Obamacare 2021 Rates for Kewaunee County

Obamacare > Rates > Wisconsin > Kewaunee 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 Kewaunee County, WI.

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, 59 Plans and 2021 Rates for Kewaunee County, Wisconsin

Below, you’ll find a summary of the 59 plans for Kewaunee County, Wisconsin 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

2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 |

ADVERTISEMENT

ADVERTISEMENT

Together with CCHP

Local: 1-844-201-4672 | Toll Free: 1-844-201-4672 | TTY: 1-844-531-4856

Toc - Plan #1 Together with CCHP
Expanded Bronze

(EPO) Together Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-201-4672

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
$268,63
$304,88
$343,29
$479,75
$729,03
$474,12
$510,37
$548,78
$685,24
$679,61
$715,86
$754,27
$890,73
$885,10
$921,35
$959,76
$1 096,22
$205,49
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$537,26
$609,76
$686,58
$959,50
$1 458,06
$742,75
$815,25
$892,07
$1 164,99
$948,24
$1 020,74
$1 097,56
$1 370,48
$1 153,73
$1 226,23
$1 303,05
$1 575,97
$205,49
Toc - Plan #2 Together with CCHP
Silver

(EPO) Together Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-201-4672

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 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
$368,48
$418,22
$470,91
$658,10
$1 000,04
$650,36
$700,10
$752,79
$939,98
$932,24
$981,98
$1 034,67
$1 221,86
$1 214,12
$1 263,86
$1 316,55
$1 503,74
$281,88
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$736,96
$836,44
$941,82
$1 316,20
$2 000,08
$1 018,84
$1 118,32
$1 223,70
$1 598,08
$1 300,72
$1 400,20
$1 505,58
$1 879,96
$1 582,60
$1 682,08
$1 787,46
$2 161,84
$281,88
Toc - Plan #3 Together with CCHP
Silver

(EPO) Together Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-201-4672

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$326,11
$370,12
$416,76
$582,41
$885,04
$575,58
$619,59
$666,23
$831,88
$825,05
$869,06
$915,70
$1 081,35
$1 074,52
$1 118,53
$1 165,17
$1 330,82
$249,47
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$652,22
$740,24
$833,52
$1 164,82
$1 770,08
$901,69
$989,71
$1 082,99
$1 414,29
$1 151,16
$1 239,18
$1 332,46
$1 663,76
$1 400,63
$1 488,65
$1 581,93
$1 913,23
$249,47
Toc - Plan #4 Together with CCHP
Gold

(EPO) Together Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-201-4672

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$6,500 $13,000 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
$385,80
$437,87
$493,04
$689,03
$1 047,04
$680,93
$733,00
$788,17
$984,16
$976,06
$1 028,13
$1 083,30
$1 279,29
$1 271,19
$1 323,26
$1 378,43
$1 574,42
$295,13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$771,60
$875,74
$986,08
$1 378,06
$2 094,08
$1 066,73
$1 170,87
$1 281,21
$1 673,19
$1 361,86
$1 466,00
$1 576,34
$1 968,32
$1 656,99
$1 761,13
$1 871,47
$2 263,45
$295,13
Toc - Plan #5 Together with CCHP
Expanded Bronze

(EPO) Together Bronze HDHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-201-4672

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$290,37
$329,56
$371,08
$518,58
$788,03
$512,49
$551,68
$593,20
$740,70
$734,61
$773,80
$815,32
$962,82
$956,73
$995,92
$1 037,44
$1 184,94
$222,12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$580,74
$659,12
$742,16
$1 037,16
$1 576,06
$802,86
$881,24
$964,28
$1 259,28
$1 024,98
$1 103,36
$1 186,40
$1 481,40
$1 247,10
$1 325,48
$1 408,52
$1 703,52
$222,12
Toc - Plan #6 Together with CCHP
Silver

(EPO) Together Silver Select

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-201-4672

Annual Out of Pocket Expenses:

Individual Family
$3,250 $6,500 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
$354,85
$402,74
$453,49
$633,75
$963,04
$626,30
$674,19
$724,94
$905,20
$897,75
$945,64
$996,39
$1 176,65
$1 169,20
$1 217,09
$1 267,84
$1 448,10
$271,45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$709,70
$805,48
$906,98
$1 267,50
$1 926,08
$981,15
$1 076,93
$1 178,43
$1 538,95
$1 252,60
$1 348,38
$1 449,88
$1 810,40
$1 524,05
$1 619,83
$1 721,33
$2 081,85
$271,45
Toc - Plan #7 Together with CCHP
Catastrophic

(EPO) Together Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-844-201-4672

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
$226,25
$256,79
$289,14
$404,07
$614,02
$399,33
$429,87
$462,22
$577,15
$572,41
$602,95
$635,30
$750,23
$745,49
$776,03
$808,38
$923,31
$173,08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$452,50
$513,58
$578,28
$808,14
$1 228,04
$625,58
$686,66
$751,36
$981,22
$798,66
$859,74
$924,44
$1 154,30
$971,74
$1 032,82
$1 097,52
$1 327,38
$173,08

ADVERTISEMENT

HealthPartners

Local: 1-952-883-5900 | Toll Free: 1-855-813-3887 | TTY: 1-952-883-6060

Toc - Plan #8 HealthPartners
Gold

(PPO) Robin Oak $1,200 w/Copay Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family
$1,200 $2,400 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$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
$1 338,12
$1 392,94
$1 451,02
$1 657,32
$310,67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
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
$1 744,23
$1 853,87
$1 970,03
$2 382,63
$310,67
Toc - Plan #9 HealthPartners
Silver

(PPO) Robin Oak $4,000 Plus Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$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
$1 206,27
$1 255,69
$1 308,04
$1 494,02
$280,06
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
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
$1 572,36
$1 671,20
$1 775,90
$2 147,86
$280,06
Toc - Plan #10 HealthPartners
Expanded Bronze

(PPO) Robin Oak $6,800 Plus Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family
$6,800 $13,600 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
$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
$957,53
$996,76
$1 038,32
$1 185,94
$222,31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
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
$1 248,13
$1 326,59
$1 409,71
$1 704,95
$222,31
Toc - Plan #11 HealthPartners
Catastrophic

(PPO) Robin Oak $8,550 Catastrophic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

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
$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
$734,37
$764,46
$796,33
$909,55
$170,50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
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
$957,24
$1 017,42
$1 081,16
$1 307,60
$170,50
Toc - Plan #12 HealthPartners
Silver

(PPO) Robin Oak $3,500 w/Copay P-S Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 Annual Deductible
$7,900 $15,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$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
$1 331,74
$1 386,30
$1 444,10
$1 649,42
$309,19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
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
$1 735,91
$1 845,03
$1 960,63
$2 371,27
$309,19
Toc - Plan #13 HealthPartners
Silver

(PPO) Robin Oak $5,000 Plus Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-813-3887

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$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
$1 163,80
$1 211,48
$1 261,99
$1 441,42
$270,20
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
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
$1 517,00
$1 612,36
$1 713,38
$2 072,24
$270,20

ADVERTISEMENT

Dean Health Plan

Local: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302

Toc - Plan #14 Dean Health Plan
Gold

(HMO) Prevea360 Gold Copay Plus 1500X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 Annual Deductible
$5,100 $10,200 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
$406,49
$461,37
$519,50
$725,99
$1 103,22
$717,46
$772,34
$830,47
$1 036,96
$1 028,43
$1 083,31
$1 141,44
$1 347,93
$1 339,40
$1 394,28
$1 452,41
$1 658,90
$310,97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$812,98
$922,74
$1 039,00
$1 451,98
$2 206,44
$1 123,95
$1 233,71
$1 349,97
$1 762,95
$1 434,92
$1 544,68
$1 660,94
$2 073,92
$1 745,89
$1 855,65
$1 971,91
$2 384,89
$310,97
Toc - Plan #15 Dean Health Plan
Silver

(HMO) Prevea360 Silver Copay Plus 4800X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

Annual Out of Pocket Expenses:

Individual Family
$4,800 $9,600 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
$412,67
$468,38
$527,40
$737,03
$1 119,99
$728,36
$784,07
$843,09
$1 052,72
$1 044,05
$1 099,76
$1 158,78
$1 368,41
$1 359,74
$1 415,45
$1 474,47
$1 684,10
$315,69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$825,34
$936,76
$1 054,80
$1 474,06
$2 239,98
$1 141,03
$1 252,45
$1 370,49
$1 789,75
$1 456,72
$1 568,14
$1 686,18
$2 105,44
$1 772,41
$1 883,83
$2 001,87
$2 421,13
$315,69
Toc - Plan #16 Dean Health Plan
Expanded Bronze

(HMO) Prevea360 Bronze Copay Plus 8500X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

Annual Out of Pocket Expenses:

Individual Family
$8,500 $17,000 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
$271,40
$308,04
$346,85
$484,73
$736,59
$479,02
$515,66
$554,47
$692,35
$686,64
$723,28
$762,09
$899,97
$894,26
$930,90
$969,71
$1 107,59
$207,62
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$542,80
$616,08
$693,70
$969,46
$1 473,18
$750,42
$823,70
$901,32
$1 177,08
$958,04
$1 031,32
$1 108,94
$1 384,70
$1 165,66
$1 238,94
$1 316,56
$1 592,32
$207,62
Toc - Plan #17 Dean Health Plan
Silver

(HMO) Prevea360 Silver Classic 5000X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

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
$404,21
$458,78
$516,59
$721,93
$1 097,04
$713,43
$768,00
$825,81
$1 031,15
$1 022,65
$1 077,22
$1 135,03
$1 340,37
$1 331,87
$1 386,44
$1 444,25
$1 649,59
$309,22
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$808,42
$917,56
$1 033,18
$1 443,86
$2 194,08
$1 117,64
$1 226,78
$1 342,40
$1 753,08
$1 426,86
$1 536,00
$1 651,62
$2 062,30
$1 736,08
$1 845,22
$1 960,84
$2 371,52
$309,22
Toc - Plan #18 Dean Health Plan
Gold

(HMO) Prevea360 Gold Value Copay 3700X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

Annual Out of Pocket Expenses:

Individual Family
$3,700 $7,400 Annual Deductible
$3,700 $7,400 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
$393,84
$447,01
$503,33
$703,40
$1 068,88
$695,13
$748,30
$804,62
$1 004,69
$996,42
$1 049,59
$1 105,91
$1 305,98
$1 297,71
$1 350,88
$1 407,20
$1 607,27
$301,29
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$787,68
$894,02
$1 006,66
$1 406,80
$2 137,76
$1 088,97
$1 195,31
$1 307,95
$1 708,09
$1 390,26
$1 496,60
$1 609,24
$2 009,38
$1 691,55
$1 797,89
$1 910,53
$2 310,67
$301,29
Toc - Plan #19 Dean Health Plan
Silver

(HMO) Prevea360 Silver Value Copay 5000X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

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
$411,62
$467,19
$526,06
$735,16
$1 117,15
$726,51
$782,08
$840,95
$1 050,05
$1 041,40
$1 096,97
$1 155,84
$1 364,94
$1 356,29
$1 411,86
$1 470,73
$1 679,83
$314,89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$823,24
$934,38
$1 052,12
$1 470,32
$2 234,30
$1 138,13
$1 249,27
$1 367,01
$1 785,21
$1 453,02
$1 564,16
$1 681,90
$2 100,10
$1 767,91
$1 879,05
$1 996,79
$2 414,99
$314,89
Toc - Plan #20 Dean Health Plan
Bronze

(HMO) Prevea360 Bronze Value Copay 8500X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

Annual Out of Pocket Expenses:

Individual Family
$8,500 $17,000 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
$264,32
$300,00
$337,80
$472,07
$717,36
$466,52
$502,20
$540,00
$674,27
$668,72
$704,40
$742,20
$876,47
$870,92
$906,60
$944,40
$1 078,67
$202,20
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$528,64
$600,00
$675,60
$944,14
$1 434,72
$730,84
$802,20
$877,80
$1 146,34
$933,04
$1 004,40
$1 080,00
$1 348,54
$1 135,24
$1 206,60
$1 282,20
$1 550,74
$202,20
Toc - Plan #21 Dean Health Plan
Silver

(HMO) Prevea360 Silver HSA-E 4500X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 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
$394,92
$448,24
$504,71
$705,33
$1 071,82
$697,04
$750,36
$806,83
$1 007,45
$999,16
$1 052,48
$1 108,95
$1 309,57
$1 301,28
$1 354,60
$1 411,07
$1 611,69
$302,12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$789,84
$896,48
$1 009,42
$1 410,66
$2 143,64
$1 091,96
$1 198,60
$1 311,54
$1 712,78
$1 394,08
$1 500,72
$1 613,66
$2 014,90
$1 696,20
$1 802,84
$1 915,78
$2 317,02
$302,12
Toc - Plan #22 Dean Health Plan
Expanded Bronze

(HMO) Prevea360 Bronze HSA-E 6850X

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

Annual Out of Pocket Expenses:

Individual Family
$6,850 $13,700 Annual Deductible
$6,850 $13,700 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
$280,77
$318,67
$358,82
$501,45
$762,00
$495,56
$533,46
$573,61
$716,24
$710,35
$748,25
$788,40
$931,03
$925,14
$963,04
$1 003,19
$1 145,82
$214,79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$561,54
$637,34
$717,64
$1 002,90
$1 524,00
$776,33
$852,13
$932,43
$1 217,69
$991,12
$1 066,92
$1 147,22
$1 432,48
$1 205,91
$1 281,71
$1 362,01
$1 647,27
$214,79
Toc - Plan #23 Dean Health Plan
Catastrophic

(HMO) Prevea360 Catastrophic Safety Net

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-279-1302

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
$218,84
$248,39
$279,68
$390,86
$593,94
$386,26
$415,81
$447,10
$558,28
$553,68
$583,23
$614,52
$725,70
$721,10
$750,65
$781,94
$893,12
$167,42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$437,68
$496,78
$559,36
$781,72
$1 187,88
$605,10
$664,20
$726,78
$949,14
$772,52
$831,62
$894,20
$1 116,56
$939,94
$999,04
$1 061,62
$1 283,98
$167,42

ADVERTISEMENT

Molina Healthcare

Local: 1-888-560-2043 | Toll Free: 1-888-560-2043

Toc - Plan #24 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:

Individual Family
$2,925 $5,850 Annual Deductible
$6,500 $13,000 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
$364,30
$413,48
$465,58
$650,64
$988,71
$642,99
$692,17
$744,27
$929,33
$921,68
$970,86
$1 022,96
$1 208,02
$1 200,37
$1 249,55
$1 301,65
$1 486,71
$278,69
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$728,60
$826,96
$931,16
$1 301,28
$1 977,42
$1 007,29
$1 105,65
$1 209,85
$1 579,97
$1 285,98
$1 384,34
$1 488,54
$1 858,66
$1 564,67
$1 663,03
$1 767,23
$2 137,35
$278,69
Toc - Plan #25 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:

Individual Family
$0 $0 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
$321,11
$364,46
$410,38
$573,50
$871,49
$566,76
$610,11
$656,03
$819,15
$812,41
$855,76
$901,68
$1 064,80
$1 058,06
$1 101,41
$1 147,33
$1 310,45
$245,65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$642,22
$728,92
$820,76
$1 147,00
$1 742,98
$887,87
$974,57
$1 066,41
$1 392,65
$1 133,52
$1 220,22
$1 312,06
$1 638,30
$1 379,17
$1 465,87
$1 557,71
$1 883,95
$245,65
Toc - Plan #26 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:

Individual Family
$6,100 $12,200 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
$254,51
$288,87
$325,27
$454,56
$690,75
$449,21
$483,57
$519,97
$649,26
$643,91
$678,27
$714,67
$843,96
$838,61
$872,97
$909,37
$1 038,66
$194,70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$509,02
$577,74
$650,54
$909,12
$1 381,50
$703,72
$772,44
$845,24
$1 103,82
$898,42
$967,14
$1 039,94
$1 298,52
$1 093,12
$1 161,84
$1 234,64
$1 493,22
$194,70
Toc - Plan #27 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:

Individual Family
$7,450 $14,900 Annual Deductible
$7,450 $14,900 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
$317,72
$360,61
$406,04
$567,44
$862,28
$560,77
$603,66
$649,09
$810,49
$803,82
$846,71
$892,14
$1 053,54
$1 046,87
$1 089,76
$1 135,19
$1 296,59
$243,05
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$635,44
$721,22
$812,08
$1 134,88
$1 724,56
$878,49
$964,27
$1 055,13
$1 377,93
$1 121,54
$1 207,32
$1 298,18
$1 620,98
$1 364,59
$1 450,37
$1 541,23
$1 864,03
$243,05
Toc - Plan #28 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:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$266,60
$302,59
$340,72
$476,15
$723,55
$470,55
$506,54
$544,67
$680,10
$674,50
$710,49
$748,62
$884,05
$878,45
$914,44
$952,57
$1 088,00
$203,95
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$533,20
$605,18
$681,44
$952,30
$1 447,10
$737,15
$809,13
$885,39
$1 156,25
$941,10
$1 013,08
$1 089,34
$1 360,20
$1 145,05
$1 217,03
$1 293,29
$1 564,15
$203,95
Toc - Plan #29 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:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$259,21
$294,20
$331,27
$462,95
$703,50
$457,51
$492,50
$529,57
$661,25
$655,81
$690,80
$727,87
$859,55
$854,11
$889,10
$926,17
$1 057,85
$198,30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$518,42
$588,40
$662,54
$925,90
$1 407,00
$716,72
$786,70
$860,84
$1 124,20
$915,02
$985,00
$1 059,14
$1 322,50
$1 113,32
$1 183,30
$1 257,44
$1 520,80
$198,30
Toc - Plan #30 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:

Individual Family
$2,925 $5,850 Annual Deductible
$6,500 $13,000 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
$367,18
$416,75
$469,26
$655,79
$996,53
$648,07
$697,64
$750,15
$936,68
$928,96
$978,53
$1 031,04
$1 217,57
$1 209,85
$1 259,42
$1 311,93
$1 498,46
$280,89
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$734,36
$833,50
$938,52
$1 311,58
$1 993,06
$1 015,25
$1 114,39
$1 219,41
$1 592,47
$1 296,14
$1 395,28
$1 500,30
$1 873,36
$1 577,03
$1 676,17
$1 781,19
$2 154,25
$280,89
Toc - Plan #31 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:

Individual Family
$0 $0 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
$323,99
$367,73
$414,06
$578,65
$879,31
$571,84
$615,58
$661,91
$826,50
$819,69
$863,43
$909,76
$1 074,35
$1 067,54
$1 111,28
$1 157,61
$1 322,20
$247,85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$647,98
$735,46
$828,12
$1 157,30
$1 758,62
$895,83
$983,31
$1 075,97
$1 405,15
$1 143,68
$1 231,16
$1 323,82
$1 653,00
$1 391,53
$1 479,01
$1 571,67
$1 900,85
$247,85
Toc - Plan #32 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:

Individual Family
$6,100 $12,200 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
$257,39
$292,14
$328,95
$459,71
$698,57
$454,30
$489,05
$525,86
$656,62
$651,21
$685,96
$722,77
$853,53
$848,12
$882,87
$919,68
$1 050,44
$196,91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$514,78
$584,28
$657,90
$919,42
$1 397,14
$711,69
$781,19
$854,81
$1 116,33
$908,60
$978,10
$1 051,72
$1 313,24
$1 105,51
$1 175,01
$1 248,63
$1 510,15
$196,91
Toc - Plan #33 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:

Individual Family
$5,200 $10,400 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$320,76
$364,07
$409,94
$572,88
$870,55
$566,14
$609,45
$655,32
$818,26
$811,52
$854,83
$900,70
$1 063,64
$1 056,90
$1 100,21
$1 146,08
$1 309,02
$245,38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$641,52
$728,14
$819,88
$1 145,76
$1 741,10
$886,90
$973,52
$1 065,26
$1 391,14
$1 132,28
$1 218,90
$1 310,64
$1 636,52
$1 377,66
$1 464,28
$1 556,02
$1 881,90
$245,38
Toc - Plan #34 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:

Individual Family
$8,000 $16,000 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
$252,26
$286,32
$322,39
$450,54
$684,64
$445,24
$479,30
$515,37
$643,52
$638,22
$672,28
$708,35
$836,50
$831,20
$865,26
$901,33
$1 029,48
$192,98
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$504,52
$572,64
$644,78
$901,08
$1 369,28
$697,50
$765,62
$837,76
$1 094,06
$890,48
$958,60
$1 030,74
$1 287,04
$1 083,46
$1 151,58
$1 223,72
$1 480,02
$192,98

ADVERTISEMENT

Arise Health Plan

Local: 1-920-490-6900 | Toll Free: 1-800-332-6249 | TTY: 1-888-332-0144

Toc - Plan #35 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:

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
$289,26
$328,31
$369,67
$516,62
$785,05
$510,54
$549,59
$590,95
$737,90
$731,82
$770,87
$812,23
$959,18
$953,10
$992,15
$1 033,51
$1 180,46
$221,28
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$578,52
$656,62
$739,34
$1 033,24
$1 570,10
$799,80
$877,90
$960,62
$1 254,52
$1 021,08
$1 099,18
$1 181,90
$1 475,80
$1 242,36
$1 320,46
$1 403,18
$1 697,08
$221,28
Toc - Plan #36 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:

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
$300,34
$340,89
$383,83
$536,41
$815,12
$530,10
$570,65
$613,59
$766,17
$759,86
$800,41
$843,35
$995,93
$989,62
$1 030,17
$1 073,11
$1 225,69
$229,76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$600,68
$681,78
$767,66
$1 072,82
$1 630,24
$830,44
$911,54
$997,42
$1 302,58
$1 060,20
$1 141,30
$1 227,18
$1 532,34
$1 289,96
$1 371,06
$1 456,94
$1 762,10
$229,76
Toc - Plan #37 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:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$294,27
$334,00
$376,08
$525,57
$798,65
$519,39
$559,12
$601,20
$750,69
$744,51
$784,24
$826,32
$975,81
$969,63
$1 009,36
$1 051,44
$1 200,93
$225,12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$588,54
$668,00
$752,16
$1 051,14
$1 597,30
$813,66
$893,12
$977,28
$1 276,26
$1 038,78
$1 118,24
$1 202,40
$1 501,38
$1 263,90
$1 343,36
$1 427,52
$1 726,50
$225,12
Toc - Plan #38 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:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$388,86
$441,36
$496,96
$694,50
$1 055,37
$686,34
$738,84
$794,44
$991,98
$983,82
$1 036,32
$1 091,92
$1 289,46
$1 281,30
$1 333,80
$1 389,40
$1 586,94
$297,48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$777,72
$882,72
$993,92
$1 389,00
$2 110,74
$1 075,20
$1 180,20
$1 291,40
$1 686,48
$1 372,68
$1 477,68
$1 588,88
$1 983,96
$1 670,16
$1 775,16
$1 886,36
$2 281,44
$297,48
Toc - Plan #39 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:

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
$389,79
$442,41
$498,15
$696,16
$1 057,89
$687,98
$740,60
$796,34
$994,35
$986,17
$1 038,79
$1 094,53
$1 292,54
$1 284,36
$1 336,98
$1 392,72
$1 590,73
$298,19
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$779,58
$884,82
$996,30
$1 392,32
$2 115,78
$1 077,77
$1 183,01
$1 294,49
$1 690,51
$1 375,96
$1 481,20
$1 592,68
$1 988,70
$1 674,15
$1 779,39
$1 890,87
$2 286,89
$298,19
Toc - Plan #40 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:

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
$405,45
$460,19
$518,17
$724,13
$1 100,39
$715,62
$770,36
$828,34
$1 034,30
$1 025,79
$1 080,53
$1 138,51
$1 344,47
$1 335,96
$1 390,70
$1 448,68
$1 654,64
$310,17
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$810,90
$920,38
$1 036,34
$1 448,26
$2 200,78
$1 121,07
$1 230,55
$1 346,51
$1 758,43
$1 431,24
$1 540,72
$1 656,68
$2 068,60
$1 741,41
$1 850,89
$1 966,85
$2 378,77
$310,17
Toc - Plan #41 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:

Individual Family
$2,500 $5,000 Annual Deductible
$5,000 $10,000 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
$537,08
$609,59
$686,39
$959,22
$1 457,64
$947,95
$1 020,46
$1 097,26
$1 370,09
$1 358,82
$1 431,33
$1 508,13
$1 780,96
$1 769,69
$1 842,20
$1 919,00
$2 191,83
$410,87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$1 074,16
$1 219,18
$1 372,78
$1 918,44
$2 915,28
$1 485,03
$1 630,05
$1 783,65
$2 329,31
$1 895,90
$2 040,92
$2 194,52
$2 740,18
$2 306,77
$2 451,79
$2 605,39
$3 151,05
$410,87
Toc - Plan #42 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:

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
$251,47
$285,42
$321,38
$449,13
$682,49
$443,84
$477,79
$513,75
$641,50
$636,21
$670,16
$706,12
$833,87
$828,58
$862,53
$898,49
$1 026,24
$192,37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$502,94
$570,84
$642,76
$898,26
$1 364,98
$695,31
$763,21
$835,13
$1 090,63
$887,68
$955,58
$1 027,50
$1 283,00
$1 080,05
$1 147,95
$1 219,87
$1 475,37
$192,37
Toc - Plan #43 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:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$300,71
$341,31
$384,31
$537,07
$816,13
$530,75
$571,35
$614,35
$767,11
$760,79
$801,39
$844,39
$997,15
$990,83
$1 031,43
$1 074,43
$1 227,19
$230,04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$601,42
$682,62
$768,62
$1 074,14
$1 632,26
$831,46
$912,66
$998,66
$1 304,18
$1 061,50
$1 142,70
$1 228,70
$1 534,22
$1 291,54
$1 372,74
$1 458,74
$1 764,26
$230,04
Toc - Plan #44 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:

Individual Family
$6,830 $13,660 Annual Deductible
$6,830 $13,660 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
$306,85
$348,27
$392,15
$548,03
$832,79
$541,59
$583,01
$626,89
$782,77
$776,33
$817,75
$861,63
$1 017,51
$1 011,07
$1 052,49
$1 096,37
$1 252,25
$234,74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$613,70
$696,54
$784,30
$1 096,06
$1 665,58
$848,44
$931,28
$1 019,04
$1 330,80
$1 083,18
$1 166,02
$1 253,78
$1 565,54
$1 317,92
$1 400,76
$1 488,52
$1 800,28
$234,74
Toc - Plan #45 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:

Individual Family
$6,000 $12,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$301,34
$342,02
$385,11
$538,19
$817,84
$531,87
$572,55
$615,64
$768,72
$762,40
$803,08
$846,17
$999,25
$992,93
$1 033,61
$1 076,70
$1 229,78
$230,53
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$602,68
$684,04
$770,22
$1 076,38
$1 635,68
$833,21
$914,57
$1 000,75
$1 306,91
$1 063,74
$1 145,10
$1 231,28
$1 537,44
$1 294,27
$1 375,63
$1 461,81
$1 767,97
$230,53
Toc - Plan #46 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:

Individual Family
$2,800 $5,600 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
$399,63
$453,58
$510,73
$713,74
$1 084,60
$705,35
$759,30
$816,45
$1 019,46
$1 011,07
$1 065,02
$1 122,17
$1 325,18
$1 316,79
$1 370,74
$1 427,89
$1 630,90
$305,72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$799,26
$907,16
$1 021,46
$1 427,48
$2 169,20
$1 104,98
$1 212,88
$1 327,18
$1 733,20
$1 410,70
$1 518,60
$1 632,90
$2 038,92
$1 716,42
$1 824,32
$1 938,62
$2 344,64
$305,72
Toc - Plan #47 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:

Individual Family
$4,500 $9,000 Annual Deductible
$4,500 $9,000 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
$398,70
$452,52
$509,54
$712,08
$1 082,07
$703,71
$757,53
$814,55
$1 017,09
$1 008,72
$1 062,54
$1 119,56
$1 322,10
$1 313,73
$1 367,55
$1 424,57
$1 627,11
$305,01
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$797,40
$905,04
$1 019,08
$1 424,16
$2 164,14
$1 102,41
$1 210,05
$1 324,09
$1 729,17
$1 407,42
$1 515,06
$1 629,10
$2 034,18
$1 712,43
$1 820,07
$1 934,11
$2 339,19
$305,01
Toc - Plan #48 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:

Individual Family
$5,500 $11,000 Annual Deductible
$5,500 $11,000 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
$378,57
$429,68
$483,81
$676,13
$1 027,44
$668,18
$719,29
$773,42
$965,74
$957,79
$1 008,90
$1 063,03
$1 255,35
$1 247,40
$1 298,51
$1 352,64
$1 544,96
$289,61
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$757,14
$859,36
$967,62
$1 352,26
$2 054,88
$1 046,75
$1 148,97
$1 257,23
$1 641,87
$1 336,36
$1 438,58
$1 546,84
$1 931,48
$1 625,97
$1 728,19
$1 836,45
$2 221,09
$289,61
Toc - Plan #49 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:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$309,39
$351,16
$395,40
$552,57
$839,68
$546,07
$587,84
$632,08
$789,25
$782,75
$824,52
$868,76
$1 025,93
$1 019,43
$1 061,20
$1 105,44
$1 262,61
$236,68
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$618,78
$702,32
$790,80
$1 105,14
$1 679,36
$855,46
$939,00
$1 027,48
$1 341,82
$1 092,14
$1 175,68
$1 264,16
$1 578,50
$1 328,82
$1 412,36
$1 500,84
$1 815,18
$236,68
Toc - Plan #50 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:

Individual Family
$6,000 $12,000 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$322,27
$365,78
$411,86
$575,57
$874,64
$568,81
$612,32
$658,40
$822,11
$815,35
$858,86
$904,94
$1 068,65
$1 061,89
$1 105,40
$1 151,48
$1 315,19
$246,54
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$644,54
$731,56
$823,72
$1 151,14
$1 749,28
$891,08
$978,10
$1 070,26
$1 397,68
$1 137,62
$1 224,64
$1 316,80
$1 644,22
$1 384,16
$1 471,18
$1 563,34
$1 890,76
$246,54

ADVERTISEMENT

Common Ground Healthcare Cooperative

Local: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-844-472-2442

Toc - Plan #51 Common Ground Healthcare Cooperative
Gold

(EPO) Envision - Gold 1800/80

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

Annual Out of Pocket Expenses:

Individual Family
$1,800 $3,600 Annual Deductible
$6,500 $13,000 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
$398,34
$452,11
$509,07
$711,42
$1 081,07
$703,06
$756,83
$813,79
$1 016,14
$1 007,78
$1 061,55
$1 118,51
$1 320,86
$1 312,50
$1 366,27
$1 423,23
$1 625,58
$304,72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$796,68
$904,22
$1 018,14
$1 422,84
$2 162,14
$1 101,40
$1 208,94
$1 322,86
$1 727,56
$1 406,12
$1 513,66
$1 627,58
$2 032,28
$1 710,84
$1 818,38
$1 932,30
$2 337,00
$304,72
Toc - Plan #52 Common Ground Healthcare Cooperative
Gold

(EPO) Envision - Gold 2000/80

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 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
$374,52
$425,07
$478,62
$668,87
$1 016,41
$661,02
$711,57
$765,12
$955,37
$947,52
$998,07
$1 051,62
$1 241,87
$1 234,02
$1 284,57
$1 338,12
$1 528,37
$286,50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$749,04
$850,14
$957,24
$1 337,74
$2 032,82
$1 035,54
$1 136,64
$1 243,74
$1 624,24
$1 322,04
$1 423,14
$1 530,24
$1 910,74
$1 608,54
$1 709,64
$1 816,74
$2 197,24
$286,50
Toc - Plan #53 Common Ground Healthcare Cooperative
Silver

(EPO) Envision - Silver 4000/75

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

Annual Out of Pocket Expenses:

Individual Family
$4,000 $8,000 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
$366,29
$415,73
$468,10
$654,17
$994,08
$646,49
$695,93
$748,30
$934,37
$926,69
$976,13
$1 028,50
$1 214,57
$1 206,89
$1 256,33
$1 308,70
$1 494,77
$280,20
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$732,58
$831,46
$936,20
$1 308,34
$1 988,16
$1 012,78
$1 111,66
$1 216,40
$1 588,54
$1 292,98
$1 391,86
$1 496,60
$1 868,74
$1 573,18
$1 672,06
$1 776,80
$2 148,94
$280,20
Toc - Plan #54 Common Ground Healthcare Cooperative
Silver

(EPO) Envision - Silver 3000/75/Copay40

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

Annual Out of Pocket Expenses:

Individual Family
$3,000 $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
$383,07
$434,77
$489,55
$684,14
$1 039,62
$676,11
$727,81
$782,59
$977,18
$969,15
$1 020,85
$1 075,63
$1 270,22
$1 262,19
$1 313,89
$1 368,67
$1 563,26
$293,04
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$766,14
$869,54
$979,10
$1 368,28
$2 079,24
$1 059,18
$1 162,58
$1 272,14
$1 661,32
$1 352,22
$1 455,62
$1 565,18
$1 954,36
$1 645,26
$1 748,66
$1 858,22
$2 247,40
$293,04
Toc - Plan #55 Common Ground Healthcare Cooperative
Catastrophic

(EPO) Envision - Catastrophic 8550/100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

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
$181,28
$205,74
$231,66
$323,74
$491,96
$319,95
$344,41
$370,33
$462,41
$458,62
$483,08
$509,00
$601,08
$597,29
$621,75
$647,67
$739,75
$138,67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$362,56
$411,48
$463,32
$647,48
$983,92
$501,23
$550,15
$601,99
$786,15
$639,90
$688,82
$740,66
$924,82
$778,57
$827,49
$879,33
$1 063,49
$138,67
Toc - Plan #56 Common Ground Healthcare Cooperative
Expanded Bronze

(EPO) Envision - Bronze 8550/100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

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
$255,03
$289,45
$325,92
$455,47
$692,13
$450,12
$484,54
$521,01
$650,56
$645,21
$679,63
$716,10
$845,65
$840,30
$874,72
$911,19
$1 040,74
$195,09
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$510,06
$578,90
$651,84
$910,94
$1 384,26
$705,15
$773,99
$846,93
$1 106,03
$900,24
$969,08
$1 042,02
$1 301,12
$1 095,33
$1 164,17
$1 237,11
$1 496,21
$195,09
Toc - Plan #57 Common Ground Healthcare Cooperative
Expanded Bronze

(EPO) Envision - Bronze 8150/ 100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$271,66
$308,32
$347,17
$485,17
$737,26
$479,47
$516,13
$554,98
$692,98
$687,28
$723,94
$762,79
$900,79
$895,09
$931,75
$970,60
$1 108,60
$207,81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$543,32
$616,64
$694,34
$970,34
$1 474,52
$751,13
$824,45
$902,15
$1 178,15
$958,94
$1 032,26
$1 109,96
$1 385,96
$1 166,75
$1 240,07
$1 317,77
$1 593,77
$207,81
Toc - Plan #58 Common Ground Healthcare Cooperative
Expanded Bronze

(EPO) Envision - HSA Bronze 7000/100

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$269,46
$305,83
$344,36
$481,24
$731,29
$475,59
$511,96
$550,49
$687,37
$681,72
$718,09
$756,62
$893,50
$887,85
$924,22
$962,75
$1 099,63
$206,13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$538,92
$611,66
$688,72
$962,48
$1 462,58
$745,05
$817,79
$894,85
$1 168,61
$951,18
$1 023,92
$1 100,98
$1 374,74
$1 157,31
$1 230,05
$1 307,11
$1 580,87
$206,13
Toc - Plan #59 Common Ground Healthcare Cooperative
Silver

(EPO) Envision - Silver 7000/75

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-514-2442

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
$304,55
$345,65
$389,20
$543,90
$826,51
$537,52
$578,62
$622,17
$776,87
$770,49
$811,59
$855,14
$1 009,84
$1 003,46
$1 044,56
$1 088,11
$1 242,81
$232,97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$609,10
$691,30
$778,40
$1 087,80
$1 653,02
$842,07
$924,27
$1 011,37
$1 320,77
$1 075,04
$1 157,24
$1 244,34
$1 553,74
$1 308,01
$1 390,21
$1 477,31
$1 786,71
$232,97

‡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 Kewaunee County here.

Kewaunee County is in “Rating Area 16” of Wisconsin.

Currently, there are 59 plans offered in Rating Area 16.

Top

2021 Obamacare Plans for Kewaunee County, WI

Plan Browser: 59 Plans
scroll down for more
Speak with a Health Insurance Expert 800-943-6832Ads by +HealthNetwork