1,033.68
$1,163.90
$1,626.56
$2,471.72		 $1,259.07
$1,382.03
$1,512.25
$1,974.91		 $1,607.42
$1,730.38
$1,860.60
$2,323.26		 $1,955.77
$2,078.73
$2,208.95
$2,671.61		 $803.71
$865.19
$930.30
$1,161.63		 $1,152.06
$1,213.54
$1,278.65
$1,509.98		 $1,500.41
$1,561.89
$1,627.00
$1,858.33		 $415.75

Plan: (HMO) Health First GYM ACCESS Gold HMO 100 1736

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $3,050 : Family: $6,100

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
Gold 21
30
40
50
60		 $399.80
$453.77
$510.94
$714.04
$1,085.05		 $799.60
$907.54
$1,021.88
$1,428.08
$2,170.10		 $1,105.45
$1,213.39
$1,327.73
$1,733.93		 $1,411.30
$1,519.24
$1,633.58
$2,039.78		 $1,717.15
$1,825.09
$1,939.43
$2,345.63		 $705.65
$759.62
$816.79
$1,019.89		 $1,011.50
$1,065.47
$1,122.64
$1,325.74		 $1,317.35
$1,371.32
$1,428.49
$1,631.59		 $365.02

Plan: (HMO) Health First GYM ACCESS Gold HMO 80 1740

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $3,450 : Family: $6,900
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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		 $372.21
$422.45
$475.68
$664.76
$1,010.17		 $744.42
$844.90
$951.36
$1,329.52
$2,020.34		 $1,029.16
$1,129.64
$1,236.10
$1,614.26		 $1,313.90
$1,414.38
$1,520.84
$1,899.00		 $1,598.64
$1,699.12
$1,805.58
$2,183.74		 $656.95
$707.19
$760.42
$949.50		 $941.69
$991.93
$1,045.16
$1,234.24		 $1,226.43
$1,276.67
$1,329.90
$1,518.98		 $339.82

Plan: (HMO) Health First GYM ACCESS Gold HMO 70 1742

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
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		 $414.17
$470.08
$529.31
$739.70
$1,124.05		 $828.34
$940.16
$1,058.62
$1,479.40
$2,248.10		 $1,145.18
$1,257.00
$1,375.46
$1,796.24		 $1,462.02
$1,573.84
$1,692.30
$2,113.08		 $1,778.86
$1,890.68
$2,009.14
$2,429.92		 $731.01
$786.92
$846.15
$1,056.54		 $1,047.85
$1,103.76
$1,162.99
$1,373.38		 $1,364.69
$1,420.60
$1,479.83
$1,690.22		 $378.13

Plan: (HMO) Health First GYM ACCESS Gold HMO 90 HSA 1744

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

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		 $396.98
$450.57
$507.34
$709.00
$1,077.40		 $793.96
$901.14
$1,014.68
$1,418.00
$2,154.80		 $1,097.65
$1,204.83
$1,318.37
$1,721.69		 $1,401.34
$1,508.52
$1,622.06
$2,025.38		 $1,705.03
$1,812.21
$1,925.75
$2,329.07		 $700.67
$754.26
$811.03
$1,012.69		 $1,004.36
$1,057.95
$1,114.72
$1,316.38		 $1,308.05
$1,361.64
$1,418.41
$1,620.07		 $362.44

Plan: (HMO) Health First GYM ACCESS Catastrophic HMO 1746

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $7,900 : Family: $15,800
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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
Catastrophic 21
30
40
50
60		 $183.03
$207.74
$233.92
$326.90
$496.75		 $366.06
$415.48
$467.84
$653.80
$993.50		 $506.08
$555.50
$607.86
$793.82		 $646.10
$695.52
$747.88
$933.84		 $786.12
$835.54
$887.90
$1,073.86		 $323.05
$347.76
$373.94
$466.92		 $463.07
$487.78
$513.96
$606.94		 $603.09
$627.80
$653.98
$746.96		 $167.11

Plan: (HMO) Health First GYM ACCESS Bronze HMO 50 1796

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $6,900 : Family: $13,800
Out of Pocket Maximum per year: Individual: $7,700 : Family: $15,400

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
Bronze 21
30
40
50
60		 $298.57
$338.88
$381.57
$533.25
$810.32		 $597.14
$677.76
$763.14
$1,066.50
$1,620.64		 $825.55
$906.17
$991.55
$1,294.91		 $1,053.96
$1,134.58
$1,219.96
$1,523.32		 $1,282.37
$1,362.99
$1,448.37
$1,751.73		 $526.98
$567.29
$609.98
$761.66		 $755.39
$795.70
$838.39
$990.07		 $983.80
$1,024.11
$1,066.80
$1,218.48		 $272.59

Plan: (HMO) Health First Bronze HMO 60 1750

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $7,500 : Family: $15,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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
Expanded Bronze 21
30
40
50
60		 $311.96
$354.08
$398.69
$557.16
$846.66		 $623.92
$708.16
$797.38
$1,114.32
$1,693.32		 $862.57
$946.81
$1,036.03
$1,352.97		 $1,101.22
$1,185.46
$1,274.68
$1,591.62		 $1,339.87
$1,424.11
$1,513.33
$1,830.27		 $550.61
$592.73
$637.34
$795.81		 $789.26
$831.38
$875.99
$1,034.46		 $1,027.91
$1,070.03
$1,114.64
$1,273.11		 $284.82

Plan: (HMO) Health First Silver HMO 80 1754

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $3,900 : Family: $7,800
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $448.39
$508.92
$573.04
$800.82
$1,216.93		 $896.78
$1,017.84
$1,146.08
$1,601.64
$2,433.86		 $1,239.80
$1,360.86
$1,489.10
$1,944.66		 $1,582.82
$1,703.88
$1,832.12
$2,287.68		 $1,925.84
$2,046.90
$2,175.14
$2,630.70		 $791.41
$851.94
$916.06
$1,143.84		 $1,134.43
$1,194.96
$1,259.08
$1,486.86		 $1,477.45
$1,537.98
$1,602.10
$1,829.88		 $409.38

Plan: (HMO) Health First Gold HMO 80 1770

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

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		 $388.14
$440.54
$496.04
$693.22
$1,053.41		 $776.28
$881.08
$992.08
$1,386.44
$2,106.82		 $1,073.21
$1,178.01
$1,289.01
$1,683.37		 $1,370.14
$1,474.94
$1,585.94
$1,980.30		 $1,667.07
$1,771.87
$1,882.87
$2,277.23		 $685.07
$737.47
$792.97
$990.15		 $982.00
$1,034.40
$1,089.90
$1,287.08		 $1,278.93
$1,331.33
$1,386.83
$1,584.01		 $354.37

Plan: (HMO) Health First Bronze HMO 100 1774

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $7,900 : Family: $15,800
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $289.57
$328.66
$370.07
$517.17
$785.89		 $579.14
$657.32
$740.14
$1,034.34
$1,571.78		 $800.66
$878.84
$961.66
$1,255.86		 $1,022.18
$1,100.36
$1,183.18
$1,477.38		 $1,243.70
$1,321.88
$1,404.70
$1,698.90		 $511.09
$550.18
$591.59
$738.69		 $732.61
$771.70
$813.11
$960.21		 $954.13
$993.22
$1,034.63
$1,181.73		 $264.38

Plan: (HMO) Health First Silver HMO 80 1778

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $2,900 : Family: $5,800
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $446.17
$506.41
$570.21
$796.86
$1,210.91		 $892.34
$1,012.82
$1,140.42
$1,593.72
$2,421.82		 $1,233.66
$1,354.14
$1,481.74
$1,935.04		 $1,574.98
$1,695.46
$1,823.06
$2,276.36		 $1,916.30
$2,036.78
$2,164.38
$2,617.68		 $787.49
$847.73
$911.53
$1,138.18		 $1,128.81
$1,189.05
$1,252.85
$1,479.50		 $1,470.13
$1,530.37
$1,594.17
$1,820.82		 $407.36

Plan: (HMO) Health First Bronze HMO 100 HSA 1794

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $6,450 : Family: $12,900
Out of Pocket Maximum per year: Individual: $6,450 : Family: $12,900

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		 $303.49
$344.46
$387.86
$542.03
$823.66		 $606.98
$688.92
$775.72
$1,084.06
$1,647.32		 $839.15
$921.09
$1,007.89
$1,316.23		 $1,071.32
$1,153.26
$1,240.06
$1,548.40		 $1,303.49
$1,385.43
$1,472.23
$1,780.57		 $535.66
$576.63
$620.03
$774.20		 $767.83
$808.80
$852.20
$1,006.37		 $1,000.00
$1,040.97
$1,084.37
$1,238.54		 $277.08

Plan: (HMO) Health First Silver HMO 65 1806

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-855-443-4735 - Provider Directory for This Plan: (Health First Commercial Plans, Inc.)

Deductible: Individual: $2,650 : Family: $5,300
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $425.90
$483.40
$544.30
$760.66
$1,155.89		 $851.80
$966.80
$1,088.60
$1,521.32
$2,311.78		 $1,177.61
$1,292.61
$1,414.41
$1,847.13		 $1,503.42
$1,618.42
$1,740.22
$2,172.94		 $1,829.23
$1,944.23
$2,066.03
$2,498.75		 $751.71
$809.21
$870.11
$1,086.47		 $1,077.52
$1,135.02
$1,195.92
$1,412.28		 $1,403.33
$1,460.83
$1,521.73
$1,738.09		 $388.85
ADVERTISEMENT

Florida Health Care Plan, Inc.

Local: 1-386-676-7110 | Toll Free: 1-800-232-0578

TTY: 1-800-955-8771

Plan: (HMO) Gym Access IND Essential Plus Catastrophic HMO 36

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $7,900 : Family: $15,800
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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
Catastrophic 21
30
40
50
60		 $212.54
$241.23
$271.62
$379.59
$576.83		 $425.08
$482.46
$543.24
$759.18
$1,153.66		 $587.67
$645.05
$705.83
$921.77		 $750.26
$807.64
$868.42
$1,084.36		 $912.85
$970.23
$1,031.01
$1,246.95		 $375.13
$403.82
$434.21
$542.18		 $537.72
$566.41
$596.80
$704.77		 $700.31
$729.00
$759.39
$867.36		 $194.05

Plan: (POS) Gym Access IND Essential Plus Catastrophic POS 37

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $7,900 : Family: $15,800
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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
Catastrophic 21
30
40
50
60		 $233.79
$265.35
$298.78
$417.55
$634.50		 $467.58
$530.70
$597.56
$835.10
$1,269.00		 $646.43
$709.55
$776.41
$1,013.95		 $825.28
$888.40
$955.26
$1,192.80		 $1,004.13
$1,067.25
$1,134.11
$1,371.65		 $412.64
$444.20
$477.63
$596.40		 $591.49
$623.05
$656.48
$775.25		 $770.34
$801.90
$835.33
$954.10		 $213.45

Plan: (HMO) Gym Access IND Essential Plus Silver HMO 53

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $362.23
$411.13
$462.93
$646.94
$983.09		 $724.46
$822.26
$925.86
$1,293.88
$1,966.18		 $1,001.56
$1,099.36
$1,202.96
$1,570.98		 $1,278.66
$1,376.46
$1,480.06
$1,848.08		 $1,555.76
$1,653.56
$1,757.16
$2,125.18		 $639.33
$688.23
$740.03
$924.04		 $916.43
$965.33
$1,017.13
$1,201.14		 $1,193.53
$1,242.43
$1,294.23
$1,478.24		 $330.71

Plan: (HMO) Gym Access IND Essential Plus Gold HMO 63

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

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		 $356.63
$404.78
$455.78
$636.95
$967.90		 $713.26
$809.56
$911.56
$1,273.90
$1,935.80		 $986.08
$1,082.38
$1,184.38
$1,546.72		 $1,258.90
$1,355.20
$1,457.20
$1,819.54		 $1,531.72
$1,628.02
$1,730.02
$2,092.36		 $629.45
$677.60
$728.60
$909.77		 $902.27
$950.42
$1,001.42
$1,182.59		 $1,175.09
$1,223.24
$1,274.24
$1,455.41		 $325.61

Plan: (HMO) Gym Access IND Essential Plus Platinum HMO 65

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: 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
Platinum 21
30
40
50
60		 $465.87
$528.76
$595.38
$832.04
$1,264.36		 $931.74
$1,057.52
$1,190.76
$1,664.08
$2,528.72		 $1,288.13
$1,413.91
$1,547.15
$2,020.47		 $1,644.52
$1,770.30
$1,903.54
$2,376.86		 $2,000.91
$2,126.69
$2,259.93
$2,733.25		 $822.26
$885.15
$951.77
$1,188.43		 $1,178.65
$1,241.54
$1,308.16
$1,544.82		 $1,535.04
$1,597.93
$1,664.55
$1,901.21		 $425.34

Plan: (POS) Gym Access IND Essential Plus Silver POS 54

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $381.12
$432.58
$487.08
$680.69
$1,034.37		 $762.24
$865.16
$974.16
$1,361.38
$2,068.74		 $1,053.80
$1,156.72
$1,265.72
$1,652.94		 $1,345.36
$1,448.28
$1,557.28
$1,944.50		 $1,636.92
$1,739.84
$1,848.84
$2,236.06		 $672.68
$724.14
$778.64
$972.25		 $964.24
$1,015.70
$1,070.20
$1,263.81		 $1,255.80
$1,307.26
$1,361.76
$1,555.37		 $347.97

Plan: (HMO) Gym Access IND Platinum HMO 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: 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
Platinum 21
30
40
50
60		 $455.92
$517.47
$582.67
$814.28
$1,237.37		 $911.84
$1,034.94
$1,165.34
$1,628.56
$2,474.74		 $1,260.62
$1,383.72
$1,514.12
$1,977.34		 $1,609.40
$1,732.50
$1,862.90
$2,326.12		 $1,958.18
$2,081.28
$2,211.68
$2,674.90		 $804.70
$866.25
$931.45
$1,163.06		 $1,153.48
$1,215.03
$1,280.23
$1,511.84		 $1,502.26
$1,563.81
$1,629.01
$1,860.62		 $416.26

Plan: (POS) Gym Access IND Platinum POS 4000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: 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
Platinum 21
30
40
50
60		 $501.51
$569.22
$640.93
$895.70
$1,361.10		 $1,003.02
$1,138.44
$1,281.86
$1,791.40
$2,722.20		 $1,386.68
$1,522.10
$1,665.52
$2,175.06		 $1,770.34
$1,905.76
$2,049.18
$2,558.72		 $2,154.00
$2,289.42
$2,432.84
$2,942.38		 $885.17
$952.88
$1,024.59
$1,279.36		 $1,268.83
$1,336.54
$1,408.25
$1,663.02		 $1,652.49
$1,720.20
$1,791.91
$2,046.68		 $457.88

Plan: (HMO) Gym Access IND Gold HMO 5500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: 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
Gold 21
30
40
50
60		 $355.73
$403.75
$454.62
$635.33
$965.45		 $711.46
$807.50
$909.24
$1,270.66
$1,930.90		 $983.59
$1,079.63
$1,181.37
$1,542.79		 $1,255.72
$1,351.76
$1,453.50
$1,814.92		 $1,527.85
$1,623.89
$1,725.63
$2,087.05		 $627.86
$675.88
$726.75
$907.46		 $899.99
$948.01
$998.88
$1,179.59		 $1,172.12
$1,220.14
$1,271.01
$1,451.72		 $324.78

Plan: (POS) Gym Access IND Gold POS 5500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $2,500 : Family: $5,000
Out of Pocket Maximum per year: 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
Gold 21
30
40
50
60		 $391.30
$444.13
$500.08
$698.86
$1,061.99		 $782.60
$888.26
$1,000.16
$1,397.72
$2,123.98		 $1,081.94
$1,187.60
$1,299.50
$1,697.06		 $1,381.28
$1,486.94
$1,598.84
$1,996.40		 $1,680.62
$1,786.28
$1,898.18
$2,295.74		 $690.64
$743.47
$799.42
$998.20		 $989.98
$1,042.81
$1,098.76
$1,297.54		 $1,289.32
$1,342.15
$1,398.10
$1,596.88		 $357.26

Plan: (HMO) Gym Access IND Gold HMO 4500

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $2,000 : Family: $4,000
Out of Pocket Maximum per year: Individual: $4,500 : Family: $9,000

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		 $357.05
$405.25
$456.31
$637.68
$969.02		 $714.10
$810.50
$912.62
$1,275.36
$1,938.04		 $987.24
$1,083.64
$1,185.76
$1,548.50		 $1,260.38
$1,356.78
$1,458.90
$1,821.64		 $1,533.52
$1,629.92
$1,732.04
$2,094.78		 $630.19
$678.39
$729.45
$910.82		 $903.33
$951.53
$1,002.59
$1,183.96		 $1,176.47
$1,224.67
$1,275.73
$1,457.10		 $325.98

Plan: (HMO) Gym Access IND Bronze HMO HSA 5000/6550

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

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
Expanded Bronze 21
30
40
50
60		 $244.04
$276.99
$311.89
$435.86
$662.33		 $488.08
$553.98
$623.78
$871.72
$1,324.66		 $674.77
$740.67
$810.47
$1,058.41		 $861.46
$927.36
$997.16
$1,245.10		 $1,048.15
$1,114.05
$1,183.85
$1,431.79		 $430.73
$463.68
$498.58
$622.55		 $617.42
$650.37
$685.27
$809.24		 $804.11
$837.06
$871.96
$995.93		 $222.81

Plan: (HMO) Gym Access IND Bronze HMO HSA 6000/6000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

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		 $248.30
$281.82
$317.33
$443.46
$673.88		 $496.60
$563.64
$634.66
$886.92
$1,347.76		 $686.55
$753.59
$824.61
$1,076.87		 $876.50
$943.54
$1,014.56
$1,266.82		 $1,066.45
$1,133.49
$1,204.51
$1,456.77		 $438.25
$471.77
$507.28
$633.41		 $628.20
$661.72
$697.23
$823.36		 $818.15
$851.67
$887.18
$1,013.31		 $226.70

Plan: (HMO) Gym Access IND Bronze HMO BC 3841

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $6,400 : Family: $12,800
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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
Expanded Bronze 21
30
40
50
60		 $260.41
$295.57
$332.81
$465.10
$706.76		 $520.82
$591.14
$665.62
$930.20
$1,413.52		 $720.04
$790.36
$864.84
$1,129.42		 $919.26
$989.58
$1,064.06
$1,328.64		 $1,118.48
$1,188.80
$1,263.28
$1,527.86		 $459.63
$494.79
$532.03
$664.32		 $658.85
$694.01
$731.25
$863.54		 $858.07
$893.23
$930.47
$1,062.76		 $237.76

Plan: (POS) Gym Access IND Bronze POS BC 3841

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $6,400 : Family: $12,800
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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
Expanded Bronze 21
30
40
50
60		 $286.46
$325.13
$366.09
$511.61
$777.45		 $572.92
$650.26
$732.18
$1,023.22
$1,554.90		 $792.06
$869.40
$951.32
$1,242.36		 $1,011.20
$1,088.54
$1,170.46
$1,461.50		 $1,230.34
$1,307.68
$1,389.60
$1,680.64		 $505.60
$544.27
$585.23
$730.75		 $724.74
$763.41
$804.37
$949.89		 $943.88
$982.55
$1,023.51
$1,169.03		 $261.54

Plan: (HMO) Gym Access IND Silver HMO BC 0941

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $5,600 : Family: $11,200
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $348.68
$395.75
$445.61
$622.74
$946.32		 $697.36
$791.50
$891.22
$1,245.48
$1,892.64		 $964.10
$1,058.24
$1,157.96
$1,512.22		 $1,230.84
$1,324.98
$1,424.70
$1,778.96		 $1,497.58
$1,591.72
$1,691.44
$2,045.70		 $615.42
$662.49
$712.35
$889.48		 $882.16
$929.23
$979.09
$1,156.22		 $1,148.90
$1,195.97
$1,245.83
$1,422.96		 $318.35

Plan: (POS) Gym Access IND Silver POS BC 0941

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $5,600 : Family: $11,200
Out of Pocket Maximum per year: Individual: $7,150 : Family: $14,300

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $383.55
$435.33
$490.18
$685.02
$1,040.96		 $767.10
$870.66
$980.36
$1,370.04
$2,081.92		 $1,060.52
$1,164.08
$1,273.78
$1,663.46		 $1,353.94
$1,457.50
$1,567.20
$1,956.88		 $1,647.36
$1,750.92
$1,860.62
$2,250.30		 $676.97
$728.75
$783.60
$978.44		 $970.39
$1,022.17
$1,077.02
$1,271.86		 $1,263.81
$1,315.59
$1,370.44
$1,565.28		 $350.18

Plan: (HMO) IND Silver HMO BC 7741

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $7,300 : Family: $14,600

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		 $336.32
$381.73
$429.82
$600.68
$912.79		 $672.64
$763.46
$859.64
$1,201.36
$1,825.58		 $929.93
$1,020.75
$1,116.93
$1,458.65		 $1,187.22
$1,278.04
$1,374.22
$1,715.94		 $1,444.51
$1,535.33
$1,631.51
$1,973.23		 $593.61
$639.02
$687.11
$857.97		 $850.90
$896.31
$944.40
$1,115.26		 $1,108.19
$1,153.60
$1,201.69
$1,372.55		 $307.06

Plan: (POS) Gym Access IND Silver POS BC 7741

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $7,300 : Family: $14,600

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		 $370.70
$420.74
$473.75
$662.07
$1,006.08		 $741.40
$841.48
$947.50
$1,324.14
$2,012.16		 $1,024.98
$1,125.06
$1,231.08
$1,607.72		 $1,308.56
$1,408.64
$1,514.66
$1,891.30		 $1,592.14
$1,692.22
$1,798.24
$2,174.88		 $654.28
$704.32
$757.33
$945.65		 $937.86
$987.90
$1,040.91
$1,229.23		 $1,221.44
$1,271.48
$1,324.49
$1,512.81		 $338.45

Plan: (HMO) Gym Access IND Gold HMO BC 5651

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $0 : Family: $0
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		 $374.40
$424.94
$478.48
$668.68
$1,016.12		 $748.80
$849.88
$956.96
$1,337.36
$2,032.24		 $1,035.22
$1,136.30
$1,243.38
$1,623.78		 $1,321.64
$1,422.72
$1,529.80
$1,910.20		 $1,608.06
$1,709.14
$1,816.22
$2,196.62		 $660.82
$711.36
$764.90
$955.10		 $947.24
$997.78
$1,051.32
$1,241.52		 $1,233.66
$1,284.20
$1,337.74
$1,527.94		 $341.83

Plan: (POS) Gym Access IND Gold POS BC 5651

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $0 : Family: $0
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		 $411.84
$467.44
$526.33
$735.54
$1,117.73		 $823.68
$934.88
$1,052.66
$1,471.08
$2,235.46		 $1,138.74
$1,249.94
$1,367.72
$1,786.14		 $1,453.80
$1,565.00
$1,682.78
$2,101.20		 $1,768.86
$1,880.06
$1,997.84
$2,416.26		 $726.90
$782.50
$841.39
$1,050.60		 $1,041.96
$1,097.56
$1,156.45
$1,365.66		 $1,357.02
$1,412.62
$1,471.51
$1,680.72		 $376.01

Plan: (HMO) Gym Access IND Platinum HMO BC 5841

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $800 : Family: $1,600
Out of Pocket Maximum per year: Individual: $2,500 : Family: $5,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Platinum 21
30
40
50
60		 $447.19
$507.56
$571.50
$798.67
$1,213.66		 $894.38
$1,015.12
$1,143.00
$1,597.34
$2,427.32		 $1,236.48
$1,357.22
$1,485.10
$1,939.44		 $1,578.58
$1,699.32
$1,827.20
$2,281.54		 $1,920.68
$2,041.42
$2,169.30
$2,623.64		 $789.29
$849.66
$913.60
$1,140.77		 $1,131.39
$1,191.76
$1,255.70
$1,482.87		 $1,473.49
$1,533.86
$1,597.80
$1,824.97		 $408.28

Plan: (POS) Gym Access IND Platinum POS BC 5841

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $800 : Family: $1,600
Out of Pocket Maximum per year: Individual: $2,500 : Family: $5,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Platinum 21
30
40
50
60		 $491.91
$558.31
$628.66
$878.55
$1,335.03		 $983.82
$1,116.62
$1,257.32
$1,757.10
$2,670.06		 $1,360.13
$1,492.93
$1,633.63
$2,133.41		 $1,736.44
$1,869.24
$2,009.94
$2,509.72		 $2,112.75
$2,245.55
$2,386.25
$2,886.03		 $868.22
$934.62
$1,004.97
$1,254.86		 $1,244.53
$1,310.93
$1,381.28
$1,631.17		 $1,620.84
$1,687.24
$1,757.59
$2,007.48		 $449.11

Plan: (HMO) Gym Access IND Platinum HMO BC 1941

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: 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
Platinum 21
30
40
50
60		 $465.71
$528.58
$595.17
$831.75
$1,263.92		 $931.42
$1,057.16
$1,190.34
$1,663.50
$2,527.84		 $1,287.68
$1,413.42
$1,546.60
$2,019.76		 $1,643.94
$1,769.68
$1,902.86
$2,376.02		 $2,000.20
$2,125.94
$2,259.12
$2,732.28		 $821.97
$884.84
$951.43
$1,188.01		 $1,178.23
$1,241.10
$1,307.69
$1,544.27		 $1,534.49
$1,597.36
$1,663.95
$1,900.53		 $425.19

Plan: (POS) Gym Access IND Platinum POS BC 1941

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $0 : Family: $0
Out of Pocket Maximum per year: 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
Platinum 21
30
40
50
60		 $512.27
$581.43
$654.68
$914.92
$1,390.31		 $1,024.54
$1,162.86
$1,309.36
$1,829.84
$2,780.62		 $1,416.43
$1,554.75
$1,701.25
$2,221.73		 $1,808.32
$1,946.64
$2,093.14
$2,613.62		 $2,200.21
$2,338.53
$2,485.03
$3,005.51		 $904.16
$973.32
$1,046.57
$1,306.81		 $1,296.05
$1,365.21
$1,438.46
$1,698.70		 $1,687.94
$1,757.10
$1,830.35
$2,090.59		 $467.70

Plan: (HMO) Gym Access IND Platinum HMO 91

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $250 : Family: $500
Out of Pocket Maximum per year: Individual: $2,500 : Family: $5,000

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Platinum 21
30
40
50
60		 $463.95
$526.58
$592.93
$828.61
$1,259.16		 $927.90
$1,053.16
$1,185.86
$1,657.22
$2,518.32		 $1,282.82
$1,408.08
$1,540.78
$2,012.14		 $1,637.74
$1,763.00
$1,895.70
$2,367.06		 $1,992.66
$2,117.92
$2,250.62
$2,721.98		 $818.87
$881.50
$947.85
$1,183.53		 $1,173.79
$1,236.42
$1,302.77
$1,538.45		 $1,528.71
$1,591.34
$1,657.69
$1,893.37		 $423.58

Plan: (HMO) Gym Acccess IND Platinum HMO 92

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $500 : Family: $1,000
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
Platinum 21
30
40
50
60		 $462.87
$525.36
$591.55
$826.69
$1,256.23		 $925.74
$1,050.72
$1,183.10
$1,653.38
$2,512.46		 $1,279.84
$1,404.82
$1,537.20
$2,007.48		 $1,633.94
$1,758.92
$1,891.30
$2,361.58		 $1,988.04
$2,113.02
$2,245.40
$2,715.68		 $816.97
$879.46
$945.65
$1,180.79		 $1,171.07
$1,233.56
$1,299.75
$1,534.89		 $1,525.17
$1,587.66
$1,653.85
$1,888.99		 $422.60

Plan: (HMO) Gym Access IND Bronze Standardized HMO

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

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		 $247.83
$281.28
$316.72
$442.62
$672.60		 $495.66
$562.56
$633.44
$885.24
$1,345.20		 $685.25
$752.15
$823.03
$1,074.83		 $874.84
$941.74
$1,012.62
$1,264.42		 $1,064.43
$1,131.33
$1,202.21
$1,454.01		 $437.42
$470.87
$506.31
$632.21		 $627.01
$660.46
$695.90
$821.80		 $816.60
$850.05
$885.49
$1,011.39		 $226.27

Plan: (HMO) Gym Access IND Silver Standardized HMO 1

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $3,500 : Family: $7,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Silver 21
30
40
50
60		 $365.10
$414.39
$466.60
$652.07
$990.88		 $730.20
$828.78
$933.20
$1,304.14
$1,981.76		 $1,009.50
$1,108.08
$1,212.50
$1,583.44		 $1,288.80
$1,387.38
$1,491.80
$1,862.74		 $1,568.10
$1,666.68
$1,771.10
$2,142.04		 $644.40
$693.69
$745.90
$931.37		 $923.70
$972.99
$1,025.20
$1,210.67		 $1,203.00
$1,252.29
$1,304.50
$1,489.97		 $333.34

Plan: (HMO) Gym Access IND Bronze HMO 1340

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $7,900 : Family: $15,800
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

Monthly Premiums:
Metal level Age Individual
 Couple
Couple
w 1 Kid
 Couple
w 2 Kids
 Couple
w3+Kids
 Single
w 1 Kid
 Single
w 2 Kids
 Single
w3+Kids
 Child
any age
Bronze 21
30
40
50
60		 $225.75
$256.23
$288.51
$403.19
$612.69		 $451.50
$512.46
$577.02
$806.38
$1,225.38		 $624.20
$685.16
$749.72
$979.08		 $796.90
$857.86
$922.42
$1,151.78		 $969.60
$1,030.56
$1,095.12
$1,324.48		 $398.45
$428.93
$461.21
$575.89		 $571.15
$601.63
$633.91
$748.59		 $743.85
$774.33
$806.61
$921.29		 $206.11

Plan: (HMO) Gym Access IND Bronze HMO 1041

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $4,500 : Family: $9,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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
Expanded Bronze 21
30
40
50
60		 $253.96
$288.24
$324.56
$453.57
$689.24		 $507.92
$576.48
$649.12
$907.14
$1,378.48		 $702.20
$770.76
$843.40
$1,101.42		 $896.48
$965.04
$1,037.68
$1,295.70		 $1,090.76
$1,159.32
$1,231.96
$1,489.98		 $448.24
$482.52
$518.84
$647.85		 $642.52
$676.80
$713.12
$842.13		 $836.80
$871.08
$907.40
$1,036.41		 $231.86

Plan: (POS) Gym Access IND Bronze POS 1042

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $5,000 : Family: $10,000
Out of Pocket Maximum per year: Individual: $7,900 : Family: $15,800

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
Expanded Bronze 21
30
40
50
60		 $279.35
$317.06
$357.01
$498.92
$758.16		 $558.70
$634.12
$714.02
$997.84
$1,516.32		 $772.40
$847.82
$927.72
$1,211.54		 $986.10
$1,061.52
$1,141.42
$1,425.24		 $1,199.80
$1,275.22
$1,355.12
$1,638.94		 $493.05
$530.76
$570.71
$712.62		 $706.75
$744.46
$784.41
$926.32		 $920.45
$958.16
$998.11
$1,140.02		 $255.05

Plan: (HMO) Gym Access IND Gold HMO H.S.A 9010

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-232-0578 - Provider Directory for This Plan: (Florida Health Care Plan, Inc.)

Deductible: Individual: $1,500 : Family: $3,000
Out of Pocket Maximum per year: 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
Gold 21
30
40
50
60		 $345.45
$392.08
$441.48
$616.97
$937.55		 $690.90
$784.16
$882.96
$1,233.94
$1,875.10		 $955.17
$1,048.43
$1,147.23
$1,498.21		 $1,219.44
$1,312.70
$1,411.50
$1,762.48		 $1,483.71
$1,576.97
$1,675.77
$2,026.75		 $609.72
$656.35
$705.75
$881.24		 $873.99
$920.62
$970.02
$1,145.51		 $1,138.26
$1,184.89
$1,234.29
$1,409.78		 $315.39

‡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 Brevard County here.

 

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