Obamacare 2021 Rates for Sheboygan County
Obamacare > Rates > Wisconsin > Sheboygan County
Obamacare > Rates > Wisconsin > Sheboygan County
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Dean Health PlanLocal: 1-800-279-1302 | Toll Free: 1-800-279-1302 | TTY: 1-800-279-1302 |
Toc - Plan #1 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Prevea360 Gold Copay Plus 1500X |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
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 |
$406,49 $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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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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 |
Toc - Plan #2 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Prevea360 Silver Copay Plus 4800X |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
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 |
$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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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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 |
Toc - Plan #3 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Prevea360 Bronze Copay Plus 8500X |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
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 |
$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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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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 |
Toc - Plan #4 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Prevea360 Silver Classic 5000X |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
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 |
$404,21 $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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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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 |
Toc - Plan #5 Dean Health Plan | ||||||||||||||||||||
Gold
(HMO) Prevea360 Gold Value Copay 3700X |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
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 |
$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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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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 |
Toc - Plan #6 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Prevea360 Silver Value Copay 5000X |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
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 |
$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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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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 |
Toc - Plan #7 Dean Health Plan | ||||||||||||||||||||
Bronze
(HMO) Prevea360 Bronze Value Copay 8500X |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
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 |
$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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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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 |
Toc - Plan #8 Dean Health Plan | ||||||||||||||||||||
Silver
(HMO) Prevea360 Silver HSA-E 4500X |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
|
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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21 30 40 50 60 |
$394,92 $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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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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 |
Toc - Plan #9 Dean Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) Prevea360 Bronze HSA-E 6850X |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
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 |
$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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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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 |
Toc - Plan #10 Dean Health Plan | ||||||||||||||||||||
Catastrophic
(HMO) Prevea360 Catastrophic Safety Net |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-279-1302
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 |
$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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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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 |
ADVERTISEMENT
Molina HealthcareLocal: 1-888-560-2043 | Toll Free: 1-888-560-2043 |
Toc - Plan #11 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 #12 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 #13 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 #14 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 |
|||||||||||||||||
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 #15 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 #16 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 #17 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 #18 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 |
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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 #19 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 #20 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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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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 #21 Molina Healthcare | ||||||||||||||||||||
Bronze
(HMO) Core Care Bronze 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 |
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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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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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
Arise Health PlanLocal: 1-920-490-6900 | Toll Free: 1-800-332-6249 | TTY: 1-888-332-0144 |
Toc - Plan #22 Arise Health Plan | ||||||||||||||||||||
Bronze
(HMO) WPS HMO Bronze $8,550 | Select Network |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
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 |
$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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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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 #23 Arise Health Plan | ||||||||||||||||||||
Expanded Bronze
(HMO) WPS HMO Bronze $6,500 with 3 Free PCP Visits | Select Network |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-800-332-6249
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 |
$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 #24 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 #25 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 #26 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 #27 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 #28 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 #29 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 #30 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 #31 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 #32 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 #33 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 #34 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 #35 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 #36 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 #37 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 #38 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 #39 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 #40 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 #41 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 #42 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 #43 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 #44 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 #45 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 #46 Common Ground Healthcare Cooperative | ||||||||||||||||||||
Silver
(EPO) Envision - Silver 7000/75 |
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Benefits & Coverage
Plan Brochure
Provider Directory
Customer Service Phone: 1-877-514-2442
Annual Out of Pocket Expenses:
Monthly Premiums:
[show premiums]
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Age | Individual |
Individual 1 Child |
Individual 2 Children |
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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 |
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Age | Couple |
Couple 1 Child |
Couple 2 Chidren |
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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 Sheboygan County here.
Sheboygan County is in “Rating Area 11” of Wisconsin.
Currently, there are 46 plans offered in Rating Area 11.