Obamacare 2021 Rates for Green Lake County
Obamacare > Rates > Wisconsin > Green Lake County
Obamacare > Rates > Wisconsin > Green Lake County
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HealthPartnersLocal: 1-952-883-5900 | Toll Free: 1-855-813-3887 | TTY: 1-952-883-6060 |
Toc - Plan #1 HealthPartners | ||||||||||||||||||||
Gold
(PPO) Robin Oak $1,200 w/Copay Gold |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$406,11 $460,93 $519,01 $725,31 $1 102,18 |
$716,78 $771,60 $829,68 $1 035,98 |
$1 027,45 $1 082,27 $1 140,35 $1 346,65 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$812,22 $921,86 $1 038,02 $1 450,62 $2 204,36 |
$1 122,89 $1 232,53 $1 348,69 $1 761,29 |
$1 433,56 $1 543,20 $1 659,36 $2 071,96 |
Toc - Plan #2 HealthPartners | ||||||||||||||||||||
Silver
(PPO) Robin Oak $4,000 Plus Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$366,09 $415,51 $467,86 $653,84 $993,57 |
$646,15 $695,57 $747,92 $933,90 |
$926,21 $975,63 $1 027,98 $1 213,96 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$732,18 $831,02 $935,72 $1 307,68 $1 987,14 |
$1 012,24 $1 111,08 $1 215,78 $1 587,74 |
$1 292,30 $1 391,14 $1 495,84 $1 867,80 |
Toc - Plan #3 HealthPartners | ||||||||||||||||||||
Expanded Bronze
(PPO) Robin Oak $6,800 Plus Bronze |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$290,60 $329,83 $371,39 $519,01 $788,69 |
$512,91 $552,14 $593,70 $741,32 |
$735,22 $774,45 $816,01 $963,63 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$581,20 $659,66 $742,78 $1 038,02 $1 577,38 |
$803,51 $881,97 $965,09 $1 260,33 |
$1 025,82 $1 104,28 $1 187,40 $1 482,64 |
Toc - Plan #4 HealthPartners | ||||||||||||||||||||
Catastrophic
(PPO) Robin Oak $8,550 Catastrophic |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$222,87 $252,96 $284,83 $398,05 $604,87 |
$393,37 $423,46 $455,33 $568,55 |
$563,87 $593,96 $625,83 $739,05 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$445,74 $505,92 $569,66 $796,10 $1 209,74 |
$616,24 $676,42 $740,16 $966,60 |
$786,74 $846,92 $910,66 $1 137,10 |
Toc - Plan #5 HealthPartners | ||||||||||||||||||||
Silver
(PPO) Robin Oak $3,500 w/Copay P-S Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$404,17 $458,73 $516,53 $721,85 $1 096,92 |
$713,36 $767,92 $825,72 $1 031,04 |
$1 022,55 $1 077,11 $1 134,91 $1 340,23 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$808,34 $917,46 $1 033,06 $1 443,70 $2 193,84 |
$1 117,53 $1 226,65 $1 342,25 $1 752,89 |
$1 426,72 $1 535,84 $1 651,44 $2 062,08 |
Toc - Plan #6 HealthPartners | ||||||||||||||||||||
Silver
(PPO) Robin Oak $5,000 Plus Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-813-3887
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$353,20 $400,88 $451,39 $630,82 $958,58 |
$623,40 $671,08 $721,59 $901,02 |
$893,60 $941,28 $991,79 $1 171,22 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$706,40 $801,76 $902,78 $1 261,64 $1 917,16 |
$976,60 $1 071,96 $1 172,98 $1 531,84 |
$1 246,80 $1 342,16 $1 443,18 $1 802,04 |
ADVERTISEMENT
QuartzLocal: 1-608-644-3430 | Toll Free: 1-800-362-3310 | TTY: 1-800-877-8973 |
Toc - Plan #7 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I302 with Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$417,59 $473,95 $533,67 $745,80 $1 133,32 |
$737,04 $793,40 $853,12 $1 065,25 |
$1 056,49 $1 112,85 $1 172,57 $1 384,70 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$835,18 $947,90 $1 067,34 $1 491,60 $2 266,64 |
$1 154,63 $1 267,35 $1 386,79 $1 811,05 |
$1 474,08 $1 586,80 $1 706,24 $2 130,50 |
Toc - Plan #8 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I303 with Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$402,09 $456,37 $513,87 $718,13 $1 091,27 |
$709,69 $763,97 $821,47 $1 025,73 |
$1 017,29 $1 071,57 $1 129,07 $1 333,33 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$804,18 $912,74 $1 027,74 $1 436,26 $2 182,54 |
$1 111,78 $1 220,34 $1 335,34 $1 743,86 |
$1 419,38 $1 527,94 $1 642,94 $2 051,46 |
Toc - Plan #9 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I402 Maintenance with Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$369,19 $419,03 $471,82 $659,37 $1 001,97 |
$651,62 $701,46 $754,25 $941,80 |
$934,05 $983,89 $1 036,68 $1 224,23 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$738,38 $838,06 $943,64 $1 318,74 $2 003,94 |
$1 020,81 $1 120,49 $1 226,07 $1 601,17 |
$1 303,24 $1 402,92 $1 508,50 $1 883,60 |
Toc - Plan #10 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I401 with Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$373,44 $423,85 $477,26 $666,96 $1 013,52 |
$659,12 $709,53 $762,94 $952,64 |
$944,80 $995,21 $1 048,62 $1 238,32 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$746,88 $847,70 $954,52 $1 333,92 $2 027,04 |
$1 032,56 $1 133,38 $1 240,20 $1 619,60 |
$1 318,24 $1 419,06 $1 525,88 $1 905,28 |
Toc - Plan #11 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I301 with Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$416,82 $473,09 $532,69 $744,43 $1 131,24 |
$735,68 $791,95 $851,55 $1 063,29 |
$1 054,54 $1 110,81 $1 170,41 $1 382,15 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$833,64 $946,18 $1 065,38 $1 488,86 $2 262,48 |
$1 152,50 $1 265,04 $1 384,24 $1 807,72 |
$1 471,36 $1 583,90 $1 703,10 $2 126,58 |
Toc - Plan #12 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I202 with Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$288,04 $326,92 $368,10 $514,43 $781,72 |
$508,38 $547,26 $588,44 $734,77 |
$728,72 $767,60 $808,78 $955,11 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$576,08 $653,84 $736,20 $1 028,86 $1 563,44 |
$796,42 $874,18 $956,54 $1 249,20 |
$1 016,76 $1 094,52 $1 176,88 $1 469,54 |
Toc - Plan #13 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I405 with Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$369,69 $419,60 $472,46 $660,26 $1 003,33 |
$652,50 $702,41 $755,27 $943,07 |
$935,31 $985,22 $1 038,08 $1 225,88 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$739,38 $839,20 $944,92 $1 320,52 $2 006,66 |
$1 022,19 $1 122,01 $1 227,73 $1 603,33 |
$1 305,00 $1 404,82 $1 510,54 $1 886,14 |
Toc - Plan #14 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I201 with Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$289,07 $328,08 $369,42 $516,26 $784,51 |
$510,20 $549,21 $590,55 $737,39 |
$731,33 $770,34 $811,68 $958,52 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$578,14 $656,16 $738,84 $1 032,52 $1 569,02 |
$799,27 $877,29 $959,97 $1 253,65 |
$1 020,40 $1 098,42 $1 181,10 $1 474,78 |
Toc - Plan #15 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I204 with Dental |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$300,94 $341,56 $384,60 $537,47 $816,74 |
$531,16 $571,78 $614,82 $767,69 |
$761,38 $802,00 $845,04 $997,91 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$601,88 $683,12 $769,20 $1 074,94 $1 633,48 |
$832,10 $913,34 $999,42 $1 305,16 |
$1 062,32 $1 143,56 $1 229,64 $1 535,38 |
Toc - Plan #16 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I302 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$401,27 $455,43 $512,81 $716,65 $1 089,02 |
$708,23 $762,39 $819,77 $1 023,61 |
$1 015,19 $1 069,35 $1 126,73 $1 330,57 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$802,54 $910,86 $1 025,62 $1 433,30 $2 178,04 |
$1 109,50 $1 217,82 $1 332,58 $1 740,26 |
$1 416,46 $1 524,78 $1 639,54 $2 047,22 |
Toc - Plan #17 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I303 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$386,38 $438,53 $493,78 $690,06 $1 048,62 |
$681,96 $734,11 $789,36 $985,64 |
$977,54 $1 029,69 $1 084,94 $1 281,22 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$772,76 $877,06 $987,56 $1 380,12 $2 097,24 |
$1 068,34 $1 172,64 $1 283,14 $1 675,70 |
$1 363,92 $1 468,22 $1 578,72 $1 971,28 |
Toc - Plan #18 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I402 Maintenance |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$354,76 $402,65 $453,38 $633,60 $962,81 |
$626,15 $674,04 $724,77 $904,99 |
$897,54 $945,43 $996,16 $1 176,38 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$709,52 $805,30 $906,76 $1 267,20 $1 925,62 |
$980,91 $1 076,69 $1 178,15 $1 538,59 |
$1 252,30 $1 348,08 $1 449,54 $1 809,98 |
Toc - Plan #19 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I401 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$358,85 $407,29 $458,60 $640,90 $973,90 |
$633,37 $681,81 $733,12 $915,42 |
$907,89 $956,33 $1 007,64 $1 189,94 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$717,70 $814,58 $917,20 $1 281,80 $1 947,80 |
$992,22 $1 089,10 $1 191,72 $1 556,32 |
$1 266,74 $1 363,62 $1 466,24 $1 830,84 |
Toc - Plan #20 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I301 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$400,53 $454,60 $511,87 $715,34 $1 087,03 |
$706,93 $761,00 $818,27 $1 021,74 |
$1 013,33 $1 067,40 $1 124,67 $1 328,14 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$801,06 $909,20 $1 023,74 $1 430,68 $2 174,06 |
$1 107,46 $1 215,60 $1 330,14 $1 737,08 |
$1 413,86 $1 522,00 $1 636,54 $2 043,48 |
Toc - Plan #21 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I202 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$276,78 $314,14 $353,72 $494,32 $751,17 |
$488,51 $525,87 $565,45 $706,05 |
$700,24 $737,60 $777,18 $917,78 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$553,56 $628,28 $707,44 $988,64 $1 502,34 |
$765,29 $840,01 $919,17 $1 200,37 |
$977,02 $1 051,74 $1 130,90 $1 412,10 |
Toc - Plan #22 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I405 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$355,24 $403,20 $454,00 $634,46 $964,12 |
$627,00 $674,96 $725,76 $906,22 |
$898,76 $946,72 $997,52 $1 177,98 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$710,48 $806,40 $908,00 $1 268,92 $1 928,24 |
$982,24 $1 078,16 $1 179,76 $1 540,68 |
$1 254,00 $1 349,92 $1 451,52 $1 812,44 |
Toc - Plan #23 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I201 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$277,77 $315,26 $354,98 $496,08 $753,85 |
$490,26 $527,75 $567,47 $708,57 |
$702,75 $740,24 $779,96 $921,06 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$555,54 $630,52 $709,96 $992,16 $1 507,70 |
$768,03 $843,01 $922,45 $1 204,65 |
$980,52 $1 055,50 $1 134,94 $1 417,14 |
Toc - Plan #24 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I204 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$289,18 $328,21 $369,57 $516,47 $784,82 |
$510,40 $549,43 $590,79 $737,69 |
$731,62 $770,65 $812,01 $958,91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$578,36 $656,42 $739,14 $1 032,94 $1 569,64 |
$799,58 $877,64 $960,36 $1 254,16 |
$1 020,80 $1 098,86 $1 181,58 $1 475,38 |
Toc - Plan #25 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I404 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$374,01 $424,50 $477,98 $667,98 $1 015,05 |
$660,12 $710,61 $764,09 $954,09 |
$946,23 $996,72 $1 050,20 $1 240,20 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$748,02 $849,00 $955,96 $1 335,96 $2 030,10 |
$1 034,13 $1 135,11 $1 242,07 $1 622,07 |
$1 320,24 $1 421,22 $1 528,18 $1 908,18 |
Toc - Plan #26 Quartz | ||||||||||||||||||||
Expanded Bronze
(HMO) Quartz One Bronze I203 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$284,50 $322,91 $363,59 $508,11 $772,13 |
$502,14 $540,55 $581,23 $725,75 |
$719,78 $758,19 $798,87 $943,39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$569,00 $645,82 $727,18 $1 016,22 $1 544,26 |
$786,64 $863,46 $944,82 $1 233,86 |
$1 004,28 $1 081,10 $1 162,46 $1 451,50 |
Toc - Plan #27 Quartz | ||||||||||||||||||||
Catastrophic
(HMO) Quartz One Catastrophic I101 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$207,19 $235,15 $264,78 $370,03 $562,30 |
$365,69 $393,65 $423,28 $528,53 |
$524,19 $552,15 $581,78 $687,03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$414,38 $470,30 $529,56 $740,06 $1 124,60 |
$572,88 $628,80 $688,06 $898,56 |
$731,38 $787,30 $846,56 $1 057,06 |
Toc - Plan #28 Quartz | ||||||||||||||||||||
Silver
(HMO) Quartz One Silver I304 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$413,90 $469,77 $528,96 $739,22 $1 123,31 |
$730,53 $786,40 $845,59 $1 055,85 |
$1 047,16 $1 103,03 $1 162,22 $1 372,48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$827,80 $939,54 $1 057,92 $1 478,44 $2 246,62 |
$1 144,43 $1 256,17 $1 374,55 $1 795,07 |
$1 461,06 $1 572,80 $1 691,18 $2 111,70 |
Toc - Plan #29 Quartz | ||||||||||||||||||||
Gold
(HMO) Quartz One Gold I403 HSA |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-362-3310
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$379,51 $430,74 $485,01 $677,80 $1 029,99 |
$669,84 $721,07 $775,34 $968,13 |
$960,17 $1 011,40 $1 065,67 $1 258,46 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$759,02 $861,48 $970,02 $1 355,60 $2 059,98 |
$1 049,35 $1 151,81 $1 260,35 $1 645,93 |
$1 339,68 $1 442,14 $1 550,68 $1 936,26 |
ADVERTISEMENT
Dean Health PlanLocal: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302 |
Toc - Plan #30 Dean Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) Dean Catastrophic Safety Net |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$187,53 $212,85 $239,67 $334,94 $508,97 |
$330,99 $356,31 $383,13 $478,40 |
$474,45 $499,77 $526,59 $621,86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$375,06 $425,70 $479,34 $669,88 $1 017,94 |
$518,52 $569,16 $622,80 $813,34 |
$661,98 $712,62 $766,26 $956,80 |
Toc - Plan #31 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Copay Plus 4800X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$353,46 $401,18 $451,73 $631,28 $959,30 |
$623,86 $671,58 $722,13 $901,68 |
$894,26 $941,98 $992,53 $1 172,08 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$706,92 $802,36 $903,46 $1 262,56 $1 918,60 |
$977,32 $1 072,76 $1 173,86 $1 532,96 |
$1 247,72 $1 343,16 $1 444,26 $1 803,36 |
Toc - Plan #32 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Classic 5000X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$346,24 $392,98 $442,50 $618,39 $939,70 |
$611,11 $657,85 $707,37 $883,26 |
$875,98 $922,72 $972,24 $1 148,13 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$692,48 $785,96 $885,00 $1 236,78 $1 879,40 |
$957,35 $1 050,83 $1 149,87 $1 501,65 |
$1 222,22 $1 315,70 $1 414,74 $1 766,52 |
Toc - Plan #33 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Value Copay 5000X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$352,59 $400,19 $450,61 $629,73 $956,93 |
$622,32 $669,92 $720,34 $899,46 |
$892,05 $939,65 $990,07 $1 169,19 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$705,18 $800,38 $901,22 $1 259,46 $1 913,86 |
$974,91 $1 070,11 $1 170,95 $1 529,19 |
$1 244,64 $1 339,84 $1 440,68 $1 798,92 |
Toc - Plan #34 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Value Copay 3700X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$337,36 $382,91 $431,15 $602,53 $915,60 |
$595,44 $640,99 $689,23 $860,61 |
$853,52 $899,07 $947,31 $1 118,69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$674,72 $765,82 $862,30 $1 205,06 $1 831,20 |
$932,80 $1 023,90 $1 120,38 $1 463,14 |
$1 190,88 $1 281,98 $1 378,46 $1 721,22 |
Toc - Plan #35 Dean Health Plan | ||||||||||||||||||||
Bronze
(HMO) Dean Bronze Value Copay 8500X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$226,47 $257,05 $289,43 $404,48 $614,65 |
$399,72 $430,30 $462,68 $577,73 |
$572,97 $603,55 $635,93 $750,98 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$452,94 $514,10 $578,86 $808,96 $1 229,30 |
$626,19 $687,35 $752,11 $982,21 |
$799,44 $860,60 $925,36 $1 155,46 |
Toc - Plan #36 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver HSA-E 4500X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$338,30 $383,97 $432,34 $604,20 $918,14 |
$597,10 $642,77 $691,14 $863,00 |
$855,90 $901,57 $949,94 $1 121,80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$676,60 $767,94 $864,68 $1 208,40 $1 836,28 |
$935,40 $1 026,74 $1 123,48 $1 467,20 |
$1 194,20 $1 285,54 $1 382,28 $1 726,00 |
Toc - Plan #37 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Copay Plus 1500X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$348,20 $395,20 $445,00 $621,88 $945,01 |
$614,57 $661,57 $711,37 $888,25 |
$880,94 $927,94 $977,74 $1 154,62 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$696,40 $790,40 $890,00 $1 243,76 $1 890,02 |
$962,77 $1 056,77 $1 156,37 $1 510,13 |
$1 229,14 $1 323,14 $1 422,74 $1 776,50 |
Toc - Plan #38 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze HSA-E 6850X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$240,56 $273,03 $307,43 $429,63 $652,87 |
$424,59 $457,06 $491,46 $613,66 |
$608,62 $641,09 $675,49 $797,69 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$481,12 $546,06 $614,86 $859,26 $1 305,74 |
$665,15 $730,09 $798,89 $1 043,29 |
$849,18 $914,12 $982,92 $1 227,32 |
Toc - Plan #39 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Dean Bronze Copay Plus 8500X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$232,55 $263,95 $297,20 $415,34 $631,15 |
$410,45 $441,85 $475,10 $593,24 |
$588,35 $619,75 $653,00 $771,14 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$465,10 $527,90 $594,40 $830,68 $1 262,30 |
$643,00 $705,80 $772,30 $1 008,58 |
$820,90 $883,70 $950,20 $1 186,48 |
Toc - Plan #40 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Dean Gold Copay Elite 1500X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$331,01 $375,70 $423,04 $591,19 $898,37 |
$584,24 $628,93 $676,27 $844,42 |
$837,47 $882,16 $929,50 $1 097,65 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$662,02 $751,40 $846,08 $1 182,38 $1 796,74 |
$915,25 $1 004,63 $1 099,31 $1 435,61 |
$1 168,48 $1 257,86 $1 352,54 $1 688,84 |
Toc - Plan #41 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Dean Silver Copay Elite 4800X |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$336,16 $381,54 $429,61 $600,38 $912,34 |
$593,32 $638,70 $686,77 $857,54 |
$850,48 $895,86 $943,93 $1 114,70 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$672,32 $763,08 $859,22 $1 200,76 $1 824,68 |
$929,48 $1 020,24 $1 116,38 $1 457,92 |
$1 186,64 $1 277,40 $1 373,54 $1 715,08 |
ADVERTISEMENT
Molina HealthcareLocal: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
Toc - Plan #42 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$365,79 $415,17 $467,48 $653,30 $992,75 |
$645,62 $695,00 $747,31 $933,13 |
$925,45 $974,83 $1 027,14 $1 212,96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$731,58 $830,34 $934,96 $1 306,60 $1 985,50 |
$1 011,41 $1 110,17 $1 214,79 $1 586,43 |
$1 291,24 $1 390,00 $1 494,62 $1 866,26 |
Toc - Plan #43 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$322,42 $365,95 $412,05 $575,84 $875,05 |
$569,07 $612,60 $658,70 $822,49 |
$815,72 $859,25 $905,35 $1 069,14 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$644,84 $731,90 $824,10 $1 151,68 $1 750,10 |
$891,49 $978,55 $1 070,75 $1 398,33 |
$1 138,14 $1 225,20 $1 317,40 $1 644,98 |
Toc - Plan #44 Molina Healthcare | ||||||||||||||||||||
Bronze
(HMO) Core Care Bronze 1 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$255,55 $290,05 $326,60 $456,42 $693,57 |
$451,05 $485,55 $522,10 $651,92 |
$646,55 $681,05 $717,60 $847,42 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$511,10 $580,10 $653,20 $912,84 $1 387,14 |
$706,60 $775,60 $848,70 $1 108,34 |
$902,10 $971,10 $1 044,20 $1 303,84 |
Toc - Plan #45 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 4 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$319,01 $362,08 $407,70 $569,76 $865,80 |
$563,06 $606,13 $651,75 $813,81 |
$807,11 $850,18 $895,80 $1 057,86 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$638,02 $724,16 $815,40 $1 139,52 $1 731,60 |
$882,07 $968,21 $1 059,45 $1 383,57 |
$1 126,12 $1 212,26 $1 303,50 $1 627,62 |
Toc - Plan #46 Molina Healthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) Core Care Bronze 4 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$267,69 $303,83 $342,11 $478,09 $726,51 |
$472,47 $508,61 $546,89 $682,87 |
$677,25 $713,39 $751,67 $887,65 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$535,38 $607,66 $684,22 $956,18 $1 453,02 |
$740,16 $812,44 $889,00 $1 160,96 |
$944,94 $1 017,22 $1 093,78 $1 365,74 |
Toc - Plan #47 Molina Healthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) Core Care Bronze 5 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$260,27 $295,41 $332,62 $464,84 $706,37 |
$459,38 $494,52 $531,73 $663,95 |
$658,49 $693,63 $730,84 $863,06 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$520,54 $590,82 $665,24 $929,68 $1 412,74 |
$719,65 $789,93 $864,35 $1 128,79 |
$918,76 $989,04 $1 063,46 $1 327,90 |
Toc - Plan #48 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 1 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$368,68 $418,45 $471,17 $658,47 $1 000,60 |
$650,72 $700,49 $753,21 $940,51 |
$932,76 $982,53 $1 035,25 $1 222,55 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$737,36 $836,90 $942,34 $1 316,94 $2 001,20 |
$1 019,40 $1 118,94 $1 224,38 $1 598,98 |
$1 301,44 $1 400,98 $1 506,42 $1 881,02 |
Toc - Plan #49 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$325,32 $369,23 $415,75 $581,01 $882,91 |
$574,19 $618,10 $664,62 $829,88 |
$823,06 $866,97 $913,49 $1 078,75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$650,64 $738,46 $831,50 $1 162,02 $1 765,82 |
$899,51 $987,33 $1 080,37 $1 410,89 |
$1 148,38 $1 236,20 $1 329,24 $1 659,76 |
Toc - Plan #50 Molina Healthcare | ||||||||||||||||||||
Bronze
(HMO) Core Care Bronze 1 + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$258,45 $293,34 $330,29 $461,58 $701,42 |
$456,16 $491,05 $528,00 $659,29 |
$653,87 $688,76 $725,71 $857,00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$516,90 $586,68 $660,58 $923,16 $1 402,84 |
$714,61 $784,39 $858,29 $1 120,87 |
$912,32 $982,10 $1 056,00 $1 318,58 |
Toc - Plan #51 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 2 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$322,07 $365,55 $411,61 $575,22 $874,11 |
$568,46 $611,94 $658,00 $821,61 |
$814,85 $858,33 $904,39 $1 068,00 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$644,14 $731,10 $823,22 $1 150,44 $1 748,22 |
$890,53 $977,49 $1 069,61 $1 396,83 |
$1 136,92 $1 223,88 $1 316,00 $1 643,22 |
Toc - Plan #52 Molina Healthcare | ||||||||||||||||||||
Bronze
(HMO) Core Care Bronze 2 |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$253,29 $287,49 $323,71 $452,38 $687,44 |
$447,06 $481,26 $517,48 $646,15 |
$640,83 $675,03 $711,25 $839,92 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$506,58 $574,98 $647,42 $904,76 $1 374,88 |
$700,35 $768,75 $841,19 $1 098,53 |
$894,12 $962,52 $1 034,96 $1 292,30 |
ADVERTISEMENT
Arise Health PlanLocal: 1-920-490-6900 | Toll Free: 1-800-332-6249 | TTY: 1-888-332-0144 |
Toc - Plan #53 Arise Health Plan | ||||||||||||||||||||
Bronze
(HMO) WPS HMO Bronze $8,550 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$306,55 $347,93 $391,77 $547,50 $831,98 |
$541,06 $582,44 $626,28 $782,01 |
$775,57 $816,95 $860,79 $1 016,52 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$613,10 $695,86 $783,54 $1 095,00 $1 663,96 |
$847,61 $930,37 $1 018,05 $1 329,51 |
$1 082,12 $1 164,88 $1 252,56 $1 564,02 |
Toc - Plan #54 Arise Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO Bronze $6,500 with 3 Free PCP Visits | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$318,30 $361,27 $406,79 $568,48 $863,87 |
$561,80 $604,77 $650,29 $811,98 |
$805,30 $848,27 $893,79 $1 055,48 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$636,60 $722,54 $813,58 $1 136,96 $1 727,74 |
$880,10 $966,04 $1 057,08 $1 380,46 |
$1 123,60 $1 209,54 $1 300,58 $1 623,96 |
Toc - Plan #55 Arise Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO Bronze $7,200 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$311,86 $353,96 $398,56 $556,98 $846,39 |
$550,43 $592,53 $637,13 $795,55 |
$789,00 $831,10 $875,70 $1 034,12 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$623,72 $707,92 $797,12 $1 113,96 $1 692,78 |
$862,29 $946,49 $1 035,69 $1 352,53 |
$1 100,86 $1 185,06 $1 274,26 $1 591,10 |
Toc - Plan #56 Arise Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO Silver $7,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$412,10 $467,73 $526,66 $736,01 $1 118,44 |
$727,36 $782,99 $841,92 $1 051,27 |
$1 042,62 $1 098,25 $1 157,18 $1 366,53 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$824,20 $935,46 $1 053,32 $1 472,02 $2 236,88 |
$1 139,46 $1 250,72 $1 368,58 $1 787,28 |
$1 454,72 $1 565,98 $1 683,84 $2 102,54 |
Toc - Plan #57 Arise Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO Silver $4,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$413,09 $468,86 $527,93 $737,78 $1 121,13 |
$729,10 $784,87 $843,94 $1 053,79 |
$1 045,11 $1 100,88 $1 159,95 $1 369,80 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$826,18 $937,72 $1 055,86 $1 475,56 $2 242,26 |
$1 142,19 $1 253,73 $1 371,87 $1 791,57 |
$1 458,20 $1 569,74 $1 687,88 $2 107,58 |
Toc - Plan #58 Arise Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO Silver $5,000 with 3 Free PCP Visits | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$429,69 $487,70 $549,14 $767,43 $1 166,18 |
$758,40 $816,41 $877,85 $1 096,14 |
$1 087,11 $1 145,12 $1 206,56 $1 424,85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$859,38 $975,40 $1 098,28 $1 534,86 $2 332,36 |
$1 188,09 $1 304,11 $1 426,99 $1 863,57 |
$1 516,80 $1 632,82 $1 755,70 $2 192,28 |
Toc - Plan #59 Arise Health Plan | ||||||||||||||||||||
Gold
(HMO) WPS HMO Gold $2,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$569,19 $646,03 $727,42 $1 016,57 $1 544,78 |
$1 004,62 $1 081,46 $1 162,85 $1 452,00 |
$1 440,05 $1 516,89 $1 598,28 $1 887,43 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1 138,38 $1 292,06 $1 454,84 $2 033,14 $3 089,56 |
$1 573,81 $1 727,49 $1 890,27 $2 468,57 |
$2 009,24 $2 162,92 $2 325,70 $2 904,00 |
Toc - Plan #60 Arise Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) WPS HMO Catastrophic $8,550 with 3 Free PCP Visits | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$266,51 $302,49 $340,60 $475,99 $723,31 |
$470,39 $506,37 $544,48 $679,87 |
$674,27 $710,25 $748,36 $883,75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$533,02 $604,98 $681,20 $951,98 $1 446,62 |
$736,90 $808,86 $885,08 $1 155,86 |
$940,78 $1 012,74 $1 088,96 $1 359,74 |
Toc - Plan #61 Arise Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO HDHP Bronze $7,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$318,69 $361,71 $407,29 $569,18 $864,92 |
$562,49 $605,51 $651,09 $812,98 |
$806,29 $849,31 $894,89 $1 056,78 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$637,38 $723,42 $814,58 $1 138,36 $1 729,84 |
$881,18 $967,22 $1 058,38 $1 382,16 |
$1 124,98 $1 211,02 $1 302,18 $1 625,96 |
Toc - Plan #62 Arise Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO HDHP Bronze $6,830 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$325,19 $369,09 $415,59 $580,79 $882,57 |
$573,96 $617,86 $664,36 $829,56 |
$822,73 $866,63 $913,13 $1 078,33 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$650,38 $738,18 $831,18 $1 161,58 $1 765,14 |
$899,15 $986,95 $1 079,95 $1 410,35 |
$1 147,92 $1 235,72 $1 328,72 $1 659,12 |
Toc - Plan #63 Arise Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO HDHP Bronze $6,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$319,35 $362,46 $408,13 $570,36 $866,72 |
$563,65 $606,76 $652,43 $814,66 |
$807,95 $851,06 $896,73 $1 058,96 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$638,70 $724,92 $816,26 $1 140,72 $1 733,44 |
$883,00 $969,22 $1 060,56 $1 385,02 |
$1 127,30 $1 213,52 $1 304,86 $1 629,32 |
Toc - Plan #64 Arise Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO HDHP Silver $2,800 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$423,52 $480,70 $541,26 $756,41 $1 149,43 |
$747,51 $804,69 $865,25 $1 080,40 |
$1 071,50 $1 128,68 $1 189,24 $1 404,39 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$847,04 $961,40 $1 082,52 $1 512,82 $2 298,86 |
$1 171,03 $1 285,39 $1 406,51 $1 836,81 |
$1 495,02 $1 609,38 $1 730,50 $2 160,80 |
Toc - Plan #65 Arise Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO HDHP Silver $4,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$422,54 $479,58 $540,01 $754,66 $1 146,77 |
$745,78 $802,82 $863,25 $1 077,90 |
$1 069,02 $1 126,06 $1 186,49 $1 401,14 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$845,08 $959,16 $1 080,02 $1 509,32 $2 293,54 |
$1 168,32 $1 282,40 $1 403,26 $1 832,56 |
$1 491,56 $1 605,64 $1 726,50 $2 155,80 |
Toc - Plan #66 Arise Health Plan | ||||||||||||||||||||
Silver
(HMO) WPS HMO HDHP Silver $5,500 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$401,20 $455,36 $512,73 $716,54 $1 088,86 |
$708,12 $762,28 $819,65 $1 023,46 |
$1 015,04 $1 069,20 $1 126,57 $1 330,38 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$802,40 $910,72 $1 025,46 $1 433,08 $2 177,72 |
$1 109,32 $1 217,64 $1 332,38 $1 740,00 |
$1 416,24 $1 524,56 $1 639,30 $2 046,92 |
Toc - Plan #67 Arise Health Plan | ||||||||||||||||||||
Bronze
(POS) WPS POS Bronze $8,550 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$327,88 $372,14 $419,03 $585,59 $889,87 |
$578,71 $622,97 $669,86 $836,42 |
$829,54 $873,80 $920,69 $1 087,25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$655,76 $744,28 $838,06 $1 171,18 $1 779,74 |
$906,59 $995,11 $1 088,89 $1 422,01 |
$1 157,42 $1 245,94 $1 339,72 $1 672,84 |
Toc - Plan #68 Arise Health Plan | ||||||||||||||||||||
Expanded Bronze
(POS) WPS POS HDHP Bronze $6,000 | Select Network |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$341,53 $387,64 $436,48 $609,97 $926,91 |
$602,80 $648,91 $697,75 $871,24 |
$864,07 $910,18 $959,02 $1 132,51 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$683,06 $775,28 $872,96 $1 219,94 $1 853,82 |
$944,33 $1 036,55 $1 134,23 $1 481,21 |
$1 205,60 $1 297,82 $1 395,50 $1 742,48 |
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Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-844-472-2442 |
Toc - Plan #69 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) Envision - Gold 1800/80 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$394,98 $448,29 $504,77 $705,41 $1 071,95 |
$697,13 $750,44 $806,92 $1 007,56 |
$999,28 $1 052,59 $1 109,07 $1 309,71 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$789,96 $896,58 $1 009,54 $1 410,82 $2 143,90 |
$1 092,11 $1 198,73 $1 311,69 $1 712,97 |
$1 394,26 $1 500,88 $1 613,84 $2 015,12 |
Toc - Plan #70 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Gold
(EPO) Envision - Gold 2000/80 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$371,36 $421,48 $474,58 $663,23 $1 007,84 |
$655,44 $705,56 $758,66 $947,31 |
$939,52 $989,64 $1 042,74 $1 231,39 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$742,72 $842,96 $949,16 $1 326,46 $2 015,68 |
$1 026,80 $1 127,04 $1 233,24 $1 610,54 |
$1 310,88 $1 411,12 $1 517,32 $1 894,62 |
Toc - Plan #71 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) Envision - Silver 4000/75 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$363,20 $412,22 $464,15 $648,65 $985,69 |
$641,04 $690,06 $741,99 $926,49 |
$918,88 $967,90 $1 019,83 $1 204,33 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$726,40 $824,44 $928,30 $1 297,30 $1 971,38 |
$1 004,24 $1 102,28 $1 206,14 $1 575,14 |
$1 282,08 $1 380,12 $1 483,98 $1 852,98 |
Toc - Plan #72 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) Envision - Silver 3000/75/Copay40 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$379,84 $431,10 $485,42 $678,37 $1 030,85 |
$670,41 $721,67 $775,99 $968,94 |
$960,98 $1 012,24 $1 066,56 $1 259,51 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$759,68 $862,20 $970,84 $1 356,74 $2 061,70 |
$1 050,25 $1 152,77 $1 261,41 $1 647,31 |
$1 340,82 $1 443,34 $1 551,98 $1 937,88 |
Toc - Plan #73 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Catastrophic
(EPO) Envision - Catastrophic 8550/100 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$179,75 $204,00 $229,70 $321,01 $487,81 |
$317,25 $341,50 $367,20 $458,51 |
$454,75 $479,00 $504,70 $596,01 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$359,50 $408,00 $459,40 $642,02 $975,62 |
$497,00 $545,50 $596,90 $779,52 |
$634,50 $683,00 $734,40 $917,02 |
Toc - Plan #74 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) Envision - Bronze 8550/100 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$252,88 $287,01 $323,17 $451,62 $686,29 |
$446,33 $480,46 $516,62 $645,07 |
$639,78 $673,91 $710,07 $838,52 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$505,76 $574,02 $646,34 $903,24 $1 372,58 |
$699,21 $767,47 $839,79 $1 096,69 |
$892,66 $960,92 $1 033,24 $1 290,14 |
Toc - Plan #75 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) Envision - Bronze 8150/ 100 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$269,37 $305,72 $344,24 $481,07 $731,03 |
$475,43 $511,78 $550,30 $687,13 |
$681,49 $717,84 $756,36 $893,19 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$538,74 $611,44 $688,48 $962,14 $1 462,06 |
$744,80 $817,50 $894,54 $1 168,20 |
$950,86 $1 023,56 $1 100,60 $1 374,26 |
Toc - Plan #76 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Expanded Bronze
(EPO) Envision - HSA Bronze 7000/100 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$267,19 $303,24 $341,45 $477,18 $725,12 |
$471,58 $507,63 $545,84 $681,57 |
$675,97 $712,02 $750,23 $885,96 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$534,38 $606,48 $682,90 $954,36 $1 450,24 |
$738,77 $810,87 $887,29 $1 158,75 |
$943,16 $1 015,26 $1 091,68 $1 363,14 |
Toc - Plan #77 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) Envision - Silver 7000/75 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$301,98 $342,73 $385,91 $539,31 $819,53 |
$532,98 $573,73 $616,91 $770,31 |
$763,98 $804,73 $847,91 $1 001,31 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$603,96 $685,46 $771,82 $1 078,62 $1 639,06 |
$834,96 $916,46 $1 002,82 $1 309,62 |
$1 065,96 $1 147,46 $1 233,82 $1 540,62 |
‡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 Green Lake County here.
Green Lake County is in “Rating Area 15” of Wisconsin.
Currently, there are 77 plans offered in Rating Area 15.