Obamacare 2021 Rates for Sarpy County

Obamacare > Rates > Nebraska > Sarpy County

Obamacare is also known as the Affordable Care Act. This page gives you an overview of the rates for individual and family health insurance plans available from , the marketplace for Sarpy County, NE.

The health insurance rates listed below are for calendar year 2021.

For information on subsidies to make your coverage affordable, you must take one of the following actions:

  • Contact a licensed health insurance agent
  • Complete an application at Healthcare.gov
  • Contact the provider directly

Obamacare Providers, 43 Plans and 2021 Rates for Sarpy County, Nebraska

Below, you’ll find a summary of the 43 plans for Sarpy County, Nebraska and rates for each of these providers.‡ This chart is designed to give you a preview of your health insurance options.

You may also be interested in:

Obamacare Rates and Providers for Other Years

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Medica

Local: 1-888-592-8211 | Toll Free: 1-888-592-8211 | TTY: 1-800-833-7352
Toc - Plan #1 Medica
Silver

(EPO) Elevate by Medica Silver Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$4,800 $14,400 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$447,32
$507,69
$571,66
$798,89
$1 213,99 		$789,51
$849,88
$913,85
$1 141,08 		$1 131,70
$1 192,07
$1 256,04
$1 483,27 		$1 473,89
$1 534,26
$1 598,23
$1 825,46 		$342,19
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$894,64
$1 015,38
$1 143,32
$1 597,78
$2 427,98 		$1 236,83
$1 357,57
$1 485,51
$1 939,97 		$1 579,02
$1 699,76
$1 827,70
$2 282,16 		$1 921,21
$2 041,95
$2 169,89
$2 624,35 		$342,19
Toc - Plan #2 Medica
Expanded Bronze

(EPO) Elevate by Medica Bronze Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,300 $16,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$304,47
$345,57
$389,10
$543,77
$826,31 		$537,38
$578,48
$622,01
$776,68 		$770,29
$811,39
$854,92
$1 009,59 		$1 003,20
$1 044,30
$1 087,83
$1 242,50 		$232,91
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$608,94
$691,14
$778,20
$1 087,54
$1 652,62 		$841,85
$924,05
$1 011,11
$1 320,45 		$1 074,76
$1 156,96
$1 244,02
$1 553,36 		$1 307,67
$1 389,87
$1 476,93
$1 786,27 		$232,91
Toc - Plan #3 Medica
Expanded Bronze

(EPO) Elevate by Medica Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$333,83
$378,88
$426,62
$596,20
$905,98 		$589,20
$634,25
$681,99
$851,57 		$844,57
$889,62
$937,36
$1 106,94 		$1 099,94
$1 144,99
$1 192,73
$1 362,31 		$255,37
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$667,66
$757,76
$853,24
$1 192,40
$1 811,96 		$923,03
$1 013,13
$1 108,61
$1 447,77 		$1 178,40
$1 268,50
$1 363,98
$1 703,14 		$1 433,77
$1 523,87
$1 619,35
$1 958,51 		$255,37
Toc - Plan #4 Medica
Catastrophic

(EPO) Elevate by Medica Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$220,60
$250,37
$281,92
$393,98
$598,69 		$389,35
$419,12
$450,67
$562,73 		$558,10
$587,87
$619,42
$731,48 		$726,85
$756,62
$788,17
$900,23 		$168,75
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$441,20
$500,74
$563,84
$787,96
$1 197,38 		$609,95
$669,49
$732,59
$956,71 		$778,70
$838,24
$901,34
$1 125,46 		$947,45
$1 006,99
$1 070,09
$1 294,21 		$168,75
Toc - Plan #5 Medica
Gold

(EPO) Elevate by Medica Gold Share

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$700 $2,100 Annual Deductible
$7,950 $15,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$436,83
$495,79
$558,26
$780,17
$1 185,54 		$771,00
$829,96
$892,43
$1 114,34 		$1 105,17
$1 164,13
$1 226,60
$1 448,51 		$1 439,34
$1 498,30
$1 560,77
$1 782,68 		$334,17
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$873,66
$991,58
$1 116,52
$1 560,34
$2 371,08 		$1 207,83
$1 325,75
$1 450,69
$1 894,51 		$1 542,00
$1 659,92
$1 784,86
$2 228,68 		$1 876,17
$1 994,09
$2 119,03
$2 562,85 		$334,17
Toc - Plan #6 Medica
Expanded Bronze

(EPO) Elevate by Medica Bronze Share Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,300 $6,900 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$309,81
$351,62
$395,92
$553,30
$840,79 		$546,80
$588,61
$632,91
$790,29 		$783,79
$825,60
$869,90
$1 027,28 		$1 020,78
$1 062,59
$1 106,89
$1 264,27 		$236,99
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$619,62
$703,24
$791,84
$1 106,60
$1 681,58 		$856,61
$940,23
$1 028,83
$1 343,59 		$1 093,60
$1 177,22
$1 265,82
$1 580,58 		$1 330,59
$1 414,21
$1 502,81
$1 817,57 		$236,99
Toc - Plan #7 Medica
Expanded Bronze

(EPO) Elevate by Medica Bronze Share

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$4,200 $12,600 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$309,30
$351,05
$395,28
$552,40
$839,43 		$545,91
$587,66
$631,89
$789,01 		$782,52
$824,27
$868,50
$1 025,62 		$1 019,13
$1 060,88
$1 105,11
$1 262,23 		$236,61
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$618,60
$702,10
$790,56
$1 104,80
$1 678,86 		$855,21
$938,71
$1 027,17
$1 341,41 		$1 091,82
$1 175,32
$1 263,78
$1 578,02 		$1 328,43
$1 411,93
$1 500,39
$1 814,63 		$236,61
Toc - Plan #8 Medica
Silver

(EPO) Medica Insure Silver Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$4,800 $14,400 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$554,62
$629,49
$708,80
$990,54
$1 505,22 		$978,90
$1 053,77
$1 133,08
$1 414,82 		$1 403,18
$1 478,05
$1 557,36
$1 839,10 		$1 827,46
$1 902,33
$1 981,64
$2 263,38 		$424,28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 109,24
$1 258,98
$1 417,60
$1 981,08
$3 010,44 		$1 533,52
$1 683,26
$1 841,88
$2 405,36 		$1 957,80
$2 107,54
$2 266,16
$2 829,64 		$2 382,08
$2 531,82
$2 690,44
$3 253,92 		$424,28
Toc - Plan #9 Medica
Expanded Bronze

(EPO) Medica Insure Bronze Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,300 $16,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$377,51
$428,47
$482,45
$674,22
$1 024,54 		$666,30
$717,26
$771,24
$963,01 		$955,09
$1 006,05
$1 060,03
$1 251,80 		$1 243,88
$1 294,84
$1 348,82
$1 540,59 		$288,79
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$755,02
$856,94
$964,90
$1 348,44
$2 049,08 		$1 043,81
$1 145,73
$1 253,69
$1 637,23 		$1 332,60
$1 434,52
$1 542,48
$1 926,02 		$1 621,39
$1 723,31
$1 831,27
$2 214,81 		$288,79
Toc - Plan #10 Medica
Expanded Bronze

(EPO) Medica Insure Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$413,91
$469,77
$528,96
$739,22
$1 123,32 		$730,54
$786,40
$845,59
$1 055,85 		$1 047,17
$1 103,03
$1 162,22
$1 372,48 		$1 363,80
$1 419,66
$1 478,85
$1 689,11 		$316,63
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$827,82
$939,54
$1 057,92
$1 478,44
$2 246,64 		$1 144,45
$1 256,17
$1 374,55
$1 795,07 		$1 461,08
$1 572,80
$1 691,18
$2 111,70 		$1 777,71
$1 889,43
$2 007,81
$2 428,33 		$316,63
Toc - Plan #11 Medica
Catastrophic

(EPO) Medica Insure Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$273,52
$310,44
$349,55
$488,49
$742,31 		$482,76
$519,68
$558,79
$697,73 		$692,00
$728,92
$768,03
$906,97 		$901,24
$938,16
$977,27
$1 116,21 		$209,24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$547,04
$620,88
$699,10
$976,98
$1 484,62 		$756,28
$830,12
$908,34
$1 186,22 		$965,52
$1 039,36
$1 117,58
$1 395,46 		$1 174,76
$1 248,60
$1 326,82
$1 604,70 		$209,24
Toc - Plan #12 Medica
Expanded Bronze

(EPO) Medica Insure Bronze Share Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,300 $6,900 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$384,13
$435,97
$490,90
$686,03
$1 042,49 		$677,98
$729,82
$784,75
$979,88 		$971,83
$1 023,67
$1 078,60
$1 273,73 		$1 265,68
$1 317,52
$1 372,45
$1 567,58 		$293,85
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$768,26
$871,94
$981,80
$1 372,06
$2 084,98 		$1 062,11
$1 165,79
$1 275,65
$1 665,91 		$1 355,96
$1 459,64
$1 569,50
$1 959,76 		$1 649,81
$1 753,49
$1 863,35
$2 253,61 		$293,85
Toc - Plan #13 Medica
Expanded Bronze

(EPO) Medica Insure Bronze Share

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$4,200 $12,600 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$383,50
$435,27
$490,10
$684,92
$1 040,80 		$676,87
$728,64
$783,47
$978,29 		$970,24
$1 022,01
$1 076,84
$1 271,66 		$1 263,61
$1 315,38
$1 370,21
$1 565,03 		$293,37
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$767,00
$870,54
$980,20
$1 369,84
$2 081,60 		$1 060,37
$1 163,91
$1 273,57
$1 663,21 		$1 353,74
$1 457,28
$1 566,94
$1 956,58 		$1 647,11
$1 750,65
$1 860,31
$2 249,95 		$293,37
Toc - Plan #14 Medica
Gold

(EPO) Medica with CHI Health Gold Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$1,150 $3,450 Annual Deductible
$7,950 $15,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$417,06
$473,35
$532,99
$744,85
$1 131,87 		$736,10
$792,39
$852,03
$1 063,89 		$1 055,14
$1 111,43
$1 171,07
$1 382,93 		$1 374,18
$1 430,47
$1 490,11
$1 701,97 		$319,04
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$834,12
$946,70
$1 065,98
$1 489,70
$2 263,74 		$1 153,16
$1 265,74
$1 385,02
$1 808,74 		$1 472,20
$1 584,78
$1 704,06
$2 127,78 		$1 791,24
$1 903,82
$2 023,10
$2 446,82 		$319,04
Toc - Plan #15 Medica
Silver

(EPO) Medica with CHI Health Silver Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$4,800 $14,400 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$425,16
$482,54
$543,34
$759,32
$1 153,86 		$750,40
$807,78
$868,58
$1 084,56 		$1 075,64
$1 133,02
$1 193,82
$1 409,80 		$1 400,88
$1 458,26
$1 519,06
$1 735,04 		$325,24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$850,32
$965,08
$1 086,68
$1 518,64
$2 307,72 		$1 175,56
$1 290,32
$1 411,92
$1 843,88 		$1 500,80
$1 615,56
$1 737,16
$2 169,12 		$1 826,04
$1 940,80
$2 062,40
$2 494,36 		$325,24
Toc - Plan #16 Medica
Expanded Bronze

(EPO) Medica with CHI Health Bronze Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,300 $16,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$289,39
$328,45
$369,83
$516,84
$785,38 		$510,77
$549,83
$591,21
$738,22 		$732,15
$771,21
$812,59
$959,60 		$953,53
$992,59
$1 033,97
$1 180,98 		$221,38
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$578,78
$656,90
$739,66
$1 033,68
$1 570,76 		$800,16
$878,28
$961,04
$1 255,06 		$1 021,54
$1 099,66
$1 182,42
$1 476,44 		$1 242,92
$1 321,04
$1 403,80
$1 697,82 		$221,38
Toc - Plan #17 Medica
Expanded Bronze

(EPO) Medica with CHI Health Bronze HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$317,29
$360,11
$405,49
$566,66
$861,10 		$560,01
$602,83
$648,21
$809,38 		$802,73
$845,55
$890,93
$1 052,10 		$1 045,45
$1 088,27
$1 133,65
$1 294,82 		$242,72
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$634,58
$720,22
$810,98
$1 133,32
$1 722,20 		$877,30
$962,94
$1 053,70
$1 376,04 		$1 120,02
$1 205,66
$1 296,42
$1 618,76 		$1 362,74
$1 448,38
$1 539,14
$1 861,48 		$242,72
Toc - Plan #18 Medica
Catastrophic

(EPO) Medica with CHI Health Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$209,68
$237,97
$267,95
$374,46
$569,03 		$370,07
$398,36
$428,34
$534,85 		$530,46
$558,75
$588,73
$695,24 		$690,85
$719,14
$749,12
$855,63 		$160,39
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$419,36
$475,94
$535,90
$748,92
$1 138,06 		$579,75
$636,33
$696,29
$909,31 		$740,14
$796,72
$856,68
$1 069,70 		$900,53
$957,11
$1 017,07
$1 230,09 		$160,39
Toc - Plan #19 Medica
Silver

(EPO) Medica with CHI Health Silver Share

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$1,400 $4,200 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$428,71
$486,58
$547,88
$765,66
$1 163,50 		$756,67
$814,54
$875,84
$1 093,62 		$1 084,63
$1 142,50
$1 203,80
$1 421,58 		$1 412,59
$1 470,46
$1 531,76
$1 749,54 		$327,96
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$857,42
$973,16
$1 095,76
$1 531,32
$2 327,00 		$1 185,38
$1 301,12
$1 423,72
$1 859,28 		$1 513,34
$1 629,08
$1 751,68
$2 187,24 		$1 841,30
$1 957,04
$2 079,64
$2 515,20 		$327,96
Toc - Plan #20 Medica
Expanded Bronze

(EPO) Medica with CHI Health Bronze Share Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$2,300 $6,900 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$294,46
$334,20
$376,31
$525,89
$799,14 		$519,72
$559,46
$601,57
$751,15 		$744,98
$784,72
$826,83
$976,41 		$970,24
$1 009,98
$1 052,09
$1 201,67 		$225,26
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$588,92
$668,40
$752,62
$1 051,78
$1 598,28 		$814,18
$893,66
$977,88
$1 277,04 		$1 039,44
$1 118,92
$1 203,14
$1 502,30 		$1 264,70
$1 344,18
$1 428,40
$1 727,56 		$225,26
Toc - Plan #21 Medica
Expanded Bronze

(EPO) Medica with CHI Health Bronze Share

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-888-592-8211

Annual Out of Pocket Expenses:

Individual Family
$4,200 $12,600 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$293,98
$333,66
$375,70
$525,04
$797,85 		$518,87
$558,55
$600,59
$749,93 		$743,76
$783,44
$825,48
$974,82 		$968,65
$1 008,33
$1 050,37
$1 199,71 		$224,89
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$587,96
$667,32
$751,40
$1 050,08
$1 595,70 		$812,85
$892,21
$976,29
$1 274,97 		$1 037,74
$1 117,10
$1 201,18
$1 499,86 		$1 262,63
$1 341,99
$1 426,07
$1 724,75 		$224,89

ADVERTISEMENT

Bright Health

Local: 1-855-827-4448 | Toll Free: 1-855-827-4448

Toc - Plan #22 Bright Health
Gold

(EPO) NHN Gold 1000 Direct

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$486,67
$552,37
$621,96
$869,19
$1 320,81 		$858,97
$924,67
$994,26
$1 241,49 		$1 231,27
$1 296,97
$1 366,56
$1 613,79 		$1 603,57
$1 669,27
$1 738,86
$1 986,09 		$372,30
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$973,34
$1 104,74
$1 243,92
$1 738,38
$2 641,62 		$1 345,64
$1 477,04
$1 616,22
$2 110,68 		$1 717,94
$1 849,34
$1 988,52
$2 482,98 		$2 090,24
$2 221,64
$2 360,82
$2 855,28 		$372,30
Toc - Plan #23 Bright Health
Silver

(EPO) NHN Silver 5000 Direct

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$452,60
$513,70
$578,42
$808,35
$1 228,36 		$798,84
$859,94
$924,66
$1 154,59 		$1 145,08
$1 206,18
$1 270,90
$1 500,83 		$1 491,32
$1 552,42
$1 617,14
$1 847,07 		$346,24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$905,20
$1 027,40
$1 156,84
$1 616,70
$2 456,72 		$1 251,44
$1 373,64
$1 503,08
$1 962,94 		$1 597,68
$1 719,88
$1 849,32
$2 309,18 		$1 943,92
$2 066,12
$2 195,56
$2 655,42 		$346,24
Toc - Plan #24 Bright Health
Silver

(EPO) NHN Silver $0 Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$461,31
$523,59
$589,56
$823,90
$1 252,00 		$814,21
$876,49
$942,46
$1 176,80 		$1 167,11
$1 229,39
$1 295,36
$1 529,70 		$1 520,01
$1 582,29
$1 648,26
$1 882,60 		$352,90
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$922,62
$1 047,18
$1 179,12
$1 647,80
$2 504,00 		$1 275,52
$1 400,08
$1 532,02
$2 000,70 		$1 628,42
$1 752,98
$1 884,92
$2 353,60 		$1 981,32
$2 105,88
$2 237,82
$2 706,50 		$352,90
Toc - Plan #25 Bright Health
Silver

(EPO) NHN Silver 3000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$456,84
$518,51
$583,84
$815,91
$1 239,86 		$806,32
$867,99
$933,32
$1 165,39 		$1 155,80
$1 217,47
$1 282,80
$1 514,87 		$1 505,28
$1 566,95
$1 632,28
$1 864,35 		$349,48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$913,68
$1 037,02
$1 167,68
$1 631,82
$2 479,72 		$1 263,16
$1 386,50
$1 517,16
$1 981,30 		$1 612,64
$1 735,98
$1 866,64
$2 330,78 		$1 962,12
$2 085,46
$2 216,12
$2 680,26 		$349,48
Toc - Plan #26 Bright Health
Expanded Bronze

(EPO) NHN Bronze 8550

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$309,50
$351,28
$395,54
$552,77
$839,99 		$546,27
$588,05
$632,31
$789,54 		$783,04
$824,82
$869,08
$1 026,31 		$1 019,81
$1 061,59
$1 105,85
$1 263,08 		$236,77
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$619,00
$702,56
$791,08
$1 105,54
$1 679,98 		$855,77
$939,33
$1 027,85
$1 342,31 		$1 092,54
$1 176,10
$1 264,62
$1 579,08 		$1 329,31
$1 412,87
$1 501,39
$1 815,85 		$236,77
Toc - Plan #27 Bright Health
Expanded Bronze

(EPO) NHN Bronze 5900

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$320,58
$363,85
$409,70
$572,55
$870,04 		$565,82
$609,09
$654,94
$817,79 		$811,06
$854,33
$900,18
$1 063,03 		$1 056,30
$1 099,57
$1 145,42
$1 308,27 		$245,24
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$641,16
$727,70
$819,40
$1 145,10
$1 740,08 		$886,40
$972,94
$1 064,64
$1 390,34 		$1 131,64
$1 218,18
$1 309,88
$1 635,58 		$1 376,88
$1 463,42
$1 555,12
$1 880,82 		$245,24
Toc - Plan #28 Bright Health
Expanded Bronze

(EPO) NHN Bronze 7000 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$352,35
$399,92
$450,30
$629,29
$956,27 		$621,90
$669,47
$719,85
$898,84 		$891,45
$939,02
$989,40
$1 168,39 		$1 161,00
$1 208,57
$1 258,95
$1 437,94 		$269,55
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$704,70
$799,84
$900,60
$1 258,58
$1 912,54 		$974,25
$1 069,39
$1 170,15
$1 528,13 		$1 243,80
$1 338,94
$1 439,70
$1 797,68 		$1 513,35
$1 608,49
$1 709,25
$2 067,23 		$269,55
Toc - Plan #29 Bright Health
Catastrophic

(EPO) NHN Catastrophic Direct

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$233,63
$265,17
$298,58
$417,27
$634,08 		$412,36
$443,90
$477,31
$596,00 		$591,09
$622,63
$656,04
$774,73 		$769,82
$801,36
$834,77
$953,46 		$178,73
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$467,26
$530,34
$597,16
$834,54
$1 268,16 		$645,99
$709,07
$775,89
$1 013,27 		$824,72
$887,80
$954,62
$1 192,00 		$1 003,45
$1 066,53
$1 133,35
$1 370,73 		$178,73
Toc - Plan #30 Bright Health
Silver

(EPO) NHN Silver $0 Primary Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$453,96
$515,24
$580,16
$810,76
$1 232,04 		$801,24
$862,52
$927,44
$1 158,04 		$1 148,52
$1 209,80
$1 274,72
$1 505,32 		$1 495,80
$1 557,08
$1 622,00
$1 852,60 		$347,28
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$907,92
$1 030,48
$1 160,32
$1 621,52
$2 464,08 		$1 255,20
$1 377,76
$1 507,60
$1 968,80 		$1 602,48
$1 725,04
$1 854,88
$2 316,08 		$1 949,76
$2 072,32
$2 202,16
$2 663,36 		$347,28
Toc - Plan #31 Bright Health
Expanded Bronze

(EPO) NHN Bronze $0 Primary Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$320,05
$363,25
$409,02
$571,60
$868,61 		$564,89
$608,09
$653,86
$816,44 		$809,73
$852,93
$898,70
$1 061,28 		$1 054,57
$1 097,77
$1 143,54
$1 306,12 		$244,84
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$640,10
$726,50
$818,04
$1 143,20
$1 737,22 		$884,94
$971,34
$1 062,88
$1 388,04 		$1 129,78
$1 216,18
$1 307,72
$1 632,88 		$1 374,62
$1 461,02
$1 552,56
$1 877,72 		$244,84
Toc - Plan #32 Bright Health
Expanded Bronze

(EPO) NHN Bronze $0 Medical Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$349,23
$396,38
$446,32
$623,72
$947,81 		$616,39
$663,54
$713,48
$890,88 		$883,55
$930,70
$980,64
$1 158,04 		$1 150,71
$1 197,86
$1 247,80
$1 425,20 		$267,16
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$698,46
$792,76
$892,64
$1 247,44
$1 895,62 		$965,62
$1 059,92
$1 159,80
$1 514,60 		$1 232,78
$1 327,08
$1 426,96
$1 781,76 		$1 499,94
$1 594,24
$1 694,12
$2 048,92 		$267,16
Toc - Plan #33 Bright Health
Gold

(EPO) Statewide Gold 1000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$619,89
$703,58
$792,23
$1 107,13
$1 682,40 		$1 094,11
$1 177,80
$1 266,45
$1 581,35 		$1 568,33
$1 652,02
$1 740,67
$2 055,57 		$2 042,55
$2 126,24
$2 214,89
$2 529,79 		$474,22
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 239,78
$1 407,16
$1 584,46
$2 214,26
$3 364,80 		$1 714,00
$1 881,38
$2 058,68
$2 688,48 		$2 188,22
$2 355,60
$2 532,90
$3 162,70 		$2 662,44
$2 829,82
$3 007,12
$3 636,92 		$474,22
Toc - Plan #34 Bright Health
Silver

(EPO) Statewide Silver 5000 Direct

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$578,23
$656,29
$738,98
$1 032,72
$1 569,32 		$1 020,58
$1 098,64
$1 181,33
$1 475,07 		$1 462,93
$1 540,99
$1 623,68
$1 917,42 		$1 905,28
$1 983,34
$2 066,03
$2 359,77 		$442,35
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 156,46
$1 312,58
$1 477,96
$2 065,44
$3 138,64 		$1 598,81
$1 754,93
$1 920,31
$2 507,79 		$2 041,16
$2 197,28
$2 362,66
$2 950,14 		$2 483,51
$2 639,63
$2 805,01
$3 392,49 		$442,35
Toc - Plan #35 Bright Health
Silver

(EPO) Statewide Silver $0 Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$588,72
$668,19
$752,38
$1 051,45
$1 597,77 		$1 039,09
$1 118,56
$1 202,75
$1 501,82 		$1 489,46
$1 568,93
$1 653,12
$1 952,19 		$1 939,83
$2 019,30
$2 103,49
$2 402,56 		$450,37
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 177,44
$1 336,38
$1 504,76
$2 102,90
$3 195,54 		$1 627,81
$1 786,75
$1 955,13
$2 553,27 		$2 078,18
$2 237,12
$2 405,50
$3 003,64 		$2 528,55
$2 687,49
$2 855,87
$3 454,01 		$450,37
Toc - Plan #36 Bright Health
Silver

(EPO) Statewide Silver 3000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$583,42
$662,18
$745,61
$1 041,99
$1 583,41 		$1 029,74
$1 108,50
$1 191,93
$1 488,31 		$1 476,06
$1 554,82
$1 638,25
$1 934,63 		$1 922,38
$2 001,14
$2 084,57
$2 380,95 		$446,32
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 166,84
$1 324,36
$1 491,22
$2 083,98
$3 166,82 		$1 613,16
$1 770,68
$1 937,54
$2 530,30 		$2 059,48
$2 217,00
$2 383,86
$2 976,62 		$2 505,80
$2 663,32
$2 830,18
$3 422,94 		$446,32
Toc - Plan #37 Bright Health
Expanded Bronze

(EPO) Statewide Bronze 8550

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$392,78
$445,81
$501,97
$701,51
$1 066,01 		$693,26
$746,29
$802,45
$1 001,99 		$993,74
$1 046,77
$1 102,93
$1 302,47 		$1 294,22
$1 347,25
$1 403,41
$1 602,95 		$300,48
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$785,56
$891,62
$1 003,94
$1 403,02
$2 132,02 		$1 086,04
$1 192,10
$1 304,42
$1 703,50 		$1 386,52
$1 492,58
$1 604,90
$2 003,98 		$1 687,00
$1 793,06
$1 905,38
$2 304,46 		$300,48
Toc - Plan #38 Bright Health
Expanded Bronze

(EPO) Statewide NHN Bronze 5900

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$406,84
$461,76
$519,94
$726,61
$1 104,15 		$718,07
$772,99
$831,17
$1 037,84 		$1 029,30
$1 084,22
$1 142,40
$1 349,07 		$1 340,53
$1 395,45
$1 453,63
$1 660,30 		$311,23
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$813,68
$923,52
$1 039,88
$1 453,22
$2 208,30 		$1 124,91
$1 234,75
$1 351,11
$1 764,45 		$1 436,14
$1 545,98
$1 662,34
$2 075,68 		$1 747,37
$1 857,21
$1 973,57
$2 386,91 		$311,23
Toc - Plan #39 Bright Health
Expanded Bronze

(EPO) Statewide Bronze 7000 HSA Direct

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$447,16
$507,52
$571,47
$798,62
$1 213,58 		$789,24
$849,60
$913,55
$1 140,70 		$1 131,32
$1 191,68
$1 255,63
$1 482,78 		$1 473,40
$1 533,76
$1 597,71
$1 824,86 		$342,08
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$894,32
$1 015,04
$1 142,94
$1 597,24
$2 427,16 		$1 236,40
$1 357,12
$1 485,02
$1 939,32 		$1 578,48
$1 699,20
$1 827,10
$2 281,40 		$1 920,56
$2 041,28
$2 169,18
$2 623,48 		$342,08
Toc - Plan #40 Bright Health
Catastrophic

(EPO) Statewide Catastrophic Direct

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$8,550 $17,100 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$297,59
$337,77
$380,32
$531,50
$807,66 		$525,25
$565,43
$607,98
$759,16 		$752,91
$793,09
$835,64
$986,82 		$980,57
$1 020,75
$1 063,30
$1 214,48 		$227,66
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$595,18
$675,54
$760,64
$1 063,00
$1 615,32 		$822,84
$903,20
$988,30
$1 290,66 		$1 050,50
$1 130,86
$1 215,96
$1 518,32 		$1 278,16
$1 358,52
$1 443,62
$1 745,98 		$227,66
Toc - Plan #41 Bright Health
Silver

(EPO) Statewide Silver $0 Primary Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$579,87
$658,16
$741,08
$1 035,66
$1 573,78 		$1 023,47
$1 101,76
$1 184,68
$1 479,26 		$1 467,07
$1 545,36
$1 628,28
$1 922,86 		$1 910,67
$1 988,96
$2 071,88
$2 366,46 		$443,60
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$1 159,74
$1 316,32
$1 482,16
$2 071,32
$3 147,56 		$1 603,34
$1 759,92
$1 925,76
$2 514,92 		$2 046,94
$2 203,52
$2 369,36
$2 958,52 		$2 490,54
$2 647,12
$2 812,96
$3 402,12 		$443,60
Toc - Plan #42 Bright Health
Expanded Bronze

(EPO) Statewide Bronze $0 Primary Care Direct

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$406,16
$461,00
$519,08
$725,41
$1 102,33 		$716,87
$771,71
$829,79
$1 036,12 		$1 027,58
$1 082,42
$1 140,50
$1 346,83 		$1 338,29
$1 393,13
$1 451,21
$1 657,54 		$310,71
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$812,32
$922,00
$1 038,16
$1 450,82
$2 204,66 		$1 123,03
$1 232,71
$1 348,87
$1 761,53 		$1 433,74
$1 543,42
$1 659,58
$2 072,24 		$1 744,45
$1 854,13
$1 970,29
$2 382,95 		$310,71
Toc - Plan #43 Bright Health
Expanded Bronze

(EPO) Statewide Bronze $0 Medical Deductible Direct

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-827-4448

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
 Individual
1 Child
 Individual
2 Children
 Individual
3+ Children
 Child
0-14
21
30
40
50
60 		$443,20
$503,03
$566,41
$791,55
$1 202,84 		$782,25
$842,08
$905,46
$1 130,60 		$1 121,30
$1 181,13
$1 244,51
$1 469,65 		$1 460,35
$1 520,18
$1 583,56
$1 808,70 		$339,05
Age Couple
Couple
1 Child
 Couple
2 Chidren
 Couple
3+ Children
 Child
0-14
21
30
40
50
60 		$886,40
$1 006,06
$1 132,82
$1 583,10
$2 405,68 		$1 225,45
$1 345,11
$1 471,87
$1 922,15 		$1 564,50
$1 684,16
$1 810,92
$2 261,20 		$1 903,55
$2 023,21
$2 149,97
$2 600,25 		$339,05

‡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 Sarpy County here.

Sarpy County is in “Rating Area 1” of Nebraska.

Currently, there are 43 plans offered in Rating Area 1.

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2021 Obamacare Plans for Sarpy County, NE

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