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Providers for Zip Code 44663

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Obamacare 2019 Marketplace Rates For Tuscarawas County, Ohio

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 Tuscarawas County, Ohio.

Obamacare Providers, Plans and 2019 Rates for Tuscarawas County

Tuscarawas County is in “Rating Area 16” of Ohio.

Currently, there are 45 plans offered in Rating Area 16.

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 New Philadelphia, OH area accept this insurance coverage as within the plan's "network".
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AultCare Insurance Company

Local: 1-330-363-6360 | Toll Free: 1-800-344-8858

TTY: 1-330-363-2393

Plan: (PPO) AultCare Bronze 6000 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,400 : Family: $12,800

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		 $378.95
$430.10
$484.29
$676.80
$1,028.46		 $757.90
$860.20
$968.58
$1,353.60
$2,056.92		 $1,047.79
$1,150.09
$1,258.47
$1,643.49		 $1,337.68
$1,439.98
$1,548.36
$1,933.38		 $1,627.57
$1,729.87
$1,838.25
$2,223.27		 $668.84
$719.99
$774.18
$966.69		 $958.73
$1,009.88
$1,064.07
$1,256.58		 $1,248.62
$1,299.77
$1,353.96
$1,546.47		 $345.98

Plan: (PPO) AultCare Bronze 5000 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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		 $396.74
$450.29
$507.02
$708.56
$1,076.73		 $793.48
$900.58
$1,014.04
$1,417.12
$2,153.46		 $1,096.98
$1,204.08
$1,317.54
$1,720.62		 $1,400.48
$1,507.58
$1,621.04
$2,024.12		 $1,703.98
$1,811.08
$1,924.54
$2,327.62		 $700.24
$753.79
$810.52
$1,012.06		 $1,003.74
$1,057.29
$1,114.02
$1,315.56		 $1,307.24
$1,360.79
$1,417.52
$1,619.06		 $362.22

Plan: (PPO) AultCare Silver 5000 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $5,000 : Family: $10,000
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
Silver 21
30
40
50
60		 $555.05
$629.98
$709.35
$991.32
$1,506.40		 $1,110.10
$1,259.96
$1,418.70
$1,982.64
$3,012.80		 $1,534.71
$1,684.57
$1,843.31
$2,407.25		 $1,959.32
$2,109.18
$2,267.92
$2,831.86		 $2,383.93
$2,533.79
$2,692.53
$3,256.47		 $979.66
$1,054.59
$1,133.96
$1,415.93		 $1,404.27
$1,479.20
$1,558.57
$1,840.54		 $1,828.88
$1,903.81
$1,983.18
$2,265.15		 $506.76

Plan: (PPO) AultCare Gold 1200 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $1,200 : Family: $2,400
Out of Pocket Maximum per year: Individual: $5,800 : Family: $11,600

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
Gold 21
30
40
50
60		 $613.38
$696.18
$783.90
$1,095.49
$1,664.71		 $1,226.76
$1,392.36
$1,567.80
$2,190.98
$3,329.42		 $1,695.99
$1,861.59
$2,037.03
$2,660.21		 $2,165.22
$2,330.82
$2,506.26
$3,129.44		 $2,634.45
$2,800.05
$2,975.49
$3,598.67		 $1,082.61
$1,165.41
$1,253.13
$1,564.72		 $1,551.84
$1,634.64
$1,722.36
$2,033.95		 $2,021.07
$2,103.87
$2,191.59
$2,503.18		 $560.01

Plan: (PPO) AultCare Gold 750 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $750 : Family: $1,500
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		 $612.95
$695.70
$783.35
$1,094.73
$1,663.54		 $1,225.90
$1,391.40
$1,566.70
$2,189.46
$3,327.08		 $1,694.81
$1,860.31
$2,035.61
$2,658.37		 $2,163.72
$2,329.22
$2,504.52
$3,127.28		 $2,632.63
$2,798.13
$2,973.43
$3,596.19		 $1,081.86
$1,164.61
$1,252.26
$1,563.64		 $1,550.77
$1,633.52
$1,721.17
$2,032.55		 $2,019.68
$2,102.43
$2,190.08
$2,501.46		 $559.62

Plan: (PPO) AultCare Gold 350 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $350 : Family: $700
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

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		 $624.87
$709.23
$798.58
$1,116.02
$1,695.90		 $1,249.74
$1,418.46
$1,597.16
$2,232.04
$3,391.80		 $1,727.77
$1,896.49
$2,075.19
$2,710.07		 $2,205.80
$2,374.52
$2,553.22
$3,188.10		 $2,683.83
$2,852.55
$3,031.25
$3,666.13		 $1,102.90
$1,187.26
$1,276.61
$1,594.05		 $1,580.93
$1,665.29
$1,754.64
$2,072.08		 $2,058.96
$2,143.32
$2,232.67
$2,550.11		 $570.51

Plan: (PPO) AultCare Catastrophic Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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		 $202.35
$229.66
$258.59
$361.38
$549.16		 $404.70
$459.32
$517.18
$722.76
$1,098.32		 $559.49
$614.11
$671.97
$877.55		 $714.28
$768.90
$826.76
$1,032.34		 $869.07
$923.69
$981.55
$1,187.13		 $357.14
$384.45
$413.38
$516.17		 $511.93
$539.24
$568.17
$670.96		 $666.72
$694.03
$722.96
$825.75		 $184.74

Plan: (PPO) AultCare Bronze 6000 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,400 : Family: $12,800

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		 $299.38
$339.79
$382.60
$534.69
$812.51		 $598.76
$679.58
$765.20
$1,069.38
$1,625.02		 $827.78
$908.60
$994.22
$1,298.40		 $1,056.80
$1,137.62
$1,223.24
$1,527.42		 $1,285.82
$1,366.64
$1,452.26
$1,756.44		 $528.40
$568.81
$611.62
$763.71		 $757.42
$797.83
$840.64
$992.73		 $986.44
$1,026.85
$1,069.66
$1,221.75		 $273.33

Plan: (PPO) AultCare Bronze 5000 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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		 $313.34
$355.63
$400.44
$559.61
$850.38		 $626.68
$711.26
$800.88
$1,119.22
$1,700.76		 $866.38
$950.96
$1,040.58
$1,358.92		 $1,106.08
$1,190.66
$1,280.28
$1,598.62		 $1,345.78
$1,430.36
$1,519.98
$1,838.32		 $553.04
$595.33
$640.14
$799.31		 $792.74
$835.03
$879.84
$1,039.01		 $1,032.44
$1,074.73
$1,119.54
$1,278.71		 $286.07

Plan: (PPO) AultCare Silver 5000 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $5,000 : Family: $10,000
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
Silver 21
30
40
50
60		 $437.37
$496.40
$558.95
$781.13
$1,187.00		 $874.74
$992.80
$1,117.90
$1,562.26
$2,374.00		 $1,209.32
$1,327.38
$1,452.48
$1,896.84		 $1,543.90
$1,661.96
$1,787.06
$2,231.42		 $1,878.48
$1,996.54
$2,121.64
$2,566.00		 $771.95
$830.98
$893.53
$1,115.71		 $1,106.53
$1,165.56
$1,228.11
$1,450.29		 $1,441.11
$1,500.14
$1,562.69
$1,784.87		 $399.31

Plan: (PPO) AultCare Gold 1200 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $1,200 : Family: $2,400
Out of Pocket Maximum per year: Individual: $5,800 : Family: $11,600

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
Gold 21
30
40
50
60		 $484.04
$549.38
$618.60
$864.48
$1,313.67		 $968.08
$1,098.76
$1,237.20
$1,728.96
$2,627.34		 $1,338.37
$1,469.05
$1,607.49
$2,099.25		 $1,708.66
$1,839.34
$1,977.78
$2,469.54		 $2,078.95
$2,209.63
$2,348.07
$2,839.83		 $854.33
$919.67
$988.89
$1,234.77		 $1,224.62
$1,289.96
$1,359.18
$1,605.06		 $1,594.91
$1,660.25
$1,729.47
$1,975.35		 $441.92

Plan: (PPO) AultCare Gold 750 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $750 : Family: $1,500
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		 $483.83
$549.15
$618.33
$864.12
$1,313.11		 $967.66
$1,098.30
$1,236.66
$1,728.24
$2,626.22		 $1,337.79
$1,468.43
$1,606.79
$2,098.37		 $1,707.92
$1,838.56
$1,976.92
$2,468.50		 $2,078.05
$2,208.69
$2,347.05
$2,838.63		 $853.96
$919.28
$988.46
$1,234.25		 $1,224.09
$1,289.41
$1,358.59
$1,604.38		 $1,594.22
$1,659.54
$1,728.72
$1,974.51		 $441.74

Plan: (PPO) AultCare Gold 350 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $350 : Family: $700
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

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		 $493.30
$559.89
$630.43
$881.03
$1,338.81		 $986.60
$1,119.78
$1,260.86
$1,762.06
$2,677.62		 $1,363.97
$1,497.15
$1,638.23
$2,139.43		 $1,741.34
$1,874.52
$2,015.60
$2,516.80		 $2,118.71
$2,251.89
$2,392.97
$2,894.17		 $870.67
$937.26
$1,007.80
$1,258.40		 $1,248.04
$1,314.63
$1,385.17
$1,635.77		 $1,625.41
$1,692.00
$1,762.54
$2,013.14		 $450.38

Plan: (PPO) AultCare Catastrophic

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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		 $259.00
$293.96
$331.00
$462.57
$702.92		 $518.00
$587.92
$662.00
$925.14
$1,405.84		 $716.13
$786.05
$860.13
$1,123.27		 $914.26
$984.18
$1,058.26
$1,321.40		 $1,112.39
$1,182.31
$1,256.39
$1,519.53		 $457.13
$492.09
$529.13
$660.70		 $655.26
$690.22
$727.26
$858.83		 $853.39
$888.35
$925.39
$1,056.96		 $236.47

Plan: (PPO) AultCare Bronze 6000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,400 : Family: $12,800

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		 $383.21
$434.93
$489.73
$684.40
$1,040.01		 $766.42
$869.86
$979.46
$1,368.80
$2,080.02		 $1,059.57
$1,163.01
$1,272.61
$1,661.95		 $1,352.72
$1,456.16
$1,565.76
$1,955.10		 $1,645.87
$1,749.31
$1,858.91
$2,248.25		 $676.36
$728.08
$782.88
$977.55		 $969.51
$1,021.23
$1,076.03
$1,270.70		 $1,262.66
$1,314.38
$1,369.18
$1,563.85		 $349.86

Plan: (PPO) AultCare Bronze 5000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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		 $401.07
$455.21
$512.56
$716.30
$1,088.48		 $802.14
$910.42
$1,025.12
$1,432.60
$2,176.96		 $1,108.95
$1,217.23
$1,331.93
$1,739.41		 $1,415.76
$1,524.04
$1,638.74
$2,046.22		 $1,722.57
$1,830.85
$1,945.55
$2,353.03		 $707.88
$762.02
$819.37
$1,023.11		 $1,014.69
$1,068.83
$1,126.18
$1,329.92		 $1,321.50
$1,375.64
$1,432.99
$1,636.73		 $366.17

Plan: (PPO) AultCare Silver 5000

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $5,000 : Family: $10,000
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
Silver 21
30
40
50
60		 $559.83
$635.40
$715.45
$999.84
$1,519.36		 $1,119.66
$1,270.80
$1,430.90
$1,999.68
$3,038.72		 $1,547.92
$1,699.06
$1,859.16
$2,427.94		 $1,976.18
$2,127.32
$2,287.42
$2,856.20		 $2,404.44
$2,555.58
$2,715.68
$3,284.46		 $988.09
$1,063.66
$1,143.71
$1,428.10		 $1,416.35
$1,491.92
$1,571.97
$1,856.36		 $1,844.61
$1,920.18
$2,000.23
$2,284.62		 $511.12

Plan: (PPO) AultCare Gold 1200

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $1,200 : Family: $2,400
Out of Pocket Maximum per year: Individual: $5,800 : Family: $11,600

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
Gold 21
30
40
50
60		 $619.57
$703.20
$791.80
$1,106.54
$1,681.49		 $1,239.14
$1,406.40
$1,583.60
$2,213.08
$3,362.98		 $1,713.11
$1,880.37
$2,057.57
$2,687.05		 $2,187.08
$2,354.34
$2,531.54
$3,161.02		 $2,661.05
$2,828.31
$3,005.51
$3,634.99		 $1,093.54
$1,177.17
$1,265.77
$1,580.51		 $1,567.51
$1,651.14
$1,739.74
$2,054.48		 $2,041.48
$2,125.11
$2,213.71
$2,528.45		 $565.66

Plan: (PPO) AultCare Gold 750

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $750 : Family: $1,500
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		 $619.31
$702.91
$791.47
$1,106.07
$1,680.78		 $1,238.62
$1,405.82
$1,582.94
$2,212.14
$3,361.56		 $1,712.39
$1,879.59
$2,056.71
$2,685.91		 $2,186.16
$2,353.36
$2,530.48
$3,159.68		 $2,659.93
$2,827.13
$3,004.25
$3,633.45		 $1,093.08
$1,176.68
$1,265.24
$1,579.84		 $1,566.85
$1,650.45
$1,739.01
$2,053.61		 $2,040.62
$2,124.22
$2,212.78
$2,527.38		 $565.42

Plan: (PPO) AultCare Gold 350

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $350 : Family: $700
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

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		 $631.42
$716.66
$806.95
$1,127.71
$1,713.67		 $1,262.84
$1,433.32
$1,613.90
$2,255.42
$3,427.34		 $1,745.88
$1,916.36
$2,096.94
$2,738.46		 $2,228.92
$2,399.40
$2,579.98
$3,221.50		 $2,711.96
$2,882.44
$3,063.02
$3,704.54		 $1,114.46
$1,199.70
$1,289.99
$1,610.75		 $1,597.50
$1,682.74
$1,773.03
$2,093.79		 $2,080.54
$2,165.78
$2,256.07
$2,576.83		 $576.49

Plan: (PPO) AultCare Catastrophic No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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		 $256.24
$290.83
$327.47
$457.64
$695.44		 $512.48
$581.66
$654.94
$915.28
$1,390.88		 $708.50
$777.68
$850.96
$1,111.30		 $904.52
$973.70
$1,046.98
$1,307.32		 $1,100.54
$1,169.72
$1,243.00
$1,503.34		 $452.26
$486.85
$523.49
$653.66		 $648.28
$682.87
$719.51
$849.68		 $844.30
$878.89
$915.53
$1,045.70		 $233.95

Plan: (PPO) AultCare Gold 350 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $350 : Family: $700
Out of Pocket Maximum per year: Individual: $6,350 : Family: $12,700

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		 $488.18
$554.08
$623.89
$871.89
$1,324.92		 $976.36
$1,108.16
$1,247.78
$1,743.78
$2,649.84		 $1,349.82
$1,481.62
$1,621.24
$2,117.24		 $1,723.28
$1,855.08
$1,994.70
$2,490.70		 $2,096.74
$2,228.54
$2,368.16
$2,864.16		 $861.64
$927.54
$997.35
$1,245.35		 $1,235.10
$1,301.00
$1,370.81
$1,618.81		 $1,608.56
$1,674.46
$1,744.27
$1,992.27		 $445.71

Plan: (PPO) AultCare Gold 750 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $750 : Family: $1,500
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		 $478.87
$543.51
$611.99
$855.25
$1,299.64		 $957.74
$1,087.02
$1,223.98
$1,710.50
$2,599.28		 $1,324.07
$1,453.35
$1,590.31
$2,076.83		 $1,690.40
$1,819.68
$1,956.64
$2,443.16		 $2,056.73
$2,186.01
$2,322.97
$2,809.49		 $845.20
$909.84
$978.32
$1,221.58		 $1,211.53
$1,276.17
$1,344.65
$1,587.91		 $1,577.86
$1,642.50
$1,710.98
$1,954.24		 $437.20

Plan: (PPO) AultCare Gold 1200 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $1,200 : Family: $2,400
Out of Pocket Maximum per year: Individual: $5,800 : Family: $11,600

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
Gold 21
30
40
50
60		 $479.21
$543.89
$612.42
$855.85
$1,300.55		 $958.42
$1,087.78
$1,224.84
$1,711.70
$2,601.10		 $1,325.01
$1,454.37
$1,591.43
$2,078.29		 $1,691.60
$1,820.96
$1,958.02
$2,444.88		 $2,058.19
$2,187.55
$2,324.61
$2,811.47		 $845.80
$910.48
$979.01
$1,222.44		 $1,212.39
$1,277.07
$1,345.60
$1,589.03		 $1,578.98
$1,643.66
$1,712.19
$1,955.62		 $437.51

Plan: (PPO) AultCare Silver 5000 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $5,000 : Family: $10,000
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
Silver 21
30
40
50
60		 $433.64
$492.17
$554.18
$774.47
$1,176.88		 $867.28
$984.34
$1,108.36
$1,548.94
$2,353.76		 $1,199.01
$1,316.07
$1,440.09
$1,880.67		 $1,530.74
$1,647.80
$1,771.82
$2,212.40		 $1,862.47
$1,979.53
$2,103.55
$2,544.13		 $765.37
$823.90
$885.91
$1,106.20		 $1,097.10
$1,155.63
$1,217.64
$1,437.93		 $1,428.83
$1,487.36
$1,549.37
$1,769.66		 $395.91

Plan: (PPO) AultCare Bronze 5000 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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		 $309.95
$351.79
$396.11
$553.56
$841.19		 $619.90
$703.58
$792.22
$1,107.12
$1,682.38		 $857.01
$940.69
$1,029.33
$1,344.23		 $1,094.12
$1,177.80
$1,266.44
$1,581.34		 $1,331.23
$1,414.91
$1,503.55
$1,818.45		 $547.06
$588.90
$633.22
$790.67		 $784.17
$826.01
$870.33
$1,027.78		 $1,021.28
$1,063.12
$1,107.44
$1,264.89		 $282.98

Plan: (PPO) AultCare Bronze 6000 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $6,000 : Family: $12,000
Out of Pocket Maximum per year: Individual: $6,400 : Family: $12,800

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		 $296.06
$336.02
$378.35
$528.75
$803.48		 $592.12
$672.04
$756.70
$1,057.50
$1,606.96		 $818.60
$898.52
$983.18
$1,283.98		 $1,045.08
$1,125.00
$1,209.66
$1,510.46		 $1,271.56
$1,351.48
$1,436.14
$1,736.94		 $522.54
$562.50
$604.83
$755.23		 $749.02
$788.98
$831.31
$981.71		 $975.50
$1,015.46
$1,057.79
$1,208.19		 $270.29

Plan: (PPO) AultCare Catastrophic Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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		 $200.19
$227.21
$255.84
$357.53
$543.31		 $400.38
$454.42
$511.68
$715.06
$1,086.62		 $553.52
$607.56
$664.82
$868.20		 $706.66
$760.70
$817.96
$1,021.34		 $859.80
$913.84
$971.10
$1,174.48		 $353.33
$380.35
$408.98
$510.67		 $506.47
$533.49
$562.12
$663.81		 $659.61
$686.63
$715.26
$816.95		 $182.77

Plan: (PPO) AultCare Silver 6850

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

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		 $482.11
$547.19
$616.13
$861.04
$1,308.43		 $964.22
$1,094.38
$1,232.26
$1,722.08
$2,616.86		 $1,333.03
$1,463.19
$1,601.07
$2,090.89		 $1,701.84
$1,832.00
$1,969.88
$2,459.70		 $2,070.65
$2,200.81
$2,338.69
$2,828.51		 $850.92
$916.00
$984.94
$1,229.85		 $1,219.73
$1,284.81
$1,353.75
$1,598.66		 $1,588.54
$1,653.62
$1,722.56
$1,967.47		 $440.16

Plan: (PPO) AultCare Silver 6850 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

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		 $376.65
$427.49
$481.35
$672.69
$1,022.21		 $753.30
$854.98
$962.70
$1,345.38
$2,044.42		 $1,041.43
$1,143.11
$1,250.83
$1,633.51		 $1,329.56
$1,431.24
$1,538.96
$1,921.64		 $1,617.69
$1,719.37
$1,827.09
$2,209.77		 $664.78
$715.62
$769.48
$960.82		 $952.91
$1,003.75
$1,057.61
$1,248.95		 $1,241.04
$1,291.88
$1,345.74
$1,537.08		 $343.88

Plan: (PPO) AultCare Silver 6850 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

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		 $476.99
$541.38
$609.59
$851.90
$1,294.55		 $953.98
$1,082.76
$1,219.18
$1,703.80
$2,589.10		 $1,318.88
$1,447.66
$1,584.08
$2,068.70		 $1,683.78
$1,812.56
$1,948.98
$2,433.60		 $2,048.68
$2,177.46
$2,313.88
$2,798.50		 $841.89
$906.28
$974.49
$1,216.80		 $1,206.79
$1,271.18
$1,339.39
$1,581.70		 $1,571.69
$1,636.08
$1,704.29
$1,946.60		 $435.49

Plan: (PPO) AultCare Silver 6850 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

Deductible: Individual: $6,850 : Family: $13,700
Out of Pocket Maximum per year: Individual: $6,850 : Family: $13,700

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		 $372.65
$422.95
$476.24
$665.55
$1,011.36		 $745.30
$845.90
$952.48
$1,331.10
$2,022.72		 $1,030.37
$1,130.97
$1,237.55
$1,616.17		 $1,315.44
$1,416.04
$1,522.62
$1,901.24		 $1,600.51
$1,701.11
$1,807.69
$2,186.31		 $657.72
$708.02
$761.31
$950.62		 $942.79
$993.09
$1,046.38
$1,235.69		 $1,227.86
$1,278.16
$1,331.45
$1,520.76		 $340.23

Plan: (PPO) AultCare Bronze 6550

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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
Expanded Bronze 21
30
40
50
60		 $380.64
$432.02
$486.45
$679.81
$1,033.04		 $761.28
$864.04
$972.90
$1,359.62
$2,066.08		 $1,052.46
$1,155.22
$1,264.08
$1,650.80		 $1,343.64
$1,446.40
$1,555.26
$1,941.98		 $1,634.82
$1,737.58
$1,846.44
$2,233.16		 $671.82
$723.20
$777.63
$970.99		 $963.00
$1,014.38
$1,068.81
$1,262.17		 $1,254.18
$1,305.56
$1,359.99
$1,553.35		 $347.52

Plan: (PPO) AultCare Bronze 6550 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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
Expanded Bronze 21
30
40
50
60		 $297.38
$337.52
$380.04
$531.10
$807.06		 $594.76
$675.04
$760.08
$1,062.20
$1,614.12		 $822.25
$902.53
$987.57
$1,289.69		 $1,049.74
$1,130.02
$1,215.06
$1,517.18		 $1,277.23
$1,357.51
$1,442.55
$1,744.67		 $524.87
$565.01
$607.53
$758.59		 $752.36
$792.50
$835.02
$986.08		 $979.85
$1,019.99
$1,062.51
$1,213.57		 $271.50

Plan: (PPO) AultCare Bronze 6550 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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
Expanded Bronze 21
30
40
50
60		 $376.59
$427.42
$481.27
$672.57
$1,022.04		 $753.18
$854.84
$962.54
$1,345.14
$2,044.08		 $1,041.26
$1,142.92
$1,250.62
$1,633.22		 $1,329.34
$1,431.00
$1,538.70
$1,921.30		 $1,617.42
$1,719.08
$1,826.78
$2,209.38		 $664.67
$715.50
$769.35
$960.65		 $952.75
$1,003.58
$1,057.43
$1,248.73		 $1,240.83
$1,291.66
$1,345.51
$1,536.81		 $343.82

Plan: (PPO) AultCare Bronze 6550 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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
Expanded Bronze 21
30
40
50
60		 $294.21
$333.92
$375.99
$525.45
$798.47		 $588.42
$667.84
$751.98
$1,050.90
$1,596.94		 $813.49
$892.91
$977.05
$1,275.97		 $1,038.56
$1,117.98
$1,202.12
$1,501.04		 $1,263.63
$1,343.05
$1,427.19
$1,726.11		 $519.28
$558.99
$601.06
$750.52		 $744.35
$784.06
$826.13
$975.59		 $969.42
$1,009.13
$1,051.20
$1,200.66		 $268.61

Plan: (PPO) AultCare Bronze Standard Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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		 $286.57
$325.26
$366.23
$511.81
$777.75		 $573.14
$650.52
$732.46
$1,023.62
$1,555.50		 $792.37
$869.75
$951.69
$1,242.85		 $1,011.60
$1,088.98
$1,170.92
$1,462.08		 $1,230.83
$1,308.21
$1,390.15
$1,681.31		 $505.80
$544.49
$585.46
$731.04		 $725.03
$763.72
$804.69
$950.27		 $944.26
$982.95
$1,023.92
$1,169.50		 $261.64

Plan: (PPO) AultCare Bronze 7350

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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		 $333.79
$378.85
$426.58
$596.14
$905.89		 $667.58
$757.70
$853.16
$1,192.28
$1,811.78		 $922.93
$1,013.05
$1,108.51
$1,447.63		 $1,178.28
$1,268.40
$1,363.86
$1,702.98		 $1,433.63
$1,523.75
$1,619.21
$1,958.33		 $589.14
$634.20
$681.93
$851.49		 $844.49
$889.55
$937.28
$1,106.84		 $1,099.84
$1,144.90
$1,192.63
$1,362.19		 $304.75

Plan: (PPO) AultCare Bronze 7350 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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		 $260.77
$295.97
$333.26
$465.73
$707.73		 $521.54
$591.94
$666.52
$931.46
$1,415.46		 $721.03
$791.43
$866.01
$1,130.95		 $920.52
$990.92
$1,065.50
$1,330.44		 $1,120.01
$1,190.41
$1,264.99
$1,529.93		 $460.26
$495.46
$532.75
$665.22		 $659.75
$694.95
$732.24
$864.71		 $859.24
$894.44
$931.73
$1,064.20		 $238.08

Plan: (PPO) AultCare Bronze 7350 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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		 $330.12
$374.68
$421.88
$589.58
$895.93		 $660.24
$749.36
$843.76
$1,179.16
$1,791.86		 $912.78
$1,001.90
$1,096.30
$1,431.70		 $1,165.32
$1,254.44
$1,348.84
$1,684.24		 $1,417.86
$1,506.98
$1,601.38
$1,936.78		 $582.66
$627.22
$674.42
$842.12		 $835.20
$879.76
$926.96
$1,094.66		 $1,087.74
$1,132.30
$1,179.50
$1,347.20		 $301.39

Plan: (PPO) AultCare Bronze 7350 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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		 $257.91
$292.72
$329.60
$460.61
$699.94		 $515.82
$585.44
$659.20
$921.22
$1,399.88		 $713.11
$782.73
$856.49
$1,118.51		 $910.40
$980.02
$1,053.78
$1,315.80		 $1,107.69
$1,177.31
$1,251.07
$1,513.09		 $455.20
$490.01
$526.89
$657.90		 $652.49
$687.30
$724.18
$855.19		 $849.78
$884.59
$921.47
$1,052.48		 $235.46

Plan: (PPO) AultCare Bronze 7900

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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		 $316.63
$359.37
$404.64
$565.49
$859.31		 $633.26
$718.74
$809.28
$1,130.98
$1,718.62		 $875.48
$960.96
$1,051.50
$1,373.20		 $1,117.70
$1,203.18
$1,293.72
$1,615.42		 $1,359.92
$1,445.40
$1,535.94
$1,857.64		 $558.85
$601.59
$646.86
$807.71		 $801.07
$843.81
$889.08
$1,049.93		 $1,043.29
$1,086.03
$1,131.30
$1,292.15		 $289.08

Plan: (PPO) AultCare Bronze 7900 Select

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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		 $247.37
$280.75
$316.13
$441.79
$671.34		 $494.74
$561.50
$632.26
$883.58
$1,342.68		 $683.97
$750.73
$821.49
$1,072.81		 $873.20
$939.96
$1,010.72
$1,262.04		 $1,062.43
$1,129.19
$1,199.95
$1,451.27		 $436.60
$469.98
$505.36
$631.02		 $625.83
$659.21
$694.59
$820.25		 $815.06
$848.44
$883.82
$1,009.48		 $225.84

Plan: (PPO) AultCare Bronze 7900 No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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		 $313.18
$355.45
$400.24
$559.33
$849.96		 $626.36
$710.90
$800.48
$1,118.66
$1,699.92		 $865.94
$950.48
$1,040.06
$1,358.24		 $1,105.52
$1,190.06
$1,279.64
$1,597.82		 $1,345.10
$1,429.64
$1,519.22
$1,837.40		 $552.76
$595.03
$639.82
$798.91		 $792.34
$834.61
$879.40
$1,038.49		 $1,031.92
$1,074.19
$1,118.98
$1,278.07		 $285.93

Plan: (PPO) AultCare Bronze 7900 Select No Pediatric Dental

Summary of Benefits and Coverage - Plan Brochure - Customer Service Phone: 1-800-344-8858 - Provider Directory for This Plan: (AultCare Insurance Company)

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		 $244.67
$277.70
$312.69
$436.98
$664.03		 $489.34
$555.40
$625.38
$873.96
$1,328.06		 $676.51
$742.57
$812.55
$1,061.13		 $863.68
$929.74
$999.72
$1,248.30		 $1,050.85
$1,116.91
$1,186.89
$1,435.47		 $431.84
$464.87
$499.86
$624.15		 $619.01
$652.04
$687.03
$811.32		 $806.18
$839.21
$874.20
$998.49		 $223.38

‡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 Tuscarawas County here.

 

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