South Carolina Obamacare 2021 Rates

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Bright Health

Local: 1-855-521-9353 | Toll Free: 1-855-521-9353 | TTY: 1-855-521-9353

Toc - Plan #1 Bright Health
Gold

(HMO) Gold 1000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

Annual Out of Pocket Expenses:

Individual Family
$1,000 $2,000 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
$439,81
$499,19
$562,08
$785,51
$1 193,65
$776,27
$835,65
$898,54
$1 121,97
$1 112,73
$1 172,11
$1 235,00
$1 458,43
$1 449,19
$1 508,57
$1 571,46
$1 794,89
$336,46
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$879,62
$998,38
$1 124,16
$1 571,02
$2 387,30
$1 216,08
$1 334,84
$1 460,62
$1 907,48
$1 552,54
$1 671,30
$1 797,08
$2 243,94
$1 889,00
$2 007,76
$2 133,54
$2 580,40
$336,46
Toc - Plan #2 Bright Health
Silver

(HMO) Silver 5000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

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
$384,55
$436,47
$491,46
$686,81
$1 043,68
$678,73
$730,65
$785,64
$980,99
$972,91
$1 024,83
$1 079,82
$1 275,17
$1 267,09
$1 319,01
$1 374,00
$1 569,35
$294,18
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$769,10
$872,94
$982,92
$1 373,62
$2 087,36
$1 063,28
$1 167,12
$1 277,10
$1 667,80
$1 357,46
$1 461,30
$1 571,28
$1 961,98
$1 651,64
$1 755,48
$1 865,46
$2 256,16
$294,18
Toc - Plan #3 Bright Health
Silver

(HMO) Silver 3000

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$7,500 $15,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$386,17
$438,30
$493,52
$689,70
$1 048,06
$681,59
$733,72
$788,94
$985,12
$977,01
$1 029,14
$1 084,36
$1 280,54
$1 272,43
$1 324,56
$1 379,78
$1 575,96
$295,42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$772,34
$876,60
$987,04
$1 379,40
$2 096,12
$1 067,76
$1 172,02
$1 282,46
$1 674,82
$1 363,18
$1 467,44
$1 577,88
$1 970,24
$1 658,60
$1 762,86
$1 873,30
$2 265,66
$295,42
Toc - Plan #4 Bright Health
Silver

(HMO) Silver $0 Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

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
$389,42
$441,99
$497,67
$695,50
$1 056,88
$687,32
$739,89
$795,57
$993,40
$985,22
$1 037,79
$1 093,47
$1 291,30
$1 283,12
$1 335,69
$1 391,37
$1 589,20
$297,90
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$778,84
$883,98
$995,34
$1 391,00
$2 113,76
$1 076,74
$1 181,88
$1 293,24
$1 688,90
$1 374,64
$1 479,78
$1 591,14
$1 986,80
$1 672,54
$1 777,68
$1 889,04
$2 284,70
$297,90
Toc - Plan #5 Bright Health
Expanded Bronze

(HMO) Bronze 8550

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

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
$291,83
$331,22
$372,95
$521,20
$792,01
$515,08
$554,47
$596,20
$744,45
$738,33
$777,72
$819,45
$967,70
$961,58
$1 000,97
$1 042,70
$1 190,95
$223,25
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$583,66
$662,44
$745,90
$1 042,40
$1 584,02
$806,91
$885,69
$969,15
$1 265,65
$1 030,16
$1 108,94
$1 192,40
$1 488,90
$1 253,41
$1 332,19
$1 415,65
$1 712,15
$223,25
Toc - Plan #6 Bright Health
Expanded Bronze

(HMO) Bronze $0 Primary Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$300,46
$341,02
$383,99
$536,62
$815,45
$530,31
$570,87
$613,84
$766,47
$760,16
$800,72
$843,69
$996,32
$990,01
$1 030,57
$1 073,54
$1 226,17
$229,85
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$600,92
$682,04
$767,98
$1 073,24
$1 630,90
$830,77
$911,89
$997,83
$1 303,09
$1 060,62
$1 141,74
$1 227,68
$1 532,94
$1 290,47
$1 371,59
$1 457,53
$1 762,79
$229,85
Toc - Plan #7 Bright Health
Expanded Bronze

(HMO) Bronze 7000 HSA

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

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
$338,78
$384,51
$432,96
$605,06
$919,44
$597,94
$643,67
$692,12
$864,22
$857,10
$902,83
$951,28
$1 123,38
$1 116,26
$1 161,99
$1 210,44
$1 382,54
$259,16
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$677,56
$769,02
$865,92
$1 210,12
$1 838,88
$936,72
$1 028,18
$1 125,08
$1 469,28
$1 195,88
$1 287,34
$1 384,24
$1 728,44
$1 455,04
$1 546,50
$1 643,40
$1 987,60
$259,16
Toc - Plan #8 Bright Health
Catastrophic

(HMO) Catastrophic 3 $0 PCP Visits

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

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
$172,83
$196,16
$220,87
$308,67
$469,05
$305,04
$328,37
$353,08
$440,88
$437,25
$460,58
$485,29
$573,09
$569,46
$592,79
$617,50
$705,30
$132,21
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$345,66
$392,32
$441,74
$617,34
$938,10
$477,87
$524,53
$573,95
$749,55
$610,08
$656,74
$706,16
$881,76
$742,29
$788,95
$838,37
$1 013,97
$132,21
Toc - Plan #9 Bright Health
Silver

(HMO) Silver $0 Primary Care

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

Annual Out of Pocket Expenses:

Individual Family
$6,700 $13,400 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
$385,60
$437,66
$492,80
$688,69
$1 046,53
$680,59
$732,65
$787,79
$983,68
$975,58
$1 027,64
$1 082,78
$1 278,67
$1 270,57
$1 322,63
$1 377,77
$1 573,66
$294,99
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$771,20
$875,32
$985,60
$1 377,38
$2 093,06
$1 066,19
$1 170,31
$1 280,59
$1 672,37
$1 361,18
$1 465,30
$1 575,58
$1 967,36
$1 656,17
$1 760,29
$1 870,57
$2 262,35
$294,99
Toc - Plan #10 Bright Health
Expanded Bronze

(HMO) Bronze $0 Medical Deductible

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-521-9353

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
$325,39
$369,32
$415,85
$581,15
$883,12
$574,32
$618,25
$664,78
$830,08
$823,25
$867,18
$913,71
$1 079,01
$1 072,18
$1 116,11
$1 162,64
$1 327,94
$248,93
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$650,78
$738,64
$831,70
$1 162,30
$1 766,24
$899,71
$987,57
$1 080,63
$1 411,23
$1 148,64
$1 236,50
$1 329,56
$1 660,16
$1 397,57
$1 485,43
$1 578,49
$1 909,09
$248,93

ADVERTISEMENT

BlueCross BlueShield of South Carolina

Local: 1-855-404-6752 | Toll Free: 1-855-404-6752 | TTY: 1-855-889-4325

Toc - Plan #11 BlueCross BlueShield of South Carolina
Gold

(EPO) BlueEssentials Gold 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$4,500 $9,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$416,84
$473,11
$532,72
$744,48
$1 131,31
$735,72
$791,99
$851,60
$1 063,36
$1 054,60
$1 110,87
$1 170,48
$1 382,24
$1 373,48
$1 429,75
$1 489,36
$1 701,12
$318,88
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$833,68
$946,22
$1 065,44
$1 488,96
$2 262,62
$1 152,56
$1 265,10
$1 384,32
$1 807,84
$1 471,44
$1 583,98
$1 703,20
$2 126,72
$1 790,32
$1 902,86
$2 022,08
$2 445,60
$318,88
Toc - Plan #12 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$1,200 $2,400 Annual Deductible
$8,150 $16,300 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$434,66
$493,34
$555,49
$776,30
$1 179,66
$767,17
$825,85
$888,00
$1 108,81
$1 099,68
$1 158,36
$1 220,51
$1 441,32
$1 432,19
$1 490,87
$1 553,02
$1 773,83
$332,51
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$869,32
$986,68
$1 110,98
$1 552,60
$2 359,32
$1 201,83
$1 319,19
$1 443,49
$1 885,11
$1 534,34
$1 651,70
$1 776,00
$2 217,62
$1 866,85
$1 984,21
$2 108,51
$2 550,13
$332,51
Toc - Plan #13 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$3,400 $6,800 Annual Deductible
$6,600 $13,200 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
$414,11
$470,02
$529,24
$739,60
$1 123,90
$730,91
$786,82
$846,04
$1 056,40
$1 047,71
$1 103,62
$1 162,84
$1 373,20
$1 364,51
$1 420,42
$1 479,64
$1 690,00
$316,80
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$828,22
$940,04
$1 058,48
$1 479,20
$2 247,80
$1 145,02
$1 256,84
$1 375,28
$1 796,00
$1 461,82
$1 573,64
$1 692,08
$2 112,80
$1 778,62
$1 890,44
$2 008,88
$2 429,60
$316,80
Toc - Plan #14 BlueCross BlueShield of South Carolina
Expanded Bronze

(EPO) BlueEssentials Bronze 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$261,64
$296,96
$334,37
$467,28
$710,08
$461,79
$497,11
$534,52
$667,43
$661,94
$697,26
$734,67
$867,58
$862,09
$897,41
$934,82
$1 067,73
$200,15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$523,28
$593,92
$668,74
$934,56
$1 420,16
$723,43
$794,07
$868,89
$1 134,71
$923,58
$994,22
$1 069,04
$1 334,86
$1 123,73
$1 194,37
$1 269,19
$1 535,01
$200,15
Toc - Plan #15 BlueCross BlueShield of South Carolina
Bronze

(EPO) BlueEssentials Bronze 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$8,250 $16,500 Annual Deductible
$8,250 $16,500 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
$261,08
$296,33
$333,66
$466,29
$708,58
$460,81
$496,06
$533,39
$666,02
$660,54
$695,79
$733,12
$865,75
$860,27
$895,52
$932,85
$1 065,48
$199,73
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$522,16
$592,66
$667,32
$932,58
$1 417,16
$721,89
$792,39
$867,05
$1 132,31
$921,62
$992,12
$1 066,78
$1 332,04
$1 121,35
$1 191,85
$1 266,51
$1 531,77
$199,73
Toc - Plan #16 BlueCross BlueShield of South Carolina
Gold

(EPO) BlueEssentials Gold 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$2,000 $4,000 Annual Deductible
$5,600 $11,200 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$406,98
$461,93
$520,13
$726,88
$1 104,56
$718,32
$773,27
$831,47
$1 038,22
$1 029,66
$1 084,61
$1 142,81
$1 349,56
$1 341,00
$1 395,95
$1 454,15
$1 660,90
$311,34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$813,96
$923,86
$1 040,26
$1 453,76
$2 209,12
$1 125,30
$1 235,20
$1 351,60
$1 765,10
$1 436,64
$1 546,54
$1 662,94
$2 076,44
$1 747,98
$1 857,88
$1 974,28
$2 387,78
$311,34
Toc - Plan #17 BlueCross BlueShield of South Carolina
Gold

(EPO) BlueEssentials HD Gold 3

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$3,000 $6,000 Annual Deductible
$3,000 $6,000 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
$414,87
$470,88
$530,20
$740,96
$1 125,96
$732,25
$788,26
$847,58
$1 058,34
$1 049,63
$1 105,64
$1 164,96
$1 375,72
$1 367,01
$1 423,02
$1 482,34
$1 693,10
$317,38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$829,74
$941,76
$1 060,40
$1 481,92
$2 251,92
$1 147,12
$1 259,14
$1 377,78
$1 799,30
$1 464,50
$1 576,52
$1 695,16
$2 116,68
$1 781,88
$1 893,90
$2 012,54
$2 434,06
$317,38
Toc - Plan #18 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials HD Silver 6

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$4,300 $8,600 Annual Deductible
$4,300 $8,600 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
$437,66
$496,74
$559,33
$781,66
$1 187,81
$772,47
$831,55
$894,14
$1 116,47
$1 107,28
$1 166,36
$1 228,95
$1 451,28
$1 442,09
$1 501,17
$1 563,76
$1 786,09
$334,81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$875,32
$993,48
$1 118,66
$1 563,32
$2 375,62
$1 210,13
$1 328,29
$1 453,47
$1 898,13
$1 544,94
$1 663,10
$1 788,28
$2 232,94
$1 879,75
$1 997,91
$2 123,09
$2 567,75
$334,81
Toc - Plan #19 BlueCross BlueShield of South Carolina
Expanded Bronze

(EPO) BlueEssentials HD Bronze 3

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$6,300 $12,600 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
$272,96
$309,81
$348,84
$487,50
$740,81
$481,77
$518,62
$557,65
$696,31
$690,58
$727,43
$766,46
$905,12
$899,39
$936,24
$975,27
$1 113,93
$208,81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$545,92
$619,62
$697,68
$975,00
$1 481,62
$754,73
$828,43
$906,49
$1 183,81
$963,54
$1 037,24
$1 115,30
$1 392,62
$1 172,35
$1 246,05
$1 324,11
$1 601,43
$208,81
Toc - Plan #20 BlueCross BlueShield of South Carolina
Expanded Bronze

(EPO) BlueEssentials Bronze 4

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

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
$263,68
$299,27
$336,98
$470,92
$715,61
$465,39
$500,98
$538,69
$672,63
$667,10
$702,69
$740,40
$874,34
$868,81
$904,40
$942,11
$1 076,05
$201,71
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$527,36
$598,54
$673,96
$941,84
$1 431,22
$729,07
$800,25
$875,67
$1 143,55
$930,78
$1 001,96
$1 077,38
$1 345,26
$1 132,49
$1 203,67
$1 279,09
$1 546,97
$201,71
Toc - Plan #21 BlueCross BlueShield of South Carolina
Expanded Bronze

(EPO) BlueEssentials HD Bronze 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$6,850 $13,700 Annual Deductible
$6,850 $13,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$273,08
$309,95
$349,00
$487,73
$741,15
$481,99
$518,86
$557,91
$696,64
$690,90
$727,77
$766,82
$905,55
$899,81
$936,68
$975,73
$1 114,46
$208,91
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$546,16
$619,90
$698,00
$975,46
$1 482,30
$755,07
$828,81
$906,91
$1 184,37
$963,98
$1 037,72
$1 115,82
$1 393,28
$1 172,89
$1 246,63
$1 324,73
$1 602,19
$208,91
Toc - Plan #22 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 7

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$7,400 $14,800 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
$400,87
$454,98
$512,31
$715,95
$1 087,95
$707,53
$761,64
$818,97
$1 022,61
$1 014,19
$1 068,30
$1 125,63
$1 329,27
$1 320,85
$1 374,96
$1 432,29
$1 635,93
$306,66
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$801,74
$909,96
$1 024,62
$1 431,90
$2 175,90
$1 108,40
$1 216,62
$1 331,28
$1 738,56
$1 415,06
$1 523,28
$1 637,94
$2 045,22
$1 721,72
$1 829,94
$1 944,60
$2 351,88
$306,66
Toc - Plan #23 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 8

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$5,250 $10,500 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
$422,72
$479,79
$540,24
$754,99
$1 147,28
$746,10
$803,17
$863,62
$1 078,37
$1 069,48
$1 126,55
$1 187,00
$1 401,75
$1 392,86
$1 449,93
$1 510,38
$1 725,13
$323,38
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$845,44
$959,58
$1 080,48
$1 509,98
$2 294,56
$1 168,82
$1 282,96
$1 403,86
$1 833,36
$1 492,20
$1 606,34
$1 727,24
$2 156,74
$1 815,58
$1 929,72
$2 050,62
$2 480,12
$323,38
Toc - Plan #24 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 9

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$6,000 $12,000 Annual Deductible
$7,850 $15,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$419,36
$475,97
$535,94
$748,97
$1 138,13
$740,17
$796,78
$856,75
$1 069,78
$1 060,98
$1 117,59
$1 177,56
$1 390,59
$1 381,79
$1 438,40
$1 498,37
$1 711,40
$320,81
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$838,72
$951,94
$1 071,88
$1 497,94
$2 276,26
$1 159,53
$1 272,75
$1 392,69
$1 818,75
$1 480,34
$1 593,56
$1 713,50
$2 139,56
$1 801,15
$1 914,37
$2 034,31
$2 460,37
$320,81
Toc - Plan #25 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 11

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$5,500 $11,000 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
$420,94
$477,76
$537,96
$751,80
$1 142,43
$742,96
$799,78
$859,98
$1 073,82
$1 064,98
$1 121,80
$1 182,00
$1 395,84
$1 387,00
$1 443,82
$1 504,02
$1 717,86
$322,02
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$841,88
$955,52
$1 075,92
$1 503,60
$2 284,86
$1 163,90
$1 277,54
$1 397,94
$1 825,62
$1 485,92
$1 599,56
$1 719,96
$2 147,64
$1 807,94
$1 921,58
$2 041,98
$2 469,66
$322,02
Toc - Plan #26 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 12

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$4,800 $9,600 Annual Deductible
$7,350 $14,700 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$427,49
$485,20
$546,34
$763,50
$1 160,21
$754,52
$812,23
$873,37
$1 090,53
$1 081,55
$1 139,26
$1 200,40
$1 417,56
$1 408,58
$1 466,29
$1 527,43
$1 744,59
$327,03
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$854,98
$970,40
$1 092,68
$1 527,00
$2 320,42
$1 182,01
$1 297,43
$1 419,71
$1 854,03
$1 509,04
$1 624,46
$1 746,74
$2 181,06
$1 836,07
$1 951,49
$2 073,77
$2 508,09
$327,03
Toc - Plan #27 BlueCross BlueShield of South Carolina
Gold

(EPO) BlueEssentials Gold 4

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$2,500 $5,000 Annual Deductible
$5,500 $11,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$407,05
$462,01
$520,21
$727,00
$1 104,74
$718,45
$773,41
$831,61
$1 038,40
$1 029,85
$1 084,81
$1 143,01
$1 349,80
$1 341,25
$1 396,21
$1 454,41
$1 661,20
$311,40
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$814,10
$924,02
$1 040,42
$1 454,00
$2 209,48
$1 125,50
$1 235,42
$1 351,82
$1 765,40
$1 436,90
$1 546,82
$1 663,22
$2 076,80
$1 748,30
$1 858,22
$1 974,62
$2 388,20
$311,40
Toc - Plan #28 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials HD Silver 13

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$5,750 $11,500 Annual Deductible
$5,750 $11,500 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$412,76
$468,49
$527,51
$737,19
$1 120,24
$728,52
$784,25
$843,27
$1 052,95
$1 044,28
$1 100,01
$1 159,03
$1 368,71
$1 360,04
$1 415,77
$1 474,79
$1 684,47
$315,76
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$825,52
$936,98
$1 055,02
$1 474,38
$2 240,48
$1 141,28
$1 252,74
$1 370,78
$1 790,14
$1 457,04
$1 568,50
$1 686,54
$2 105,90
$1 772,80
$1 884,26
$2 002,30
$2 421,66
$315,76
Toc - Plan #29 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueEssentials Silver 14

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$7,000 $14,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$399,17
$453,06
$510,14
$712,91
$1 083,34
$704,53
$758,42
$815,50
$1 018,27
$1 009,89
$1 063,78
$1 120,86
$1 323,63
$1 315,25
$1 369,14
$1 426,22
$1 628,99
$305,36
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$798,34
$906,12
$1 020,28
$1 425,82
$2 166,68
$1 103,70
$1 211,48
$1 325,64
$1 731,18
$1 409,06
$1 516,84
$1 631,00
$2 036,54
$1 714,42
$1 822,20
$1 936,36
$2 341,90
$305,36
Toc - Plan #30 BlueCross BlueShield of South Carolina
Catastrophic

(EPO) BlueEssentials Catastrophic 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

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
$173,47
$196,89
$221,69
$309,82
$470,80
$306,17
$329,59
$354,39
$442,52
$438,87
$462,29
$487,09
$575,22
$571,57
$594,99
$619,79
$707,92
$132,70
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$346,94
$393,78
$443,38
$619,64
$941,60
$479,64
$526,48
$576,08
$752,34
$612,34
$659,18
$708,78
$885,04
$745,04
$791,88
$841,48
$1 017,74
$132,70
Toc - Plan #31 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueExclusive Reedy Silver 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$7,550 $15,100 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
$381,52
$433,02
$487,58
$681,39
$1 035,43
$673,38
$724,88
$779,44
$973,25
$965,24
$1 016,74
$1 071,30
$1 265,11
$1 257,10
$1 308,60
$1 363,16
$1 556,97
$291,86
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$763,04
$866,04
$975,16
$1 362,78
$2 070,86
$1 054,90
$1 157,90
$1 267,02
$1 654,64
$1 346,76
$1 449,76
$1 558,88
$1 946,50
$1 638,62
$1 741,62
$1 850,74
$2 238,36
$291,86
Toc - Plan #32 BlueCross BlueShield of South Carolina
Silver

(EPO) BlueExclusive Reedy Silver 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$7,900 $15,800 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
$379,35
$430,56
$484,81
$677,52
$1 029,56
$669,55
$720,76
$775,01
$967,72
$959,75
$1 010,96
$1 065,21
$1 257,92
$1 249,95
$1 301,16
$1 355,41
$1 548,12
$290,20
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$758,70
$861,12
$969,62
$1 355,04
$2 059,12
$1 048,90
$1 151,32
$1 259,82
$1 645,24
$1 339,10
$1 441,52
$1 550,02
$1 935,44
$1 629,30
$1 731,72
$1 840,22
$2 225,64
$290,20
Toc - Plan #33 BlueCross BlueShield of South Carolina
Expanded Bronze

(EPO) BlueExclusive Reedy Bronze 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-855-404-6752

Annual Out of Pocket Expenses:

Individual Family
$7,900 $15,800 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
$250,81
$284,67
$320,53
$447,95
$680,70
$442,68
$476,54
$512,40
$639,82
$634,55
$668,41
$704,27
$831,69
$826,42
$860,28
$896,14
$1 023,56
$191,87
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$501,62
$569,34
$641,06
$895,90
$1 361,40
$693,49
$761,21
$832,93
$1 087,77
$885,36
$953,08
$1 024,80
$1 279,64
$1 077,23
$1 144,95
$1 216,67
$1 471,51
$191,87

ADVERTISEMENT

Molina Healthcare

Local: 1-855-885-3176 | Toll Free: 1-800-659-8331 | TTY: 1-800-659-8331

Toc - Plan #34 Molina Healthcare
Gold

(HMO) Confident Care Gold 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

Annual Out of Pocket Expenses:

Individual Family
$2,925 $5,850 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$376,96
$427,84
$481,75
$673,24
$1 023,06
$665,33
$716,21
$770,12
$961,61
$953,70
$1 004,58
$1 058,49
$1 249,98
$1 242,07
$1 292,95
$1 346,86
$1 538,35
$288,37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$753,92
$855,68
$963,50
$1 346,48
$2 046,12
$1 042,29
$1 144,05
$1 251,87
$1 634,85
$1 330,66
$1 432,42
$1 540,24
$1 923,22
$1 619,03
$1 720,79
$1 828,61
$2 211,59
$288,37
Toc - Plan #35 Molina Healthcare
Silver

(HMO) Constant Care Silver 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$340,26
$386,19
$434,85
$607,70
$923,45
$600,56
$646,49
$695,15
$868,00
$860,86
$906,79
$955,45
$1 128,30
$1 121,16
$1 167,09
$1 215,75
$1 388,60
$260,30
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$680,52
$772,38
$869,70
$1 215,40
$1 846,90
$940,82
$1 032,68
$1 130,00
$1 475,70
$1 201,12
$1 292,98
$1 390,30
$1 736,00
$1 461,42
$1 553,28
$1 650,60
$1 996,30
$260,30
Toc - Plan #36 Molina Healthcare
Bronze

(HMO) Core Care Bronze 1

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

Annual Out of Pocket Expenses:

Individual Family
$6,100 $12,200 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$245,95
$279,16
$314,33
$439,27
$667,51
$434,10
$467,31
$502,48
$627,42
$622,25
$655,46
$690,63
$815,57
$810,40
$843,61
$878,78
$1 003,72
$188,15
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$491,90
$558,32
$628,66
$878,54
$1 335,02
$680,05
$746,47
$816,81
$1 066,69
$868,20
$934,62
$1 004,96
$1 254,84
$1 056,35
$1 122,77
$1 193,11
$1 442,99
$188,15
Toc - Plan #37 Molina Healthcare
Silver

(HMO) Constant Care Silver 4

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

Annual Out of Pocket Expenses:

Individual Family
$7,450 $14,900 Annual Deductible
$7,450 $14,900 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$336,39
$381,80
$429,91
$600,79
$912,96
$593,73
$639,14
$687,25
$858,13
$851,07
$896,48
$944,59
$1 115,47
$1 108,41
$1 153,82
$1 201,93
$1 372,81
$257,34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$672,78
$763,60
$859,82
$1 201,58
$1 825,92
$930,12
$1 020,94
$1 117,16
$1 458,92
$1 187,46
$1 278,28
$1 374,50
$1 716,26
$1 444,80
$1 535,62
$1 631,84
$1 973,60
$257,34
Toc - Plan #38 Molina Healthcare
Expanded Bronze

(HMO) Core Care Bronze 4

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

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
$257,14
$291,86
$328,63
$459,26
$697,89
$453,86
$488,58
$525,35
$655,98
$650,58
$685,30
$722,07
$852,70
$847,30
$882,02
$918,79
$1 049,42
$196,72
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$514,28
$583,72
$657,26
$918,52
$1 395,78
$711,00
$780,44
$853,98
$1 115,24
$907,72
$977,16
$1 050,70
$1 311,96
$1 104,44
$1 173,88
$1 247,42
$1 508,68
$196,72
Toc - Plan #39 Molina Healthcare
Expanded Bronze

(HMO) Core Care Bronze 5

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

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
$250,15
$283,92
$319,69
$446,77
$678,91
$441,52
$475,29
$511,06
$638,14
$632,89
$666,66
$702,43
$829,51
$824,26
$858,03
$893,80
$1 020,88
$191,37
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$500,30
$567,84
$639,38
$893,54
$1 357,82
$691,67
$759,21
$830,75
$1 084,91
$883,04
$950,58
$1 022,12
$1 276,28
$1 074,41
$1 141,95
$1 213,49
$1 467,65
$191,37
Toc - Plan #40 Molina Healthcare
Gold

(HMO) Confident Care Gold 1 + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

Annual Out of Pocket Expenses:

Individual Family
$2,925 $5,850 Annual Deductible
$6,500 $13,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$380,13
$431,45
$485,81
$678,92
$1 031,68
$670,93
$722,25
$776,61
$969,72
$961,73
$1 013,05
$1 067,41
$1 260,52
$1 252,53
$1 303,85
$1 358,21
$1 551,32
$290,80
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$760,26
$862,90
$971,62
$1 357,84
$2 063,36
$1 051,06
$1 153,70
$1 262,42
$1 648,64
$1 341,86
$1 444,50
$1 553,22
$1 939,44
$1 632,66
$1 735,30
$1 844,02
$2 230,24
$290,80
Toc - Plan #41 Molina Healthcare
Silver

(HMO) Constant Care Silver 1 + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

Annual Out of Pocket Expenses:

Individual Family
$0 $0 Annual Deductible
$8,500 $17,000 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$343,46
$389,83
$438,94
$613,42
$932,15
$606,21
$652,58
$701,69
$876,17
$868,96
$915,33
$964,44
$1 138,92
$1 131,71
$1 178,08
$1 227,19
$1 401,67
$262,75
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$686,92
$779,66
$877,88
$1 226,84
$1 864,30
$949,67
$1 042,41
$1 140,63
$1 489,59
$1 212,42
$1 305,16
$1 403,38
$1 752,34
$1 475,17
$1 567,91
$1 666,13
$2 015,09
$262,75
Toc - Plan #42 Molina Healthcare
Bronze

(HMO) Core Care Bronze 1 + Vision

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

Annual Out of Pocket Expenses:

Individual Family
$6,100 $12,200 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$248,92
$282,53
$318,12
$444,57
$675,57
$439,34
$472,95
$508,54
$634,99
$629,76
$663,37
$698,96
$825,41
$820,18
$853,79
$889,38
$1 015,83
$190,42
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$497,84
$565,06
$636,24
$889,14
$1 351,14
$688,26
$755,48
$826,66
$1 079,56
$878,68
$945,90
$1 017,08
$1 269,98
$1 069,10
$1 136,32
$1 207,50
$1 460,40
$190,42
Toc - Plan #43 Molina Healthcare
Silver

(HMO) Constant Care Silver 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

Annual Out of Pocket Expenses:

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

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$340,05
$385,96
$434,59
$607,33
$922,90
$600,19
$646,10
$694,73
$867,47
$860,33
$906,24
$954,87
$1 127,61
$1 120,47
$1 166,38
$1 215,01
$1 387,75
$260,14
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$680,10
$771,92
$869,18
$1 214,66
$1 845,80
$940,24
$1 032,06
$1 129,32
$1 474,80
$1 200,38
$1 292,20
$1 389,46
$1 734,94
$1 460,52
$1 552,34
$1 649,60
$1 995,08
$260,14
Toc - Plan #44 Molina Healthcare
Bronze

(HMO) Core Care Bronze 2

Benefits & Coverage Plan Brochure Provider Directory
Customer Service Phone: 1-800-659-8331

Annual Out of Pocket Expenses:

Individual Family
$8,000 $16,000 Annual Deductible
$8,550 $17,100 Maximum Out of Pocket Per Year

Monthly Premiums:

[show premiums]
Age Individual
Individual
1 Child
Individual
2 Children
Individual
3+ Children
Child
0-14
21
30
40
50
60
$243,58
$276,46
$311,29
$435,03
$661,07
$429,92
$462,80
$497,63
$621,37
$616,26
$649,14
$683,97
$807,71
$802,60
$835,48
$870,31
$994,05
$186,34
Age Couple
Couple
1 Child
Couple
2 Chidren
Couple
3+ Children
Child
0-14
21
30
40
50
60
$487,16
$552,92
$622,58
$870,06
$1 322,14
$673,50
$739,26
$808,92
$1 056,40
$859,84
$925,60
$995,26
$1 242,74
$1 046,18
$1 111,94
$1 181,60
$1 429,08
$186,34

‡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 Greenville County here.

Greenville County is in “Rating Area 23” of South Carolina.

Currently, there are 44 plans offered in Rating Area 23.

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2021 Obamacare Plans for Greenville County, SC

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