Obamacare 2021 Rates for Fairfax County

Obamacare > Rates > Virginia > Fairfax 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 Fairfax County, VA.

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, 41 Plans and 2021 Rates for Fairfax County, Virginia

Below, you’ll find a summary of the 41 plans for Fairfax County, Virginia 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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CareFirst BlueChoice

Local: 1-855-444-3119 | Toll Free: 1-855-444-3119 | TTY: 1-202-479-3546

Toc - Plan #1 CareFirst BlueChoice
Silver

(HMO) BlueChoice HMO HSA Silver 3000

Benefits & Coverage Provider Directory
Customer Service Phone: 1-855-444-3119

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$6,650 $13,300 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
$467,88
$531,04
$597,95
$835,63
$1 269,83
$825,81
$888,97
$955,88
$1 193,56
$1 183,74
$1 246,90
$1 313,81
$1 551,49
$1 541,67
$1 604,83
$1 671,74
$1 909,42
$357,93
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$935,76
$1 062,08
$1 195,90
$1 671,26
$2 539,66
$1 293,69
$1 420,01
$1 553,83
$2 029,19
$1 651,62
$1 777,94
$1 911,76
$2 387,12
$2 009,55
$2 135,87
$2 269,69
$2 745,05
$357,93
Toc - Plan #2 CareFirst BlueChoice
Gold

(HMO) BlueChoice HMO Gold 1750

Benefits & Coverage Provider Directory
Customer Service Phone: 1-855-444-3119

Annual Out of Pocket Expenses:

Individual Family
$1,750 $3,500 Annual Deductible
$6,650 $13,300 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
$448,95
$509,56
$573,76
$801,82
$1 218,45
$792,40
$853,01
$917,21
$1 145,27
$1 135,85
$1 196,46
$1 260,66
$1 488,72
$1 479,30
$1 539,91
$1 604,11
$1 832,17
$343,45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$897,90
$1 019,12
$1 147,52
$1 603,64
$2 436,90
$1 241,35
$1 362,57
$1 490,97
$1 947,09
$1 584,80
$1 706,02
$1 834,42
$2 290,54
$1 928,25
$2 049,47
$2 177,87
$2 633,99
$343,45
Toc - Plan #3 CareFirst BlueChoice
Catastrophic

(HMO) BlueChoice HMO Young Adult 8550

Benefits & Coverage Provider Directory
Customer Service Phone: 1-855-444-3119

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
$185,92
$211,02
$237,61
$332,05
$504,59
$328,15
$353,25
$379,84
$474,28
$470,38
$495,48
$522,07
$616,51
$612,61
$637,71
$664,30
$758,74
$142,23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$371,84
$422,04
$475,22
$664,10
$1 009,18
$514,07
$564,27
$617,45
$806,33
$656,30
$706,50
$759,68
$948,56
$798,53
$848,73
$901,91
$1 090,79
$142,23

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UnitedHealthcare

Local: 1-877-265-9199 | Toll Free:  | TTY: 1-877-265-9199

Toc - Plan #4 UnitedHealthcare
Gold

(HMO) Value Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$2,100 $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
$382,19
$433,78
$488,44
$682,59
$1 037,26
$674,56
$726,15
$780,81
$974,96
$966,93
$1 018,52
$1 073,18
$1 267,33
$1 259,30
$1 310,89
$1 365,55
$1 559,70
$292,37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$764,38
$867,56
$976,88
$1 365,18
$2 074,52
$1 056,75
$1 159,93
$1 269,25
$1 657,55
$1 349,12
$1 452,30
$1 561,62
$1 949,92
$1 641,49
$1 744,67
$1 853,99
$2 242,29
$292,37
Toc - Plan #5 UnitedHealthcare
Silver

(HMO) Balance Silver 3 No Copay PCP Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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
$403,19
$457,62
$515,27
$720,09
$1 094,25
$711,63
$766,06
$823,71
$1 028,53
$1 020,07
$1 074,50
$1 132,15
$1 336,97
$1 328,51
$1 382,94
$1 440,59
$1 645,41
$308,44
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$806,38
$915,24
$1 030,54
$1 440,18
$2 188,50
$1 114,82
$1 223,68
$1 338,98
$1 748,62
$1 423,26
$1 532,12
$1 647,42
$2 057,06
$1 731,70
$1 840,56
$1 955,86
$2 365,50
$308,44
Toc - Plan #6 UnitedHealthcare
Silver

(HMO) Balance Plus Silver 3 No Copay PCP Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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
$404,65
$459,28
$517,15
$722,71
$1 098,23
$714,21
$768,84
$826,71
$1 032,27
$1 023,77
$1 078,40
$1 136,27
$1 341,83
$1 333,33
$1 387,96
$1 445,83
$1 651,39
$309,56
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$809,30
$918,56
$1 034,30
$1 445,42
$2 196,46
$1 118,86
$1 228,12
$1 343,86
$1 754,98
$1 428,42
$1 537,68
$1 653,42
$2 064,54
$1 737,98
$1 847,24
$1 962,98
$2 374,10
$309,56
Toc - Plan #7 UnitedHealthcare
Silver

(HMO) Value Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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
$406,33
$461,18
$519,28
$725,70
$1 102,77
$717,17
$772,02
$830,12
$1 036,54
$1 028,01
$1 082,86
$1 140,96
$1 347,38
$1 338,85
$1 393,70
$1 451,80
$1 658,22
$310,84
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$812,66
$922,36
$1 038,56
$1 451,40
$2 205,54
$1 123,50
$1 233,20
$1 349,40
$1 762,24
$1 434,34
$1 544,04
$1 660,24
$2 073,08
$1 745,18
$1 854,88
$1 971,08
$2 383,92
$310,84
Toc - Plan #8 UnitedHealthcare
Expanded Bronze

(HMO) Balance Bronze 3 No Copay Telehealth Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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
$305,34
$346,56
$390,23
$545,34
$828,70
$538,93
$580,15
$623,82
$778,93
$772,52
$813,74
$857,41
$1 012,52
$1 006,11
$1 047,33
$1 091,00
$1 246,11
$233,59
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$610,68
$693,12
$780,46
$1 090,68
$1 657,40
$844,27
$926,71
$1 014,05
$1 324,27
$1 077,86
$1 160,30
$1 247,64
$1 557,86
$1 311,45
$1 393,89
$1 481,23
$1 791,45
$233,59
Toc - Plan #9 UnitedHealthcare
Expanded Bronze

(HMO) Balance Bronze 3 No Copay PCP Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 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
$302,49
$343,33
$386,59
$540,25
$820,96
$533,90
$574,74
$618,00
$771,66
$765,31
$806,15
$849,41
$1 003,07
$996,72
$1 037,56
$1 080,82
$1 234,48
$231,41
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$604,98
$686,66
$773,18
$1 080,50
$1 641,92
$836,39
$918,07
$1 004,59
$1 311,91
$1 067,80
$1 149,48
$1 236,00
$1 543,32
$1 299,21
$1 380,89
$1 467,41
$1 774,73
$231,41
Toc - Plan #10 UnitedHealthcare
Expanded Bronze

(HMO) Value Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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
$306,50
$347,88
$391,71
$547,41
$831,84
$540,97
$582,35
$626,18
$781,88
$775,44
$816,82
$860,65
$1 016,35
$1 009,91
$1 051,29
$1 095,12
$1 250,82
$234,47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$613,00
$695,76
$783,42
$1 094,82
$1 663,68
$847,47
$930,23
$1 017,89
$1 329,29
$1 081,94
$1 164,70
$1 252,36
$1 563,76
$1 316,41
$1 399,17
$1 486,83
$1 798,23
$234,47

ADVERTISEMENT

CareFirst BlueCross BlueShield

Local: 1-855-444-3119 | Toll Free: 1-855-444-3119 | TTY: 1-202-479-3546

Toc - Plan #11 CareFirst BlueCross BlueShield
Gold

(PPO) BluePreferred PPO Gold 1750

Benefits & Coverage Provider Directory
Customer Service Phone: 1-855-444-3119

Annual Out of Pocket Expenses:

Individual Family
$1,750 $3,500 Annual Deductible
$6,650 $13,300 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
$1 055,82
$1 198,36
$1 349,34
$1 885,69
$2 865,50
$1 863,52
$2 006,06
$2 157,04
$2 693,39
$2 671,22
$2 813,76
$2 964,74
$3 501,09
$3 478,92
$3 621,46
$3 772,44
$4 308,79
$807,70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$2 111,64
$2 396,72
$2 698,68
$3 771,38
$5 731,00
$2 919,34
$3 204,42
$3 506,38
$4 579,08
$3 727,04
$4 012,12
$4 314,08
$5 386,78
$4 534,74
$4 819,82
$5 121,78
$6 194,48
$807,70
Toc - Plan #12 CareFirst BlueCross BlueShield
Silver

(PPO) BluePreferred PPO HSA Silver 3000

Benefits & Coverage Provider Directory
Customer Service Phone: 1-855-444-3119

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$6,650 $13,300 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
$1 070,02
$1 214,47
$1 367,49
$1 911,06
$2 904,03
$1 888,59
$2 033,04
$2 186,06
$2 729,63
$2 707,16
$2 851,61
$3 004,63
$3 548,20
$3 525,73
$3 670,18
$3 823,20
$4 366,77
$818,57
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$2 140,04
$2 428,94
$2 734,98
$3 822,12
$5 808,06
$2 958,61
$3 247,51
$3 553,55
$4 640,69
$3 777,18
$4 066,08
$4 372,12
$5 459,26
$4 595,75
$4 884,65
$5 190,69
$6 277,83
$818,57

ADVERTISEMENT

Cigna Health and Life Insurance Company

Local: 1-877-900-1237 | Toll Free: 1-877-900-1237 | TTY: 1-800-676-3777

Toc - Plan #13 Cigna Health and Life Insurance Company
Bronze

(EPO) Cigna Connect 7000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 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
$277,06
$314,46
$354,08
$494,83
$751,94
$489,01
$526,41
$566,03
$706,78
$700,96
$738,36
$777,98
$918,73
$912,91
$950,31
$989,93
$1 130,68
$211,95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$554,12
$628,92
$708,16
$989,66
$1 503,88
$766,07
$840,87
$920,11
$1 201,61
$978,02
$1 052,82
$1 132,06
$1 413,56
$1 189,97
$1 264,77
$1 344,01
$1 625,51
$211,95
Toc - Plan #14 Cigna Health and Life Insurance Company
Expanded Bronze

(EPO) Cigna Connect 6750

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$6,750 $13,500 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
$289,18
$328,22
$369,58
$516,48
$784,84
$510,41
$549,45
$590,81
$737,71
$731,64
$770,68
$812,04
$958,94
$952,87
$991,91
$1 033,27
$1 180,17
$221,23
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$578,36
$656,44
$739,16
$1 032,96
$1 569,68
$799,59
$877,67
$960,39
$1 254,19
$1 020,82
$1 098,90
$1 181,62
$1 475,42
$1 242,05
$1 320,13
$1 402,85
$1 696,65
$221,23
Toc - Plan #15 Cigna Health and Life Insurance Company
Silver

(EPO) Cigna Connect 4500 +Acupuncture

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 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
$372,13
$422,37
$475,59
$664,63
$1 009,97
$656,81
$707,05
$760,27
$949,31
$941,49
$991,73
$1 044,95
$1 233,99
$1 226,17
$1 276,41
$1 329,63
$1 518,67
$284,68
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$744,26
$844,74
$951,18
$1 329,26
$2 019,94
$1 028,94
$1 129,42
$1 235,86
$1 613,94
$1 313,62
$1 414,10
$1 520,54
$1 898,62
$1 598,30
$1 698,78
$1 805,22
$2 183,30
$284,68
Toc - Plan #16 Cigna Health and Life Insurance Company
Gold

(EPO) Cigna Connect 1500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$352,59
$400,19
$450,61
$629,72
$956,92
$622,32
$669,92
$720,34
$899,45
$892,05
$939,65
$990,07
$1 169,18
$1 161,78
$1 209,38
$1 259,80
$1 438,91
$269,73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$705,18
$800,38
$901,22
$1 259,44
$1 913,84
$974,91
$1 070,11
$1 170,95
$1 529,17
$1 244,64
$1 339,84
$1 440,68
$1 798,90
$1 514,37
$1 609,57
$1 710,41
$2 068,63
$269,73
Toc - Plan #17 Cigna Health and Life Insurance Company
Silver

(EPO) Cigna Connect 6500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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
$368,05
$417,73
$470,37
$657,33
$998,88
$649,61
$699,29
$751,93
$938,89
$931,17
$980,85
$1 033,49
$1 220,45
$1 212,73
$1 262,41
$1 315,05
$1 502,01
$281,56
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$736,10
$835,46
$940,74
$1 314,66
$1 997,76
$1 017,66
$1 117,02
$1 222,30
$1 596,22
$1 299,22
$1 398,58
$1 503,86
$1 877,78
$1 580,78
$1 680,14
$1 785,42
$2 159,34
$281,56
Toc - Plan #18 Cigna Health and Life Insurance Company
Expanded Bronze

(EPO) Cigna Connect 5500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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
$289,39
$328,46
$369,85
$516,86
$785,42
$510,78
$549,85
$591,24
$738,25
$732,17
$771,24
$812,63
$959,64
$953,56
$992,63
$1 034,02
$1 181,03
$221,39
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$578,78
$656,92
$739,70
$1 033,72
$1 570,84
$800,17
$878,31
$961,09
$1 255,11
$1 021,56
$1 099,70
$1 182,48
$1 476,50
$1 242,95
$1 321,09
$1 403,87
$1 697,89
$221,39
Toc - Plan #19 Cigna Health and Life Insurance Company
Silver

(EPO) Cigna Connect 3500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 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
$371,34
$421,47
$474,58
$663,22
$1 007,82
$655,42
$705,55
$758,66
$947,30
$939,50
$989,63
$1 042,74
$1 231,38
$1 223,58
$1 273,71
$1 326,82
$1 515,46
$284,08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$742,68
$842,94
$949,16
$1 326,44
$2 015,64
$1 026,76
$1 127,02
$1 233,24
$1 610,52
$1 310,84
$1 411,10
$1 517,32
$1 894,60
$1 594,92
$1 695,18
$1 801,40
$2 178,68
$284,08
Toc - Plan #20 Cigna Health and Life Insurance Company
Silver

(EPO) Cigna Connect 3500 Diabetes Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 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
$372,44
$422,72
$475,98
$665,18
$1 010,80
$657,36
$707,64
$760,90
$950,10
$942,28
$992,56
$1 045,82
$1 235,02
$1 227,20
$1 277,48
$1 330,74
$1 519,94
$284,92
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$744,88
$845,44
$951,96
$1 330,36
$2 021,60
$1 029,80
$1 130,36
$1 236,88
$1 615,28
$1 314,72
$1 415,28
$1 521,80
$1 900,20
$1 599,64
$1 700,20
$1 806,72
$2 185,12
$284,92
Toc - Plan #21 Cigna Health and Life Insurance Company
Gold

(EPO) Cigna Connect 2000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-900-1237

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$8,000 $16,000 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
$356,05
$404,12
$455,03
$635,91
$966,32
$628,43
$676,50
$727,41
$908,29
$900,81
$948,88
$999,79
$1 180,67
$1 173,19
$1 221,26
$1 272,17
$1 453,05
$272,38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$712,10
$808,24
$910,06
$1 271,82
$1 932,64
$984,48
$1 080,62
$1 182,44
$1 544,20
$1 256,86
$1 353,00
$1 454,82
$1 816,58
$1 529,24
$1 625,38
$1 727,20
$2 088,96
$272,38

ADVERTISEMENT

Anthem HealthKeepers

Local: 1-855-748-1810 | Toll Free: 1-855-748-1810

Toc - Plan #22 Anthem HealthKeepers
Catastrophic

(HMO) Anthem HealthKeepers Catastrophic X 8550

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

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
$224,13
$254,39
$286,44
$400,30
$608,29
$395,59
$425,85
$457,90
$571,76
$567,05
$597,31
$629,36
$743,22
$738,51
$768,77
$800,82
$914,68
$171,46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$448,26
$508,78
$572,88
$800,60
$1 216,58
$619,72
$680,24
$744,34
$972,06
$791,18
$851,70
$915,80
$1 143,52
$962,64
$1 023,16
$1 087,26
$1 314,98
$171,46
Toc - Plan #23 Anthem HealthKeepers
Expanded Bronze

(HMO) Anthem HealthKeepers Bronze X 5500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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
$293,50
$333,12
$375,09
$524,19
$796,56
$518,03
$557,65
$599,62
$748,72
$742,56
$782,18
$824,15
$973,25
$967,09
$1 006,71
$1 048,68
$1 197,78
$224,53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$587,00
$666,24
$750,18
$1 048,38
$1 593,12
$811,53
$890,77
$974,71
$1 272,91
$1 036,06
$1 115,30
$1 199,24
$1 497,44
$1 260,59
$1 339,83
$1 423,77
$1 721,97
$224,53
Toc - Plan #24 Anthem HealthKeepers
Expanded Bronze

(HMO) Anthem HealthKeepers Bronze X 5900 for HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family
$5,900 $11,800 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
$298,31
$338,58
$381,24
$532,78
$809,61
$526,52
$566,79
$609,45
$760,99
$754,73
$795,00
$837,66
$989,20
$982,94
$1 023,21
$1 065,87
$1 217,41
$228,21
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$596,62
$677,16
$762,48
$1 065,56
$1 619,22
$824,83
$905,37
$990,69
$1 293,77
$1 053,04
$1 133,58
$1 218,90
$1 521,98
$1 281,25
$1 361,79
$1 447,11
$1 750,19
$228,21
Toc - Plan #25 Anthem HealthKeepers
Bronze

(HMO) Anthem HealthKeepers Bronze X 8200

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family
$8,200 $16,400 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
$281,87
$319,92
$360,23
$503,42
$765,00
$497,50
$535,55
$575,86
$719,05
$713,13
$751,18
$791,49
$934,68
$928,76
$966,81
$1 007,12
$1 150,31
$215,63
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$563,74
$639,84
$720,46
$1 006,84
$1 530,00
$779,37
$855,47
$936,09
$1 222,47
$995,00
$1 071,10
$1 151,72
$1 438,10
$1 210,63
$1 286,73
$1 367,35
$1 653,73
$215,63
Toc - Plan #26 Anthem HealthKeepers
Gold

(HMO) Anthem HealthKeepers Gold X 2000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family
$2,000 $6,000 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
$371,67
$421,85
$474,99
$663,80
$1 008,71
$656,00
$706,18
$759,32
$948,13
$940,33
$990,51
$1 043,65
$1 232,46
$1 224,66
$1 274,84
$1 327,98
$1 516,79
$284,33
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$743,34
$843,70
$949,98
$1 327,60
$2 017,42
$1 027,67
$1 128,03
$1 234,31
$1 611,93
$1 312,00
$1 412,36
$1 518,64
$1 896,26
$1 596,33
$1 696,69
$1 802,97
$2 180,59
$284,33
Toc - Plan #27 Anthem HealthKeepers
Silver

(HMO) Anthem HealthKeepers Silver X 2200

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family
$2,200 $4,400 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
$395,10
$448,44
$504,94
$705,65
$1 072,30
$697,35
$750,69
$807,19
$1 007,90
$999,60
$1 052,94
$1 109,44
$1 310,15
$1 301,85
$1 355,19
$1 411,69
$1 612,40
$302,25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$790,20
$896,88
$1 009,88
$1 411,30
$2 144,60
$1 092,45
$1 199,13
$1 312,13
$1 713,55
$1 394,70
$1 501,38
$1 614,38
$2 015,80
$1 696,95
$1 803,63
$1 916,63
$2 318,05
$302,25
Toc - Plan #28 Anthem HealthKeepers
Silver

(HMO) Anthem HealthKeepers Silver X 6250

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family
$6,250 $12,500 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
$368,45
$418,19
$470,88
$658,05
$999,97
$650,31
$700,05
$752,74
$939,91
$932,17
$981,91
$1 034,60
$1 221,77
$1 214,03
$1 263,77
$1 316,46
$1 503,63
$281,86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$736,90
$836,38
$941,76
$1 316,10
$1 999,94
$1 018,76
$1 118,24
$1 223,62
$1 597,96
$1 300,62
$1 400,10
$1 505,48
$1 879,82
$1 582,48
$1 681,96
$1 787,34
$2 161,68
$281,86
Toc - Plan #29 Anthem HealthKeepers
Expanded Bronze

(HMO) Anthem HealthKeepers Bronze X 5800 Online Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 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
$302,27
$343,08
$386,30
$539,85
$820,36
$533,51
$574,32
$617,54
$771,09
$764,75
$805,56
$848,78
$1 002,33
$995,99
$1 036,80
$1 080,02
$1 233,57
$231,24
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$604,54
$686,16
$772,60
$1 079,70
$1 640,72
$835,78
$917,40
$1 003,84
$1 310,94
$1 067,02
$1 148,64
$1 235,08
$1 542,18
$1 298,26
$1 379,88
$1 466,32
$1 773,42
$231,24
Toc - Plan #30 Anthem HealthKeepers
Silver

(HMO) Anthem HealthKeepers Silver X 5300 Online Plus

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-748-1810

Annual Out of Pocket Expenses:

Individual Family
$5,300 $10,600 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
$374,02
$424,51
$478,00
$668,00
$1 015,09
$660,15
$710,64
$764,13
$954,13
$946,28
$996,77
$1 050,26
$1 240,26
$1 232,41
$1 282,90
$1 336,39
$1 526,39
$286,13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$748,04
$849,02
$956,00
$1 336,00
$2 030,18
$1 034,17
$1 135,15
$1 242,13
$1 622,13
$1 320,30
$1 421,28
$1 528,26
$1 908,26
$1 606,43
$1 707,41
$1 814,39
$2 194,39
$286,13

ADVERTISEMENT

Kaiser Permanente

Local: 1-800-807-1140 | Toll Free: 1-800-807-1140 | TTY: 1-703-359-7616

Toc - Plan #31 Kaiser Permanente
Gold

(HMO) KP VA Gold 0/20/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$6,950 $13,900 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
$413,56
$469,40
$528,54
$738,63
$1 122,41
$729,94
$785,78
$844,92
$1 055,01
$1 046,32
$1 102,16
$1 161,30
$1 371,39
$1 362,70
$1 418,54
$1 477,68
$1 687,77
$316,38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$827,12
$938,80
$1 057,08
$1 477,26
$2 244,82
$1 143,50
$1 255,18
$1 373,46
$1 793,64
$1 459,88
$1 571,56
$1 689,84
$2 110,02
$1 776,26
$1 887,94
$2 006,22
$2 426,40
$316,38
Toc - Plan #32 Kaiser Permanente
Silver

(HMO) KP VA Silver 2500/35/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$8,250 $16,500 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
$432,90
$491,34
$553,25
$773,16
$1 174,90
$764,07
$822,51
$884,42
$1 104,33
$1 095,24
$1 153,68
$1 215,59
$1 435,50
$1 426,41
$1 484,85
$1 546,76
$1 766,67
$331,17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$865,80
$982,68
$1 106,50
$1 546,32
$2 349,80
$1 196,97
$1 313,85
$1 437,67
$1 877,49
$1 528,14
$1 645,02
$1 768,84
$2 208,66
$1 859,31
$1 976,19
$2 100,01
$2 539,83
$331,17
Toc - Plan #33 Kaiser Permanente
Expanded Bronze

(HMO) KP VA Bronze 6000/55/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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
$326,92
$371,06
$417,81
$583,89
$887,27
$577,02
$621,16
$667,91
$833,99
$827,12
$871,26
$918,01
$1 084,09
$1 077,22
$1 121,36
$1 168,11
$1 334,19
$250,10
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$653,84
$742,12
$835,62
$1 167,78
$1 774,54
$903,94
$992,22
$1 085,72
$1 417,88
$1 154,04
$1 242,32
$1 335,82
$1 667,98
$1 404,14
$1 492,42
$1 585,92
$1 918,08
$250,10
Toc - Plan #34 Kaiser Permanente
Catastrophic

(HMO) KP VA Catastrophic 8550/0/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

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
$227,15
$257,82
$290,30
$405,69
$616,49
$400,92
$431,59
$464,07
$579,46
$574,69
$605,36
$637,84
$753,23
$748,46
$779,13
$811,61
$927,00
$173,77
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$454,30
$515,64
$580,60
$811,38
$1 232,98
$628,07
$689,41
$754,37
$985,15
$801,84
$863,18
$928,14
$1 158,92
$975,61
$1 036,95
$1 101,91
$1 332,69
$173,77
Toc - Plan #35 Kaiser Permanente
Platinum

(HMO) KP VA Platinum 0/15/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$4,000 $8,000 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
$477,88
$542,39
$610,73
$853,49
$1 296,97
$843,46
$907,97
$976,31
$1 219,07
$1 209,04
$1 273,55
$1 341,89
$1 584,65
$1 574,62
$1 639,13
$1 707,47
$1 950,23
$365,58
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$955,76
$1 084,78
$1 221,46
$1 706,98
$2 593,94
$1 321,34
$1 450,36
$1 587,04
$2 072,56
$1 686,92
$1 815,94
$1 952,62
$2 438,14
$2 052,50
$2 181,52
$2 318,20
$2 803,72
$365,58
Toc - Plan #36 Kaiser Permanente
Silver

(HMO) KP VA Silver 5000/40/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,500 $17,000 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
$419,82
$476,49
$536,53
$749,79
$1 139,38
$740,98
$797,65
$857,69
$1 070,95
$1 062,14
$1 118,81
$1 178,85
$1 392,11
$1 383,30
$1 439,97
$1 500,01
$1 713,27
$321,16
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$839,64
$952,98
$1 073,06
$1 499,58
$2 278,76
$1 160,80
$1 274,14
$1 394,22
$1 820,74
$1 481,96
$1 595,30
$1 715,38
$2 141,90
$1 803,12
$1 916,46
$2 036,54
$2 463,06
$321,16
Toc - Plan #37 Kaiser Permanente
Gold

(HMO) KP VA Gold 1250/20/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$1,250 $2,500 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
$405,32
$460,04
$518,00
$723,91
$1 100,05
$715,39
$770,11
$828,07
$1 033,98
$1 025,46
$1 080,18
$1 138,14
$1 344,05
$1 335,53
$1 390,25
$1 448,21
$1 654,12
$310,07
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$810,64
$920,08
$1 036,00
$1 447,82
$2 200,10
$1 120,71
$1 230,15
$1 346,07
$1 757,89
$1 430,78
$1 540,22
$1 656,14
$2 067,96
$1 740,85
$1 850,29
$1 966,21
$2 378,03
$310,07
Toc - Plan #38 Kaiser Permanente
Gold

(HMO) KP VA Gold 1700/25/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$1,700 $3,400 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
$396,40
$449,91
$506,60
$707,97
$1 075,83
$699,65
$753,16
$809,85
$1 011,22
$1 002,90
$1 056,41
$1 113,10
$1 314,47
$1 306,15
$1 359,66
$1 416,35
$1 617,72
$303,25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$792,80
$899,82
$1 013,20
$1 415,94
$2 151,66
$1 096,05
$1 203,07
$1 316,45
$1 719,19
$1 399,30
$1 506,32
$1 619,70
$2 022,44
$1 702,55
$1 809,57
$1 922,95
$2 325,69
$303,25
Toc - Plan #39 Kaiser Permanente
Silver

(HMO) KP VA Silver 6500/40/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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
$413,00
$468,76
$527,82
$737,63
$1 120,89
$728,95
$784,71
$843,77
$1 053,58
$1 044,90
$1 100,66
$1 159,72
$1 369,53
$1 360,85
$1 416,61
$1 475,67
$1 685,48
$315,95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$826,00
$937,52
$1 055,64
$1 475,26
$2 241,78
$1 141,95
$1 253,47
$1 371,59
$1 791,21
$1 457,90
$1 569,42
$1 687,54
$2 107,16
$1 773,85
$1 885,37
$2 003,49
$2 423,11
$315,95
Toc - Plan #40 Kaiser Permanente
Bronze

(HMO) KP VA Bronze 7500/40%/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$7,500 $15,000 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
$312,23
$354,38
$399,03
$557,65
$847,40
$551,09
$593,24
$637,89
$796,51
$789,95
$832,10
$876,75
$1 035,37
$1 028,81
$1 070,96
$1 115,61
$1 274,23
$238,86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$624,46
$708,76
$798,06
$1 115,30
$1 694,80
$863,32
$947,62
$1 036,92
$1 354,16
$1 102,18
$1 186,48
$1 275,78
$1 593,02
$1 341,04
$1 425,34
$1 514,64
$1 831,88
$238,86
Toc - Plan #41 Kaiser Permanente
Expanded Bronze

(HMO) KP VA Bronze 6900/0%/HSA/Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-807-1140

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 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
$329,17
$373,61
$420,68
$587,90
$893,37
$580,99
$625,43
$672,50
$839,72
$832,81
$877,25
$924,32
$1 091,54
$1 084,63
$1 129,07
$1 176,14
$1 343,36
$251,82
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$658,34
$747,22
$841,36
$1 175,80
$1 786,74
$910,16
$999,04
$1 093,18
$1 427,62
$1 161,98
$1 250,86
$1 345,00
$1 679,44
$1 413,80
$1 502,68
$1 596,82
$1 931,26
$251,82

‡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 Fairfax County here.

Fairfax County is in “Rating Area 10” of Virginia.

Currently, there are 41 plans offered in Rating Area 10.

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2021 Obamacare Plans for Fairfax County, VA

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