Obamacare 2021 Rates for Outagamie County
Obamacare > Rates > Wisconsin > Outagamie County
Obamacare > Rates > Wisconsin > Outagamie County
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Together with CCHPLocal: 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 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
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 |
$276,54 $313,86 $353,40 $493,88 $750,49 |
$488,08 $525,40 $564,94 $705,42 |
$699,62 $736,94 $776,48 $916,96 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$553,08 $627,72 $706,80 $987,76 $1 500,98 |
$764,62 $839,26 $918,34 $1 199,30 |
$976,16 $1 050,80 $1 129,88 $1 410,84 |
Toc - Plan #2 Together with CCHP | ||||||||||||||||||||
Silver
(EPO) Together Standard Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
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 |
$379,33 $430,53 $484,78 $677,47 $1 029,48 |
$669,51 $720,71 $774,96 $967,65 |
$959,69 $1 010,89 $1 065,14 $1 257,83 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$758,66 $861,06 $969,56 $1 354,94 $2 058,96 |
$1 048,84 $1 151,24 $1 259,74 $1 645,12 |
$1 339,02 $1 441,42 $1 549,92 $1 935,30 |
Toc - Plan #3 Together with CCHP | ||||||||||||||||||||
Silver
(EPO) Together Silver |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
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 |
$335,71 $381,02 $429,03 $599,56 $911,09 |
$592,52 $637,83 $685,84 $856,37 |
$849,33 $894,64 $942,65 $1 113,18 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$671,42 $762,04 $858,06 $1 199,12 $1 822,18 |
$928,23 $1 018,85 $1 114,87 $1 455,93 |
$1 185,04 $1 275,66 $1 371,68 $1 712,74 |
Toc - Plan #4 Together with CCHP | ||||||||||||||||||||
Gold
(EPO) Together Gold |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
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 |
$397,16 $450,77 $507,56 $709,31 $1 077,87 |
$700,98 $754,59 $811,38 $1 013,13 |
$1 004,80 $1 058,41 $1 115,20 $1 316,95 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$794,32 $901,54 $1 015,12 $1 418,62 $2 155,74 |
$1 098,14 $1 205,36 $1 318,94 $1 722,44 |
$1 401,96 $1 509,18 $1 622,76 $2 026,26 |
Toc - Plan #5 Together with CCHP | ||||||||||||||||||||
Expanded Bronze
(EPO) Together Bronze HDHP |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
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 |
$298,92 $339,26 $382,00 $533,85 $811,23 |
$527,58 $567,92 $610,66 $762,51 |
$756,24 $796,58 $839,32 $991,17 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$597,84 $678,52 $764,00 $1 067,70 $1 622,46 |
$826,50 $907,18 $992,66 $1 296,36 |
$1 055,16 $1 135,84 $1 221,32 $1 525,02 |
Toc - Plan #6 Together with CCHP | ||||||||||||||||||||
Silver
(EPO) Together Silver Select |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
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 |
$365,30 $414,60 $466,84 $652,41 $991,39 |
$644,75 $694,05 $746,29 $931,86 |
$924,20 $973,50 $1 025,74 $1 211,31 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$730,60 $829,20 $933,68 $1 304,82 $1 982,78 |
$1 010,05 $1 108,65 $1 213,13 $1 584,27 |
$1 289,50 $1 388,10 $1 492,58 $1 863,72 |
Toc - Plan #7 Together with CCHP | ||||||||||||||||||||
Catastrophic
(EPO) Together Catastrophic |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-844-201-4672
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 |
$232,91 $264,35 $297,65 $415,97 $632,10 |
$411,08 $442,52 $475,82 $594,14 |
$589,25 $620,69 $653,99 $772,31 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$465,82 $528,70 $595,30 $831,94 $1 264,20 |
$643,99 $706,87 $773,47 $1 010,11 |
$822,16 $885,04 $951,64 $1 188,28 |
ADVERTISEMENT
HealthPartnersLocal: 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 |
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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 #9 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 #10 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 #11 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 #12 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 #13 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
Molina HealthcareLocal: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
Toc - Plan #14 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 1 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
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 |
$395,71 $449,13 $505,72 $706,74 $1 073,96 |
$698,43 $751,85 $808,44 $1 009,46 |
$1 001,15 $1 054,57 $1 111,16 $1 312,18 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$791,42 $898,26 $1 011,44 $1 413,48 $2 147,92 |
$1 094,14 $1 200,98 $1 314,16 $1 716,20 |
$1 396,86 $1 503,70 $1 616,88 $2 018,92 |
Toc - Plan #15 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
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 |
$348,80 $395,88 $445,76 $622,95 $946,63 |
$615,63 $662,71 $712,59 $889,78 |
$882,46 $929,54 $979,42 $1 156,61 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$697,60 $791,76 $891,52 $1 245,90 $1 893,26 |
$964,43 $1 058,59 $1 158,35 $1 512,73 |
$1 231,26 $1 325,42 $1 425,18 $1 779,56 |
Toc - Plan #16 Molina Healthcare | ||||||||||||||||||||
Bronze
(HMO) Core Care Bronze 1 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
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 |
$276,46 $313,78 $353,31 $493,75 $750,30 |
$487,95 $525,27 $564,80 $705,24 |
$699,44 $736,76 $776,29 $916,73 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$552,92 $627,56 $706,62 $987,50 $1 500,60 |
$764,41 $839,05 $918,11 $1 198,99 |
$975,90 $1 050,54 $1 129,60 $1 410,48 |
Toc - Plan #17 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 4 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
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 |
$345,11 $391,70 $441,05 $616,37 $936,63 |
$609,12 $655,71 $705,06 $880,38 |
$873,13 $919,72 $969,07 $1 144,39 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$690,22 $783,40 $882,10 $1 232,74 $1 873,26 |
$954,23 $1 047,41 $1 146,11 $1 496,75 |
$1 218,24 $1 311,42 $1 410,12 $1 760,76 |
Toc - Plan #18 Molina Healthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) Core Care Bronze 4 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
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 |
$289,59 $328,68 $370,09 $517,20 $785,94 |
$511,12 $550,21 $591,62 $738,73 |
$732,65 $771,74 $813,15 $960,26 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$579,18 $657,36 $740,18 $1 034,40 $1 571,88 |
$800,71 $878,89 $961,71 $1 255,93 |
$1 022,24 $1 100,42 $1 183,24 $1 477,46 |
Toc - Plan #19 Molina Healthcare | ||||||||||||||||||||
Expanded Bronze
(HMO) Core Care Bronze 5 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
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 |
$281,56 $319,57 $359,83 $502,87 $764,16 |
$496,95 $534,96 $575,22 $718,26 |
$712,34 $750,35 $790,61 $933,65 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$563,12 $639,14 $719,66 $1 005,74 $1 528,32 |
$778,51 $854,53 $935,05 $1 221,13 |
$993,90 $1 069,92 $1 150,44 $1 436,52 |
Toc - Plan #20 Molina Healthcare | ||||||||||||||||||||
Gold
(HMO) Confident Care Gold 1 + Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
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 |
$398,84 $452,68 $509,72 $712,33 $1 082,45 |
$703,95 $757,79 $814,83 $1 017,44 |
$1 009,06 $1 062,90 $1 119,94 $1 322,55 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$797,68 $905,36 $1 019,44 $1 424,66 $2 164,90 |
$1 102,79 $1 210,47 $1 324,55 $1 729,77 |
$1 407,90 $1 515,58 $1 629,66 $2 034,88 |
Toc - Plan #21 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 1 + Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
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 |
$351,93 $399,44 $449,76 $628,54 $955,13 |
$621,15 $668,66 $718,98 $897,76 |
$890,37 $937,88 $988,20 $1 166,98 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$703,86 $798,88 $899,52 $1 257,08 $1 910,26 |
$973,08 $1 068,10 $1 168,74 $1 526,30 |
$1 242,30 $1 337,32 $1 437,96 $1 795,52 |
Toc - Plan #22 Molina Healthcare | ||||||||||||||||||||
Bronze
(HMO) Core Care Bronze 1 + Vision |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
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 |
$279,59 $317,33 $357,31 $499,34 $758,80 |
$493,47 $531,21 $571,19 $713,22 |
$707,35 $745,09 $785,07 $927,10 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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21 30 40 50 60 |
$559,18 $634,66 $714,62 $998,68 $1 517,60 |
$773,06 $848,54 $928,50 $1 212,56 |
$986,94 $1 062,42 $1 142,38 $1 426,44 |
Toc - Plan #23 Molina Healthcare | ||||||||||||||||||||
Silver
(HMO) Constant Care Silver 2 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-888-560-2043
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 |
$348,42 $395,46 $445,28 $622,28 $945,61 |
$614,96 $662,00 $711,82 $888,82 |
$881,50 $928,54 $978,36 $1 155,36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$696,84 $790,92 $890,56 $1 244,56 $1 891,22 |
$963,38 $1 057,46 $1 157,10 $1 511,10 |
$1 229,92 $1 324,00 $1 423,64 $1 777,64 |
Toc - Plan #24 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 |
$274,01 $311,01 $350,19 $489,39 $743,67 |
$483,63 $520,63 $559,81 $699,01 |
$693,25 $730,25 $769,43 $908,63 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$548,02 $622,02 $700,38 $978,78 $1 487,34 |
$757,64 $831,64 $910,00 $1 188,40 |
$967,26 $1 041,26 $1 119,62 $1 398,02 |
ADVERTISEMENT
Network HealthLocal: 1-920-720-1400x1400 | Toll Free: 1-855-275-1400 | TTY: 1-800-947-3529 |
Toc - Plan #25 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze 20 HDHP + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$351,97 $399,48 $449,81 $628,61 $955,22 |
$621,22 $668,73 $719,06 $897,86 |
$890,47 $937,98 $988,31 $1 167,11 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$703,94 $798,96 $899,62 $1 257,22 $1 910,44 |
$973,19 $1 068,21 $1 168,87 $1 526,47 |
$1 242,44 $1 337,46 $1 438,12 $1 795,72 |
Toc - Plan #26 Network Health | ||||||||||||||||||||
Silver
(HMO) Prestige Silver 20 HDHP + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$543,25 $616,59 $694,27 $970,24 $1 474,37 |
$958,84 $1 032,18 $1 109,86 $1 385,83 |
$1 374,43 $1 447,77 $1 525,45 $1 801,42 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1 086,50 $1 233,18 $1 388,54 $1 940,48 $2 948,74 |
$1 502,09 $1 648,77 $1 804,13 $2 356,07 |
$1 917,68 $2 064,36 $2 219,72 $2 771,66 |
Toc - Plan #27 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze Essential + Dental + Vision + Fitness + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$338,70 $384,43 $432,86 $604,92 $919,23 |
$597,81 $643,54 $691,97 $864,03 |
$856,92 $902,65 $951,08 $1 123,14 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$677,40 $768,86 $865,72 $1 209,84 $1 838,46 |
$936,51 $1 027,97 $1 124,83 $1 468,95 |
$1 195,62 $1 287,08 $1 383,94 $1 728,06 |
Toc - Plan #28 Network Health | ||||||||||||||||||||
Silver
(HMO) Prestige Silver Essential + Dental + Vision + Fitness + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$518,40 $588,39 $662,52 $925,87 $1 406,94 |
$914,98 $984,97 $1 059,10 $1 322,45 |
$1 311,56 $1 381,55 $1 455,68 $1 719,03 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1 036,80 $1 176,78 $1 325,04 $1 851,74 $2 813,88 |
$1 433,38 $1 573,36 $1 721,62 $2 248,32 |
$1 829,96 $1 969,94 $2 118,20 $2 644,90 |
Toc - Plan #29 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold Essential + Dental + Vision + Fitness + 3 Free PCP Visits |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$513,81 $583,18 $656,65 $917,67 $1 394,48 |
$906,88 $976,25 $1 049,72 $1 310,74 |
$1 299,95 $1 369,32 $1 442,79 $1 703,81 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1 027,62 $1 166,36 $1 313,30 $1 835,34 $2 788,96 |
$1 420,69 $1 559,43 $1 706,37 $2 228,41 |
$1 813,76 $1 952,50 $2 099,44 $2 621,48 |
Toc - Plan #30 Network Health | ||||||||||||||||||||
Expanded Bronze
(HMO) Prestige Bronze 0 + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$314,91 $357,43 $402,46 $562,43 $854,67 |
$555,82 $598,34 $643,37 $803,34 |
$796,73 $839,25 $884,28 $1 044,25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$629,82 $714,86 $804,92 $1 124,86 $1 709,34 |
$870,73 $955,77 $1 045,83 $1 365,77 |
$1 111,64 $1 196,68 $1 286,74 $1 606,68 |
Toc - Plan #31 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold 50 + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$529,88 $601,42 $677,19 $946,37 $1 438,09 |
$935,24 $1 006,78 $1 082,55 $1 351,73 |
$1 340,60 $1 412,14 $1 487,91 $1 757,09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1 059,76 $1 202,84 $1 354,38 $1 892,74 $2 876,18 |
$1 465,12 $1 608,20 $1 759,74 $2 298,10 |
$1 870,48 $2 013,56 $2 165,10 $2 703,46 |
Toc - Plan #32 Network Health | ||||||||||||||||||||
Gold
(HMO) Prestige Gold 0 HDHP + Dental + Vision |
||||||||||||||||||||
Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-855-275-1400
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$536,91 $609,39 $686,17 $958,92 $1 457,17 |
$947,65 $1 020,13 $1 096,91 $1 369,66 |
$1 358,39 $1 430,87 $1 507,65 $1 780,40 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1 073,82 $1 218,78 $1 372,34 $1 917,84 $2 914,34 |
$1 484,56 $1 629,52 $1 783,08 $2 328,58 |
$1 895,30 $2 040,26 $2 193,82 $2 739,32 |
ADVERTISEMENT
Arise Health PlanLocal: 1-920-490-6900 | Toll Free: 1-800-332-6249 | TTY: 1-888-332-0144 |
Toc - Plan #33 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 |
$299,32 $339,73 $382,53 $534,59 $812,35 |
$528,30 $568,71 $611,51 $763,57 |
$757,28 $797,69 $840,49 $992,55 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$598,64 $679,46 $765,06 $1 069,18 $1 624,70 |
$827,62 $908,44 $994,04 $1 298,16 |
$1 056,60 $1 137,42 $1 223,02 $1 527,14 |
Toc - Plan #34 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 |
$310,79 $352,75 $397,19 $555,07 $843,48 |
$548,54 $590,50 $634,94 $792,82 |
$786,29 $828,25 $872,69 $1 030,57 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$621,58 $705,50 $794,38 $1 110,14 $1 686,96 |
$859,33 $943,25 $1 032,13 $1 347,89 |
$1 097,08 $1 181,00 $1 269,88 $1 585,64 |
Toc - Plan #35 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 |
$304,51 $345,62 $389,16 $543,85 $826,44 |
$537,46 $578,57 $622,11 $776,80 |
$770,41 $811,52 $855,06 $1 009,75 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$609,02 $691,24 $778,32 $1 087,70 $1 652,88 |
$841,97 $924,19 $1 011,27 $1 320,65 |
$1 074,92 $1 157,14 $1 244,22 $1 553,60 |
Toc - Plan #36 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 |
$402,38 $456,70 $514,24 $718,65 $1 092,06 |
$710,20 $764,52 $822,06 $1 026,47 |
$1 018,02 $1 072,34 $1 129,88 $1 334,29 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$804,76 $913,40 $1 028,48 $1 437,30 $2 184,12 |
$1 112,58 $1 221,22 $1 336,30 $1 745,12 |
$1 420,40 $1 529,04 $1 644,12 $2 052,94 |
Toc - Plan #37 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 |
$403,34 $457,79 $515,47 $720,37 $1 094,66 |
$711,90 $766,35 $824,03 $1 028,93 |
$1 020,46 $1 074,91 $1 132,59 $1 337,49 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$806,68 $915,58 $1 030,94 $1 440,74 $2 189,32 |
$1 115,24 $1 224,14 $1 339,50 $1 749,30 |
$1 423,80 $1 532,70 $1 648,06 $2 057,86 |
Toc - Plan #38 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 |
$419,56 $476,20 $536,20 $749,33 $1 138,69 |
$740,52 $797,16 $857,16 $1 070,29 |
$1 061,48 $1 118,12 $1 178,12 $1 391,25 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$839,12 $952,40 $1 072,40 $1 498,66 $2 277,38 |
$1 160,08 $1 273,36 $1 393,36 $1 819,62 |
$1 481,04 $1 594,32 $1 714,32 $2 140,58 |
Toc - Plan #39 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 |
$555,76 $630,79 $710,26 $992,59 $1 508,33 |
$980,92 $1 055,95 $1 135,42 $1 417,75 |
$1 406,08 $1 481,11 $1 560,58 $1 842,91 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$1 111,52 $1 261,58 $1 420,52 $1 985,18 $3 016,66 |
$1 536,68 $1 686,74 $1 845,68 $2 410,34 |
$1 961,84 $2 111,90 $2 270,84 $2 835,50 |
Toc - Plan #40 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 |
$260,22 $295,35 $332,56 $464,75 $706,24 |
$459,29 $494,42 $531,63 $663,82 |
$658,36 $693,49 $730,70 $862,89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$520,44 $590,70 $665,12 $929,50 $1 412,48 |
$719,51 $789,77 $864,19 $1 128,57 |
$918,58 $988,84 $1 063,26 $1 327,64 |
Toc - Plan #41 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 |
$311,17 $353,18 $397,68 $555,75 $844,52 |
$549,22 $591,23 $635,73 $793,80 |
$787,27 $829,28 $873,78 $1 031,85 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$622,34 $706,36 $795,36 $1 111,50 $1 689,04 |
$860,39 $944,41 $1 033,41 $1 349,55 |
$1 098,44 $1 182,46 $1 271,46 $1 587,60 |
Toc - Plan #42 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 |
$317,52 $360,39 $405,79 $567,09 $861,75 |
$560,42 $603,29 $648,69 $809,99 |
$803,32 $846,19 $891,59 $1 052,89 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$635,04 $720,78 $811,58 $1 134,18 $1 723,50 |
$877,94 $963,68 $1 054,48 $1 377,08 |
$1 120,84 $1 206,58 $1 297,38 $1 619,98 |
Toc - Plan #43 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 |
$311,82 $353,92 $398,51 $556,91 $846,28 |
$550,36 $592,46 $637,05 $795,45 |
$788,90 $831,00 $875,59 $1 033,99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$623,64 $707,84 $797,02 $1 113,82 $1 692,56 |
$862,18 $946,38 $1 035,56 $1 352,36 |
$1 100,72 $1 184,92 $1 274,10 $1 590,90 |
Toc - Plan #44 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 |
$413,53 $469,36 $528,49 $738,56 $1 122,32 |
$729,88 $785,71 $844,84 $1 054,91 |
$1 046,23 $1 102,06 $1 161,19 $1 371,26 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$827,06 $938,72 $1 056,98 $1 477,12 $2 244,64 |
$1 143,41 $1 255,07 $1 373,33 $1 793,47 |
$1 459,76 $1 571,42 $1 689,68 $2 109,82 |
Toc - Plan #45 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 |
$412,57 $468,27 $527,26 $736,85 $1 119,71 |
$728,19 $783,89 $842,88 $1 052,47 |
$1 043,81 $1 099,51 $1 158,50 $1 368,09 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$825,14 $936,54 $1 054,52 $1 473,70 $2 239,42 |
$1 140,76 $1 252,16 $1 370,14 $1 789,32 |
$1 456,38 $1 567,78 $1 685,76 $2 104,94 |
Toc - Plan #46 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 |
$391,74 $444,62 $500,64 $699,65 $1 063,18 |
$691,42 $744,30 $800,32 $999,33 |
$991,10 $1 043,98 $1 100,00 $1 299,01 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$783,48 $889,24 $1 001,28 $1 399,30 $2 126,36 |
$1 083,16 $1 188,92 $1 300,96 $1 698,98 |
$1 382,84 $1 488,60 $1 600,64 $1 998,66 |
Toc - Plan #47 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 |
$320,15 $363,37 $409,15 $571,79 $868,89 |
$565,06 $608,28 $654,06 $816,70 |
$809,97 $853,19 $898,97 $1 061,61 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$640,30 $726,74 $818,30 $1 143,58 $1 737,78 |
$885,21 $971,65 $1 063,21 $1 388,49 |
$1 130,12 $1 216,56 $1 308,12 $1 633,40 |
Toc - Plan #48 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 |
$333,48 $378,50 $426,19 $595,60 $905,06 |
$588,59 $633,61 $681,30 $850,71 |
$843,70 $888,72 $936,41 $1 105,82 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$666,96 $757,00 $852,38 $1 191,20 $1 810,12 |
$922,07 $1 012,11 $1 107,49 $1 446,31 |
$1 177,18 $1 267,22 $1 362,60 $1 701,42 |
ADVERTISEMENT
Common Ground Healthcare CooperativeLocal: 1-877-514-2442 | Toll Free: 1-877-514-2442 | TTY: 1-844-472-2442 |
Toc - Plan #49 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$405,48 $460,21 $518,20 $724,18 $1 100,46 |
$715,67 $770,40 $828,39 $1 034,37 |
$1 025,86 $1 080,59 $1 138,58 $1 344,56 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$810,96 $920,42 $1 036,40 $1 448,36 $2 200,92 |
$1 121,15 $1 230,61 $1 346,59 $1 758,55 |
$1 431,34 $1 540,80 $1 656,78 $2 068,74 |
Toc - Plan #50 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$381,23 $432,69 $487,20 $680,86 $1 034,64 |
$672,87 $724,33 $778,84 $972,50 |
$964,51 $1 015,97 $1 070,48 $1 264,14 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$762,46 $865,38 $974,40 $1 361,72 $2 069,28 |
$1 054,10 $1 157,02 $1 266,04 $1 653,36 |
$1 345,74 $1 448,66 $1 557,68 $1 945,00 |
Toc - Plan #51 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$372,86 $423,18 $476,50 $665,90 $1 011,91 |
$658,09 $708,41 $761,73 $951,13 |
$943,32 $993,64 $1 046,96 $1 236,36 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$745,72 $846,36 $953,00 $1 331,80 $2 023,82 |
$1 030,95 $1 131,59 $1 238,23 $1 617,03 |
$1 316,18 $1 416,82 $1 523,46 $1 902,26 |
Toc - Plan #52 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$389,94 $442,57 $498,33 $696,41 $1 058,26 |
$688,23 $740,86 $796,62 $994,70 |
$986,52 $1 039,15 $1 094,91 $1 292,99 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$779,88 $885,14 $996,66 $1 392,82 $2 116,52 |
$1 078,17 $1 183,43 $1 294,95 $1 691,11 |
$1 376,46 $1 481,72 $1 593,24 $1 989,40 |
Toc - Plan #53 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$184,53 $209,43 $235,81 $329,55 $500,78 |
$325,69 $350,59 $376,97 $470,71 |
$466,85 $491,75 $518,13 $611,87 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$369,06 $418,86 $471,62 $659,10 $1 001,56 |
$510,22 $560,02 $612,78 $800,26 |
$651,38 $701,18 $753,94 $941,42 |
Toc - Plan #54 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$259,60 $294,64 $331,76 $463,64 $704,54 |
$458,19 $493,23 $530,35 $662,23 |
$656,78 $691,82 $728,94 $860,82 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$519,20 $589,28 $663,52 $927,28 $1 409,08 |
$717,79 $787,87 $862,11 $1 125,87 |
$916,38 $986,46 $1 060,70 $1 324,46 |
Toc - Plan #55 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$276,53 $313,85 $353,39 $493,87 $750,48 |
$488,07 $525,39 $564,93 $705,41 |
$699,61 $736,93 $776,47 $916,95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$553,06 $627,70 $706,78 $987,74 $1 500,96 |
$764,60 $839,24 $918,32 $1 199,28 |
$976,14 $1 050,78 $1 129,86 $1 410,82 |
Toc - Plan #56 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$274,29 $311,31 $350,53 $489,87 $744,40 |
$484,12 $521,14 $560,36 $699,70 |
$693,95 $730,97 $770,19 $909,53 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$548,58 $622,62 $701,06 $979,74 $1 488,80 |
$758,41 $832,45 $910,89 $1 189,57 |
$968,24 $1 042,28 $1 120,72 $1 399,40 |
Toc - Plan #57 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:
Monthly Premiums:
[show premiums]
|
||||||||||||||||||||
Age | Individual |
Individual 1 Child |
Individual 2 Children |
|||||||||||||||||
21 30 40 50 60 |
$310,01 $351,85 $396,18 $553,65 $841,33 |
$547,16 $589,00 $633,33 $790,80 |
$784,31 $826,15 $870,48 $1 027,95 |
|||||||||||||||||
Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
|||||||||||||||||
21 30 40 50 60 |
$620,02 $703,70 $792,36 $1 107,30 $1 682,66 |
$857,17 $940,85 $1 029,51 $1 344,45 |
$1 094,32 $1 178,00 $1 266,66 $1 581,60 |
‡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 Outagamie County here.
Outagamie County is in “Rating Area 11” of Wisconsin.
Currently, there are 57 plans offered in Rating Area 11.