Georgia Obamacare 2021 Rates

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Blue Cross Blue Shield Healthcare Plan of Georgia, Inc

Local: 1-855-738-6652 | Toll Free: 1-855-738-6652

Toc - Plan #1 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X Guided Access HMO 0 for HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

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
$310,25
$352,13
$396,50
$554,11
$842,02
$547,59
$589,47
$633,84
$791,45
$784,93
$826,81
$871,18
$1 028,79
$1 022,27
$1 064,15
$1 108,52
$1 266,13
$237,34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$620,50
$704,26
$793,00
$1 108,22
$1 684,04
$857,84
$941,60
$1 030,34
$1 345,56
$1 095,18
$1 178,94
$1 267,68
$1 582,90
$1 332,52
$1 416,28
$1 505,02
$1 820,24
$237,34
Toc - Plan #2 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X Guided Access HMO 3000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$7,700 $15,400 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
$365,79
$415,17
$467,48
$653,30
$992,75
$645,62
$695,00
$747,31
$933,13
$925,45
$974,83
$1 027,14
$1 212,96
$1 205,28
$1 254,66
$1 306,97
$1 492,79
$279,83
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$731,58
$830,34
$934,96
$1 306,60
$1 985,50
$1 011,41
$1 110,17
$1 214,79
$1 586,43
$1 291,24
$1 390,00
$1 494,62
$1 866,26
$1 571,07
$1 669,83
$1 774,45
$2 146,09
$279,83
Toc - Plan #3 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X Guided Access HMO 5500

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$348,84
$395,93
$445,82
$623,03
$946,75
$615,70
$662,79
$712,68
$889,89
$882,56
$929,65
$979,54
$1 156,75
$1 149,42
$1 196,51
$1 246,40
$1 423,61
$266,86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$697,68
$791,86
$891,64
$1 246,06
$1 893,50
$964,54
$1 058,72
$1 158,50
$1 512,92
$1 231,40
$1 325,58
$1 425,36
$1 779,78
$1 498,26
$1 592,44
$1 692,22
$2 046,64
$266,86
Toc - Plan #4 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X Guided Access HMO 5600

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$5,600 $11,200 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
$308,12
$349,72
$393,78
$550,30
$836,24
$543,83
$585,43
$629,49
$786,01
$779,54
$821,14
$865,20
$1 021,72
$1 015,25
$1 056,85
$1 100,91
$1 257,43
$235,71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$616,24
$699,44
$787,56
$1 100,60
$1 672,48
$851,95
$935,15
$1 023,27
$1 336,31
$1 087,66
$1 170,86
$1 258,98
$1 572,02
$1 323,37
$1 406,57
$1 494,69
$1 807,73
$235,71
Toc - Plan #5 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X Guided Access HMO 6000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$303,55
$344,53
$387,94
$542,14
$823,83
$535,77
$576,75
$620,16
$774,36
$767,99
$808,97
$852,38
$1 006,58
$1 000,21
$1 041,19
$1 084,60
$1 238,80
$232,22
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$607,10
$689,06
$775,88
$1 084,28
$1 647,66
$839,32
$921,28
$1 008,10
$1 316,50
$1 071,54
$1 153,50
$1 240,32
$1 548,72
$1 303,76
$1 385,72
$1 472,54
$1 780,94
$232,22
Toc - Plan #6 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Catastrophic

(HMO) Anthem Catastrophic Pathway X Guided Access HMO 8550

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

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
$211,59
$240,15
$270,41
$377,90
$574,26
$373,46
$402,02
$432,28
$539,77
$535,33
$563,89
$594,15
$701,64
$697,20
$725,76
$756,02
$863,51
$161,87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$423,18
$480,30
$540,82
$755,80
$1 148,52
$585,05
$642,17
$702,69
$917,67
$746,92
$804,04
$864,56
$1 079,54
$908,79
$965,91
$1 026,43
$1 241,41
$161,87
Toc - Plan #7 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Bronze

(HMO) Anthem Bronze Pathway X Guided Access HMO 6750

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$6,750 $13,500 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$293,18
$332,76
$374,68
$523,62
$795,69
$517,46
$557,04
$598,96
$747,90
$741,74
$781,32
$823,24
$972,18
$966,02
$1 005,60
$1 047,52
$1 196,46
$224,28
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$586,36
$665,52
$749,36
$1 047,24
$1 591,38
$810,64
$889,80
$973,64
$1 271,52
$1 034,92
$1 114,08
$1 197,92
$1 495,80
$1 259,20
$1 338,36
$1 422,20
$1 720,08
$224,28
Toc - Plan #8 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X Guided Access HMO 4950

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$4,950 $9,900 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
$359,09
$407,57
$458,92
$641,33
$974,57
$633,79
$682,27
$733,62
$916,03
$908,49
$956,97
$1 008,32
$1 190,73
$1 183,19
$1 231,67
$1 283,02
$1 465,43
$274,70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$718,18
$815,14
$917,84
$1 282,66
$1 949,14
$992,88
$1 089,84
$1 192,54
$1 557,36
$1 267,58
$1 364,54
$1 467,24
$1 832,06
$1 542,28
$1 639,24
$1 741,94
$2 106,76
$274,70
Toc - Plan #9 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Gold

(HMO) Anthem Gold Pathway X Guided Access HMO 1850

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$1,850 $3,700 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
$428,49
$486,34
$547,61
$765,28
$1 162,92
$756,28
$814,13
$875,40
$1 093,07
$1 084,07
$1 141,92
$1 203,19
$1 420,86
$1 411,86
$1 469,71
$1 530,98
$1 748,65
$327,79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$856,98
$972,68
$1 095,22
$1 530,56
$2 325,84
$1 184,77
$1 300,47
$1 423,01
$1 858,35
$1 512,56
$1 628,26
$1 750,80
$2 186,14
$1 840,35
$1 956,05
$2 078,59
$2 513,93
$327,79
Toc - Plan #10 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Expanded Bronze

(HMO) Anthem Bronze Pathway X Guided Access HMO 4900

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$4,900 $9,800 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
$320,54
$363,81
$409,65
$572,48
$869,95
$565,75
$609,02
$654,86
$817,69
$810,96
$854,23
$900,07
$1 062,90
$1 056,17
$1 099,44
$1 145,28
$1 308,11
$245,21
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$641,08
$727,62
$819,30
$1 144,96
$1 739,90
$886,29
$972,83
$1 064,51
$1 390,17
$1 131,50
$1 218,04
$1 309,72
$1 635,38
$1 376,71
$1 463,25
$1 554,93
$1 880,59
$245,21
Toc - Plan #11 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X Guided Access HMO 2600

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$2,600 $5,200 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
$395,74
$449,16
$505,76
$706,79
$1 074,04
$698,48
$751,90
$808,50
$1 009,53
$1 001,22
$1 054,64
$1 111,24
$1 312,27
$1 303,96
$1 357,38
$1 413,98
$1 615,01
$302,74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$791,48
$898,32
$1 011,52
$1 413,58
$2 148,08
$1 094,22
$1 201,06
$1 314,26
$1 716,32
$1 396,96
$1 503,80
$1 617,00
$2 019,06
$1 699,70
$1 806,54
$1 919,74
$2 321,80
$302,74
Toc - Plan #12 Blue Cross Blue Shield Healthcare Plan of Georgia, Inc
Silver

(HMO) Anthem Silver Pathway X Guided Access HMO 6250

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-738-6652

Annual Out of Pocket Expenses:

Individual Family
$6,250 $12,500 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$342,29
$388,50
$437,45
$611,33
$928,98
$604,14
$650,35
$699,30
$873,18
$865,99
$912,20
$961,15
$1 135,03
$1 127,84
$1 174,05
$1 223,00
$1 396,88
$261,85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$684,58
$777,00
$874,90
$1 222,66
$1 857,96
$946,43
$1 038,85
$1 136,75
$1 484,51
$1 208,28
$1 300,70
$1 398,60
$1 746,36
$1 470,13
$1 562,55
$1 660,45
$2 008,21
$261,85

ADVERTISEMENT

Oscar Health Plan of Georgia

Local: 1-855-672-2755 | Toll Free: 

Toc - Plan #13 Oscar Health Plan of Georgia
Expanded Bronze

(HMO) Oscar Bronze Classic PCP Copay

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$346,20
$392,92
$442,43
$618,29
$939,55
$611,03
$657,75
$707,26
$883,12
$875,86
$922,58
$972,09
$1 147,95
$1 140,69
$1 187,41
$1 236,92
$1 412,78
$264,83
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$692,40
$785,84
$884,86
$1 236,58
$1 879,10
$957,23
$1 050,67
$1 149,69
$1 501,41
$1 222,06
$1 315,50
$1 414,52
$1 766,24
$1 486,89
$1 580,33
$1 679,35
$2 031,07
$264,83
Toc - Plan #14 Oscar Health Plan of Georgia
Expanded Bronze

(HMO) Oscar Bronze Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$338,39
$384,06
$432,44
$604,34
$918,35
$597,25
$642,92
$691,30
$863,20
$856,11
$901,78
$950,16
$1 122,06
$1 114,97
$1 160,64
$1 209,02
$1 380,92
$258,86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$676,78
$768,12
$864,88
$1 208,68
$1 836,70
$935,64
$1 026,98
$1 123,74
$1 467,54
$1 194,50
$1 285,84
$1 382,60
$1 726,40
$1 453,36
$1 544,70
$1 641,46
$1 985,26
$258,86
Toc - Plan #15 Oscar Health Plan of Georgia
Expanded Bronze

(HMO) Oscar Bronze Classic Next

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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
$396,07
$449,52
$506,16
$707,35
$1 074,89
$699,05
$752,50
$809,14
$1 010,33
$1 002,03
$1 055,48
$1 112,12
$1 313,31
$1 305,01
$1 358,46
$1 415,10
$1 616,29
$302,98
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$792,14
$899,04
$1 012,32
$1 414,70
$2 149,78
$1 095,12
$1 202,02
$1 315,30
$1 717,68
$1 398,10
$1 505,00
$1 618,28
$2 020,66
$1 701,08
$1 807,98
$1 921,26
$2 323,64
$302,98
Toc - Plan #16 Oscar Health Plan of Georgia
Silver

(HMO) Oscar Silver Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$422,75
$479,81
$540,26
$755,01
$1 147,31
$746,15
$803,21
$863,66
$1 078,41
$1 069,55
$1 126,61
$1 187,06
$1 401,81
$1 392,95
$1 450,01
$1 510,46
$1 725,21
$323,40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$845,50
$959,62
$1 080,52
$1 510,02
$2 294,62
$1 168,90
$1 283,02
$1 403,92
$1 833,42
$1 492,30
$1 606,42
$1 727,32
$2 156,82
$1 815,70
$1 929,82
$2 050,72
$2 480,22
$323,40
Toc - Plan #17 Oscar Health Plan of Georgia
Silver

(HMO) Oscar Silver Saver 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$6,200 $12,400 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
$417,77
$474,16
$533,90
$746,13
$1 133,81
$737,36
$793,75
$853,49
$1 065,72
$1 056,95
$1 113,34
$1 173,08
$1 385,31
$1 376,54
$1 432,93
$1 492,67
$1 704,90
$319,59
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$835,54
$948,32
$1 067,80
$1 492,26
$2 267,62
$1 155,13
$1 267,91
$1 387,39
$1 811,85
$1 474,72
$1 587,50
$1 706,98
$2 131,44
$1 794,31
$1 907,09
$2 026,57
$2 451,03
$319,59
Toc - Plan #18 Oscar Health Plan of Georgia
Silver

(HMO) Oscar Silver Classic Next

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,000 $16,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$423,89
$481,11
$541,72
$757,05
$1 150,41
$748,16
$805,38
$865,99
$1 081,32
$1 072,43
$1 129,65
$1 190,26
$1 405,59
$1 396,70
$1 453,92
$1 514,53
$1 729,86
$324,27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$847,78
$962,22
$1 083,44
$1 514,10
$2 300,82
$1 172,05
$1 286,49
$1 407,71
$1 838,37
$1 496,32
$1 610,76
$1 731,98
$2 162,64
$1 820,59
$1 935,03
$2 056,25
$2 486,91
$324,27
Toc - Plan #19 Oscar Health Plan of Georgia
Catastrophic

(HMO) Oscar Secure

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

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
$295,12
$334,95
$377,15
$527,07
$800,93
$520,88
$560,71
$602,91
$752,83
$746,64
$786,47
$828,67
$978,59
$972,40
$1 012,23
$1 054,43
$1 204,35
$225,76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$590,24
$669,90
$754,30
$1 054,14
$1 601,86
$816,00
$895,66
$980,06
$1 279,90
$1 041,76
$1 121,42
$1 205,82
$1 505,66
$1 267,52
$1 347,18
$1 431,58
$1 731,42
$225,76
Toc - Plan #20 Oscar Health Plan of Georgia
Gold

(HMO) Oscar Gold Classic

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$6,000 $12,000 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
$463,79
$526,39
$592,71
$828,32
$1 258,71
$818,58
$881,18
$947,50
$1 183,11
$1 173,37
$1 235,97
$1 302,29
$1 537,90
$1 528,16
$1 590,76
$1 657,08
$1 892,69
$354,79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$927,58
$1 052,78
$1 185,42
$1 656,64
$2 517,42
$1 282,37
$1 407,57
$1 540,21
$2 011,43
$1 637,16
$1 762,36
$1 895,00
$2 366,22
$1 991,95
$2 117,15
$2 249,79
$2 721,01
$354,79
Toc - Plan #21 Oscar Health Plan of Georgia
Expanded Bronze

(HMO) Oscar Bronze HDHP

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone:

Annual Out of Pocket Expenses:

Individual Family
$5,200 $10,400 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
$354,68
$402,55
$453,27
$633,44
$962,57
$626,00
$673,87
$724,59
$904,76
$897,32
$945,19
$995,91
$1 176,08
$1 168,64
$1 216,51
$1 267,23
$1 447,40
$271,32
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$709,36
$805,10
$906,54
$1 266,88
$1 925,14
$980,68
$1 076,42
$1 177,86
$1 538,20
$1 252,00
$1 347,74
$1 449,18
$1 809,52
$1 523,32
$1 619,06
$1 720,50
$2 080,84
$271,32

ADVERTISEMENT

CareSource

Local: 1-833-230-2030 | Toll Free: 1-833-230-2030 | TTY: 1-800-255-0056

Toc - Plan #22 CareSource
Expanded Bronze

(HMO) CareSource Marketplace Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$7,700 $15,400 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
$278,42
$316,00
$355,81
$497,25
$755,61
$491,41
$528,99
$568,80
$710,24
$704,40
$741,98
$781,79
$923,23
$917,39
$954,97
$994,78
$1 136,22
$212,99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$556,84
$632,00
$711,62
$994,50
$1 511,22
$769,83
$844,99
$924,61
$1 207,49
$982,82
$1 057,98
$1 137,60
$1 420,48
$1 195,81
$1 270,97
$1 350,59
$1 633,47
$212,99
Toc - Plan #23 CareSource
Gold

(HMO) CareSource Marketplace Gold

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

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
$389,09
$441,61
$497,25
$694,90
$1 055,97
$686,74
$739,26
$794,90
$992,55
$984,39
$1 036,91
$1 092,55
$1 290,20
$1 282,04
$1 334,56
$1 390,20
$1 587,85
$297,65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$778,18
$883,22
$994,50
$1 389,80
$2 111,94
$1 075,83
$1 180,87
$1 292,15
$1 687,45
$1 373,48
$1 478,52
$1 589,80
$1 985,10
$1 671,13
$1 776,17
$1 887,45
$2 282,75
$297,65
Toc - Plan #24 CareSource
Silver

(HMO) CareSource Marketplace Low Premium Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$390,09
$442,75
$498,53
$696,69
$1 058,69
$688,51
$741,17
$796,95
$995,11
$986,93
$1 039,59
$1 095,37
$1 293,53
$1 285,35
$1 338,01
$1 393,79
$1 591,95
$298,42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$780,18
$885,50
$997,06
$1 393,38
$2 117,38
$1 078,60
$1 183,92
$1 295,48
$1 691,80
$1 377,02
$1 482,34
$1 593,90
$1 990,22
$1 675,44
$1 780,76
$1 892,32
$2 288,64
$298,42
Toc - Plan #25 CareSource
Silver

(HMO) CareSource Marketplace Standard Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 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
$408,98
$464,19
$522,67
$730,44
$1 109,97
$721,85
$777,06
$835,54
$1 043,31
$1 034,72
$1 089,93
$1 148,41
$1 356,18
$1 347,59
$1 402,80
$1 461,28
$1 669,05
$312,87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$817,96
$928,38
$1 045,34
$1 460,88
$2 219,94
$1 130,83
$1 241,25
$1 358,21
$1 773,75
$1 443,70
$1 554,12
$1 671,08
$2 086,62
$1 756,57
$1 866,99
$1 983,95
$2 399,49
$312,87
Toc - Plan #26 CareSource
Silver

(HMO) CareSource Marketplace Low Deductible Silver

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$5,100 $10,200 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
$419,57
$476,21
$536,20
$749,34
$1 138,70
$740,54
$797,18
$857,17
$1 070,31
$1 061,51
$1 118,15
$1 178,14
$1 391,28
$1 382,48
$1 439,12
$1 499,11
$1 712,25
$320,97
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$839,14
$952,42
$1 072,40
$1 498,68
$2 277,40
$1 160,11
$1 273,39
$1 393,37
$1 819,65
$1 481,08
$1 594,36
$1 714,34
$2 140,62
$1 802,05
$1 915,33
$2 035,31
$2 461,59
$320,97
Toc - Plan #27 CareSource
Expanded Bronze

(HMO) CareSource Marketplace HSA Eligible Bronze

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$5,400 $10,800 Annual Deductible
$7,000 $14,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$303,99
$345,03
$388,50
$542,93
$825,03
$536,54
$577,58
$621,05
$775,48
$769,09
$810,13
$853,60
$1 008,03
$1 001,64
$1 042,68
$1 086,15
$1 240,58
$232,55
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$607,98
$690,06
$777,00
$1 085,86
$1 650,06
$840,53
$922,61
$1 009,55
$1 318,41
$1 073,08
$1 155,16
$1 242,10
$1 550,96
$1 305,63
$1 387,71
$1 474,65
$1 783,51
$232,55
Toc - Plan #28 CareSource
Expanded Bronze

(HMO) CareSource Marketplace Bronze Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$7,700 $15,400 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
$293,78
$333,44
$375,45
$524,69
$797,32
$518,52
$558,18
$600,19
$749,43
$743,26
$782,92
$824,93
$974,17
$968,00
$1 007,66
$1 049,67
$1 198,91
$224,74
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$587,56
$666,88
$750,90
$1 049,38
$1 594,64
$812,30
$891,62
$975,64
$1 274,12
$1 037,04
$1 116,36
$1 200,38
$1 498,86
$1 261,78
$1 341,10
$1 425,12
$1 723,60
$224,74
Toc - Plan #29 CareSource
Gold

(HMO) CareSource Marketplace Gold Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

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
$409,61
$464,90
$523,48
$731,56
$1 111,67
$722,96
$778,25
$836,83
$1 044,91
$1 036,31
$1 091,60
$1 150,18
$1 358,26
$1 349,66
$1 404,95
$1 463,53
$1 671,61
$313,35
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$819,22
$929,80
$1 046,96
$1 463,12
$2 223,34
$1 132,57
$1 243,15
$1 360,31
$1 776,47
$1 445,92
$1 556,50
$1 673,66
$2 089,82
$1 759,27
$1 869,85
$1 987,01
$2 403,17
$313,35
Toc - Plan #30 CareSource
Silver

(HMO) CareSource Marketplace Low Premium Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$407,59
$462,62
$520,90
$727,96
$1 106,20
$719,40
$774,43
$832,71
$1 039,77
$1 031,21
$1 086,24
$1 144,52
$1 351,58
$1 343,02
$1 398,05
$1 456,33
$1 663,39
$311,81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$815,18
$925,24
$1 041,80
$1 455,92
$2 212,40
$1 126,99
$1 237,05
$1 353,61
$1 767,73
$1 438,80
$1 548,86
$1 665,42
$2 079,54
$1 750,61
$1 860,67
$1 977,23
$2 391,35
$311,81
Toc - Plan #31 CareSource
Silver

(HMO) CareSource Marketplace Standard Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$5,800 $11,600 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
$427,81
$485,56
$546,74
$764,07
$1 161,08
$755,08
$812,83
$874,01
$1 091,34
$1 082,35
$1 140,10
$1 201,28
$1 418,61
$1 409,62
$1 467,37
$1 528,55
$1 745,88
$327,27
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$855,62
$971,12
$1 093,48
$1 528,14
$2 322,16
$1 182,89
$1 298,39
$1 420,75
$1 855,41
$1 510,16
$1 625,66
$1 748,02
$2 182,68
$1 837,43
$1 952,93
$2 075,29
$2 509,95
$327,27
Toc - Plan #32 CareSource
Silver

(HMO) CareSource Marketplace Low Deductible Silver Dental, Vision, & Fitness

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-833-230-2030

Annual Out of Pocket Expenses:

Individual Family
$5,100 $10,200 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
$439,63
$498,97
$561,84
$785,16
$1 193,13
$775,94
$835,28
$898,15
$1 121,47
$1 112,25
$1 171,59
$1 234,46
$1 457,78
$1 448,56
$1 507,90
$1 570,77
$1 794,09
$336,31
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$879,26
$997,94
$1 123,68
$1 570,32
$2 386,26
$1 215,57
$1 334,25
$1 459,99
$1 906,63
$1 551,88
$1 670,56
$1 796,30
$2 242,94
$1 888,19
$2 006,87
$2 132,61
$2 579,25
$336,31

ADVERTISEMENT

Ambetter from Peach State Health Plan

Local: 1-877-687-1180 | Toll Free: 1-877-687-1180 | TTY: 1-877-941-9231

Toc - Plan #33 Ambetter from Peach State Health Plan
Bronze

(HMO) Ambetter Essential Care 1 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$8,300 $16,600 Annual Deductible
$8,300 $16,600 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
$276,61
$313,94
$353,49
$494,00
$750,69
$488,21
$525,54
$565,09
$705,60
$699,81
$737,14
$776,69
$917,20
$911,41
$948,74
$988,29
$1 128,80
$211,60
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$553,22
$627,88
$706,98
$988,00
$1 501,38
$764,82
$839,48
$918,58
$1 199,60
$976,42
$1 051,08
$1 130,18
$1 411,20
$1 188,02
$1 262,68
$1 341,78
$1 622,80
$211,60
Toc - Plan #34 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 4 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 Annual Deductible
$7,200 $14,400 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
$372,13
$422,36
$475,57
$664,61
$1 009,94
$656,80
$707,03
$760,24
$949,28
$941,47
$991,70
$1 044,91
$1 233,95
$1 226,14
$1 276,37
$1 329,58
$1 518,62
$284,67
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$744,26
$844,72
$951,14
$1 329,22
$2 019,88
$1 028,93
$1 129,39
$1 235,81
$1 613,89
$1 313,60
$1 414,06
$1 520,48
$1 898,56
$1 598,27
$1 698,73
$1 805,15
$2 183,23
$284,67
Toc - Plan #35 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 11 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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
$360,97
$409,69
$461,30
$644,67
$979,64
$637,10
$685,82
$737,43
$920,80
$913,23
$961,95
$1 013,56
$1 196,93
$1 189,36
$1 238,08
$1 289,69
$1 473,06
$276,13
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$721,94
$819,38
$922,60
$1 289,34
$1 959,28
$998,07
$1 095,51
$1 198,73
$1 565,47
$1 274,20
$1 371,64
$1 474,86
$1 841,60
$1 550,33
$1 647,77
$1 750,99
$2 117,73
$276,13
Toc - Plan #36 Ambetter from Peach State Health Plan
Gold

(HMO) Ambetter Secure Care 5 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$6,300 $12,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$372,02
$422,23
$475,43
$664,41
$1 009,64
$656,61
$706,82
$760,02
$949,00
$941,20
$991,41
$1 044,61
$1 233,59
$1 225,79
$1 276,00
$1 329,20
$1 518,18
$284,59
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$744,04
$844,46
$950,86
$1 328,82
$2 019,28
$1 028,63
$1 129,05
$1 235,45
$1 613,41
$1 313,22
$1 413,64
$1 520,04
$1 898,00
$1 597,81
$1 698,23
$1 804,63
$2 182,59
$284,59
Toc - Plan #37 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 12 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,400 $16,800 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
$353,67
$401,41
$451,98
$631,65
$959,85
$624,22
$671,96
$722,53
$902,20
$894,77
$942,51
$993,08
$1 172,75
$1 165,32
$1 213,06
$1 263,63
$1 443,30
$270,55
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$707,34
$802,82
$903,96
$1 263,30
$1 919,70
$977,89
$1 073,37
$1 174,51
$1 533,85
$1 248,44
$1 343,92
$1 445,06
$1 804,40
$1 518,99
$1 614,47
$1 715,61
$2 074,95
$270,55
Toc - Plan #38 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 29 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$5,450 $10,900 Annual Deductible
$8,400 $16,800 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
$350,66
$397,99
$448,13
$626,26
$951,67
$618,91
$666,24
$716,38
$894,51
$887,16
$934,49
$984,63
$1 162,76
$1 155,41
$1 202,74
$1 252,88
$1 431,01
$268,25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$701,32
$795,98
$896,26
$1 252,52
$1 903,34
$969,57
$1 064,23
$1 164,51
$1 520,77
$1 237,82
$1 332,48
$1 432,76
$1 789,02
$1 506,07
$1 600,73
$1 701,01
$2 057,27
$268,25
Toc - Plan #39 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 25 HSA (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$4,800 $9,600 Annual Deductible
$4,800 $9,600 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
$367,52
$417,12
$469,68
$656,37
$997,42
$648,66
$698,26
$750,82
$937,51
$929,80
$979,40
$1 031,96
$1 218,65
$1 210,94
$1 260,54
$1 313,10
$1 499,79
$281,14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$735,04
$834,24
$939,36
$1 312,74
$1 994,84
$1 016,18
$1 115,38
$1 220,50
$1 593,88
$1 297,32
$1 396,52
$1 501,64
$1 875,02
$1 578,46
$1 677,66
$1 782,78
$2 156,16
$281,14
Toc - Plan #40 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 26 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$5,450 $10,900 Annual Deductible
$8,100 $16,200 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
$371,09
$421,18
$474,24
$662,75
$1 007,11
$654,97
$705,06
$758,12
$946,63
$938,85
$988,94
$1 042,00
$1 230,51
$1 222,73
$1 272,82
$1 325,88
$1 514,39
$283,88
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$742,18
$842,36
$948,48
$1 325,50
$2 014,22
$1 026,06
$1 126,24
$1 232,36
$1 609,38
$1 309,94
$1 410,12
$1 516,24
$1 893,26
$1 593,82
$1 694,00
$1 800,12
$2 177,14
$283,88
Toc - Plan #41 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 27 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$2,750 $5,500 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
$386,76
$438,96
$494,26
$690,73
$1 049,63
$682,62
$734,82
$790,12
$986,59
$978,48
$1 030,68
$1 085,98
$1 282,45
$1 274,34
$1 326,54
$1 381,84
$1 578,31
$295,86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$773,52
$877,92
$988,52
$1 381,46
$2 099,26
$1 069,38
$1 173,78
$1 284,38
$1 677,32
$1 365,24
$1 469,64
$1 580,24
$1 973,18
$1 661,10
$1 765,50
$1 876,10
$2 269,04
$295,86
Toc - Plan #42 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 28 (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,200 $16,400 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
$389,55
$442,13
$497,83
$695,71
$1 057,20
$687,55
$740,13
$795,83
$993,71
$985,55
$1 038,13
$1 093,83
$1 291,71
$1 283,55
$1 336,13
$1 391,83
$1 589,71
$298,00
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$779,10
$884,26
$995,66
$1 391,42
$2 114,40
$1 077,10
$1 182,26
$1 293,66
$1 689,42
$1 375,10
$1 480,26
$1 591,66
$1 987,42
$1 673,10
$1 778,26
$1 889,66
$2 285,42
$298,00
Toc - Plan #43 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Ambetter Essential Care 2 HSA (2021)

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$301,32
$341,98
$385,07
$538,13
$817,75
$531,82
$572,48
$615,57
$768,63
$762,32
$802,98
$846,07
$999,13
$992,82
$1 033,48
$1 076,57
$1 229,63
$230,50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$602,64
$683,96
$770,14
$1 076,26
$1 635,50
$833,14
$914,46
$1 000,64
$1 306,76
$1 063,64
$1 144,96
$1 231,14
$1 537,26
$1 294,14
$1 375,46
$1 461,64
$1 767,76
$230,50
Toc - Plan #44 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 12 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 Annual Deductible
$8,400 $16,800 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
$368,01
$417,68
$470,31
$657,25
$998,76
$649,53
$699,20
$751,83
$938,77
$931,05
$980,72
$1 033,35
$1 220,29
$1 212,57
$1 262,24
$1 314,87
$1 501,81
$281,52
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$736,02
$835,36
$940,62
$1 314,50
$1 997,52
$1 017,54
$1 116,88
$1 222,14
$1 596,02
$1 299,06
$1 398,40
$1 503,66
$1 877,54
$1 580,58
$1 679,92
$1 785,18
$2 159,06
$281,52
Toc - Plan #45 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 4 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$7,200 $14,400 Annual Deductible
$7,200 $14,400 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
$387,22
$439,48
$494,85
$691,55
$1 050,88
$683,43
$735,69
$791,06
$987,76
$979,64
$1 031,90
$1 087,27
$1 283,97
$1 275,85
$1 328,11
$1 383,48
$1 580,18
$296,21
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$774,44
$878,96
$989,70
$1 383,10
$2 101,76
$1 070,65
$1 175,17
$1 285,91
$1 679,31
$1 366,86
$1 471,38
$1 582,12
$1 975,52
$1 663,07
$1 767,59
$1 878,33
$2 271,73
$296,21
Toc - Plan #46 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 11 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 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
$375,60
$426,30
$480,01
$670,81
$1 019,35
$662,93
$713,63
$767,34
$958,14
$950,26
$1 000,96
$1 054,67
$1 245,47
$1 237,59
$1 288,29
$1 342,00
$1 532,80
$287,33
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$751,20
$852,60
$960,02
$1 341,62
$2 038,70
$1 038,53
$1 139,93
$1 247,35
$1 628,95
$1 325,86
$1 427,26
$1 534,68
$1 916,28
$1 613,19
$1 714,59
$1 822,01
$2 203,61
$287,33
Toc - Plan #47 Ambetter from Peach State Health Plan
Bronze

(HMO) Ambetter Essential Care 1 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$8,300 $16,600 Annual Deductible
$8,300 $16,600 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
$287,82
$326,67
$367,82
$514,03
$781,12
$508,00
$546,85
$588,00
$734,21
$728,18
$767,03
$808,18
$954,39
$948,36
$987,21
$1 028,36
$1 174,57
$220,18
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$575,64
$653,34
$735,64
$1 028,06
$1 562,24
$795,82
$873,52
$955,82
$1 248,24
$1 016,00
$1 093,70
$1 176,00
$1 468,42
$1 236,18
$1 313,88
$1 396,18
$1 688,60
$220,18
Toc - Plan #48 Ambetter from Peach State Health Plan
Gold

(HMO) Ambetter Secure Care 5 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$1,450 $2,900 Annual Deductible
$6,300 $12,600 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
$387,10
$439,35
$494,70
$691,34
$1 050,57
$683,22
$735,47
$790,82
$987,46
$979,34
$1 031,59
$1 086,94
$1 283,58
$1 275,46
$1 327,71
$1 383,06
$1 579,70
$296,12
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$774,20
$878,70
$989,40
$1 382,68
$2 101,14
$1 070,32
$1 174,82
$1 285,52
$1 678,80
$1 366,44
$1 470,94
$1 581,64
$1 974,92
$1 662,56
$1 767,06
$1 877,76
$2 271,04
$296,12
Toc - Plan #49 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 25 HSA (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$4,800 $9,600 Annual Deductible
$4,800 $9,600 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$382,42
$434,03
$488,71
$682,98
$1 037,85
$674,96
$726,57
$781,25
$975,52
$967,50
$1 019,11
$1 073,79
$1 268,06
$1 260,04
$1 311,65
$1 366,33
$1 560,60
$292,54
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$764,84
$868,06
$977,42
$1 365,96
$2 075,70
$1 057,38
$1 160,60
$1 269,96
$1 658,50
$1 349,92
$1 453,14
$1 562,50
$1 951,04
$1 642,46
$1 745,68
$1 855,04
$2 243,58
$292,54
Toc - Plan #50 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 26 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$5,450 $10,900 Annual Deductible
$8,100 $16,200 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
$386,13
$438,25
$493,47
$689,62
$1 047,94
$681,51
$733,63
$788,85
$985,00
$976,89
$1 029,01
$1 084,23
$1 280,38
$1 272,27
$1 324,39
$1 379,61
$1 575,76
$295,38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$772,26
$876,50
$986,94
$1 379,24
$2 095,88
$1 067,64
$1 171,88
$1 282,32
$1 674,62
$1 363,02
$1 467,26
$1 577,70
$1 970,00
$1 658,40
$1 762,64
$1 873,08
$2 265,38
$295,38
Toc - Plan #51 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 27 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$2,750 $5,500 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
$402,43
$456,75
$514,30
$718,73
$1 092,18
$710,28
$764,60
$822,15
$1 026,58
$1 018,13
$1 072,45
$1 130,00
$1 334,43
$1 325,98
$1 380,30
$1 437,85
$1 642,28
$307,85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$804,86
$913,50
$1 028,60
$1 437,46
$2 184,36
$1 112,71
$1 221,35
$1 336,45
$1 745,31
$1 420,56
$1 529,20
$1 644,30
$2 053,16
$1 728,41
$1 837,05
$1 952,15
$2 361,01
$307,85
Toc - Plan #52 Ambetter from Peach State Health Plan
Silver

(HMO) Ambetter Balanced Care 28 (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,200 $16,400 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
$405,34
$460,05
$518,01
$723,92
$1 100,06
$715,42
$770,13
$828,09
$1 034,00
$1 025,50
$1 080,21
$1 138,17
$1 344,08
$1 335,58
$1 390,29
$1 448,25
$1 654,16
$310,08
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$810,68
$920,10
$1 036,02
$1 447,84
$2 200,12
$1 120,76
$1 230,18
$1 346,10
$1 757,92
$1 430,84
$1 540,26
$1 656,18
$2 068,00
$1 740,92
$1 850,34
$1 966,26
$2 378,08
$310,08
Toc - Plan #53 Ambetter from Peach State Health Plan
Expanded Bronze

(HMO) Ambetter Essential Care 2 HSA (2021) + Vision + Adult Dental

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-877-687-1180

Annual Out of Pocket Expenses:

Individual Family
$6,900 $13,800 Annual Deductible
$6,900 $13,800 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$313,53
$355,85
$400,68
$559,95
$850,90
$553,37
$595,69
$640,52
$799,79
$793,21
$835,53
$880,36
$1 039,63
$1 033,05
$1 075,37
$1 120,20
$1 279,47
$239,84
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$627,06
$711,70
$801,36
$1 119,90
$1 701,80
$866,90
$951,54
$1 041,20
$1 359,74
$1 106,74
$1 191,38
$1 281,04
$1 599,58
$1 346,58
$1 431,22
$1 520,88
$1 839,42
$239,84

ADVERTISEMENT

Kaiser Permanente

Local: 1-800-494-5314 | Toll Free: 1-800-494-5314

Toc - Plan #54 Kaiser Permanente
Gold

(HMO) KP GA Signature Gold 500/20

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-494-5314

Annual Out of Pocket Expenses:

Individual Family
$500 $1,000 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
$378,24
$429,30
$483,39
$675,54
$1 026,55
$667,60
$718,66
$772,75
$964,90
$956,96
$1 008,02
$1 062,11
$1 254,26
$1 246,32
$1 297,38
$1 351,47
$1 543,62
$289,36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$756,48
$858,60
$966,78
$1 351,08
$2 053,10
$1 045,84
$1 147,96
$1 256,14
$1 640,44
$1 335,20
$1 437,32
$1 545,50
$1 929,80
$1 624,56
$1 726,68
$1 834,86
$2 219,16
$289,36
Toc - Plan #55 Kaiser Permanente
Silver

(HMO) KP GA Signature Silver 3000/30

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-494-5314

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 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
$370,97
$421,05
$474,09
$662,54
$1 006,80
$654,76
$704,84
$757,88
$946,33
$938,55
$988,63
$1 041,67
$1 230,12
$1 222,34
$1 272,42
$1 325,46
$1 513,91
$283,79
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$741,94
$842,10
$948,18
$1 325,08
$2 013,60
$1 025,73
$1 125,89
$1 231,97
$1 608,87
$1 309,52
$1 409,68
$1 515,76
$1 892,66
$1 593,31
$1 693,47
$1 799,55
$2 176,45
$283,79
Toc - Plan #56 Kaiser Permanente
Silver

(HMO) KP GA Signature Silver 3500/20% HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-494-5314

Annual Out of Pocket Expenses:

Individual Family
$3,500 $7,000 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
$349,50
$396,68
$446,66
$624,21
$948,54
$616,87
$664,05
$714,03
$891,58
$884,24
$931,42
$981,40
$1 158,95
$1 151,61
$1 198,79
$1 248,77
$1 426,32
$267,37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$699,00
$793,36
$893,32
$1 248,42
$1 897,08
$966,37
$1 060,73
$1 160,69
$1 515,79
$1 233,74
$1 328,10
$1 428,06
$1 783,16
$1 501,11
$1 595,47
$1 695,43
$2 050,53
$267,37
Toc - Plan #57 Kaiser Permanente
Expanded Bronze

(HMO) KP GA Signature Bronze 5000/50

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-494-5314

Annual Out of Pocket Expenses:

Individual Family
$5,000 $10,000 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$269,94
$306,38
$344,98
$482,11
$732,61
$476,44
$512,88
$551,48
$688,61
$682,94
$719,38
$757,98
$895,11
$889,44
$925,88
$964,48
$1 101,61
$206,50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$539,88
$612,76
$689,96
$964,22
$1 465,22
$746,38
$819,26
$896,46
$1 170,72
$952,88
$1 025,76
$1 102,96
$1 377,22
$1 159,38
$1 232,26
$1 309,46
$1 583,72
$206,50
Toc - Plan #58 Kaiser Permanente
Expanded Bronze

(HMO) KP GA Signature Bronze 6500/40%/HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-494-5314

Annual Out of Pocket Expenses:

Individual Family
$6,500 $13,000 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
$269,94
$306,38
$344,98
$482,11
$732,61
$476,44
$512,88
$551,48
$688,61
$682,94
$719,38
$757,98
$895,11
$889,44
$925,88
$964,48
$1 101,61
$206,50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$539,88
$612,76
$689,96
$964,22
$1 465,22
$746,38
$819,26
$896,46
$1 170,72
$952,88
$1 025,76
$1 102,96
$1 377,22
$1 159,38
$1 232,26
$1 309,46
$1 583,72
$206,50
Toc - Plan #59 Kaiser Permanente
Catastrophic

(HMO) KP GA Signature Catastrophic 8550/0

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-494-5314

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
$237,25
$269,28
$303,21
$423,73
$643,90
$418,75
$450,78
$484,71
$605,23
$600,25
$632,28
$666,21
$786,73
$781,75
$813,78
$847,71
$968,23
$181,50
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$474,50
$538,56
$606,42
$847,46
$1 287,80
$656,00
$720,06
$787,92
$1 028,96
$837,50
$901,56
$969,42
$1 210,46
$1 019,00
$1 083,06
$1 150,92
$1 391,96
$181,50
Toc - Plan #60 Kaiser Permanente
Gold

(HMO) KP GA Signature Gold 1500/20

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-494-5314

Annual Out of Pocket Expenses:

Individual Family
$1,500 $3,000 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
$367,91
$417,58
$470,19
$657,08
$998,50
$649,36
$699,03
$751,64
$938,53
$930,81
$980,48
$1 033,09
$1 219,98
$1 212,26
$1 261,93
$1 314,54
$1 501,43
$281,45
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$735,82
$835,16
$940,38
$1 314,16
$1 997,00
$1 017,27
$1 116,61
$1 221,83
$1 595,61
$1 298,72
$1 398,06
$1 503,28
$1 877,06
$1 580,17
$1 679,51
$1 784,73
$2 158,51
$281,45
Toc - Plan #61 Kaiser Permanente
Silver

(HMO) KP GA Signature Silver 4500/35

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-494-5314

Annual Out of Pocket Expenses:

Individual Family
$4,500 $9,000 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
$348,57
$395,62
$445,47
$622,54
$946,01
$615,22
$662,27
$712,12
$889,19
$881,87
$928,92
$978,77
$1 155,84
$1 148,52
$1 195,57
$1 245,42
$1 422,49
$266,65
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$697,14
$791,24
$890,94
$1 245,08
$1 892,02
$963,79
$1 057,89
$1 157,59
$1 511,73
$1 230,44
$1 324,54
$1 424,24
$1 778,38
$1 497,09
$1 591,19
$1 690,89
$2 045,03
$266,65
Toc - Plan #62 Kaiser Permanente
Gold

(HMO) KP GA Signature Gold 1700/25

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-494-5314

Annual Out of Pocket Expenses:

Individual Family
$1,700 $3,400 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
$350,96
$398,34
$448,53
$626,81
$952,50
$619,44
$666,82
$717,01
$895,29
$887,92
$935,30
$985,49
$1 163,77
$1 156,40
$1 203,78
$1 253,97
$1 432,25
$268,48
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$701,92
$796,68
$897,06
$1 253,62
$1 905,00
$970,40
$1 065,16
$1 165,54
$1 522,10
$1 238,88
$1 333,64
$1 434,02
$1 790,58
$1 507,36
$1 602,12
$1 702,50
$2 059,06
$268,48

‡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 Fulton County here.

Fulton County is in “Rating Area 3” of Georgia.

Currently, there are 62 plans offered in Rating Area 3.

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2021 Obamacare Plans for Fulton County, GA

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