Individual & Family
| # | The Cheapest Plan Bronze 60 PPO |
The Most Popular Plan Silver 1750 PPO |
The Most Value Added Plan Gold 80 PPO |
The Most Expensive Plan Platinum 90 PPO |
|---|---|---|---|---|
| Best for | Young & Healthy Applicants who are age 30 and below | Frequent doctor visits and taking prescription drugs | Frequent doctor visits and taking prescription drugs | Major illness, Pregnant, Newborn Children |
| Annual Deductible | $6,300 Single $12,600 Family |
$1,750 Single $3,500 Family |
$0 Single $0 Family |
$0 Single $0 Family |
| Annual Out of Pocket Maximum | $8,200 Single $16,400 Family |
$8,200 Single $16,400 Family |
$8,200 Single $16,400 Family |
$4,500 Single $9,000 Family |
| Doctor Visit Copay (Family\ Internal) |
$65 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $40 per visit | $35 per visit | $15 per visit |
| Doctor Visit Copay (Specialist) |
$95 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $75 per visit | $65 per visit | $30 per visit |
| Urgent Care Visit Copay | $65 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $40 per visit | $35 per visit | $15 per visit |
| Preventive Care | $0 (Once Per Year) | $0 (Once Per Year) | $0 (Once Per Year) | $0 (Once Per Year) |
| Laboratory fee Copay | $40 per visit | $40 per visit | $40 per visit | $15 per visit |
| Inpatient Fee | 40% after the annual deductible | 35% after the annual deductible | 20% | 10% |
| Outpatient Fee | 40% after the annual deductible | 35% after the annual deductible | 20% | 10% |
| Prescription Drug Fee | $18/40% after the $500 drug deductible | $15/$60/$80/35% after $300 drug deductible | $15/$55/$80/20% | $5/$15/$25/10% |
| Lifetime Maximum | Unlimited | Unlimited | Unlimited | Unlimited |
| Acupuncture Visit Copay | $65 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $40 per visit | $35 per visit | $15 per visit |
| Emergency Room Visit Copay | 40% after the annual deductible | 35% after the annual deductible | $350 per visit | $150 per visit |
| Ambulance | 40% after the annual deductible | 35% after the annual deductible | $250 per trip | $150 per trip |
| Maternity Benefit (Inpatient) |
40% after the annual deductible | 35% after the annual deductible | 20% | 10% |
| Maternity Benefit （Maternity Benefit） |
40% after the annual deductible | 35% after the annual deductible | 20% | 10% |
| X Ray/Ultrasound | 40% after the annual deductible | 35% after the annual deductible | $75 per visit | $30 per visit |
| CT Scan/MRI Imaging | 40% after the annual deductible | 35% after the annual deductible | 20% | 10% |
| Dental Insurance | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan |
| Vision Insurance | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan |
| Summary of Benefits(SBC) |
| # | The Cheapest Plan Minimum Coverage Ambetter PPO |
The Most Popular Plan Bronze 60 Ambetter PPO |
The Most Value Added Plan Silver Value Ambetter PPO |
The Most Expensive Plan Platinum 90 Ambetter PPO |
|---|---|---|---|---|
| Best for | Young & Healthy Applicants who are age 30 and below | Limited Budget, favorable to hospital benefits | Frequent doctor visits and taking prescription drugs | Major illness, Pregnant, Newborn Children |
| Annual Deductible | $8,700 Single $17,400 Family |
$6,300 Single $12,600 Family |
$5,000 Single $10,000 Family |
$0 Single $0 Family |
| Annual Out of Pocket Maximum | $8,700 Single $17,400 Family |
$8,200 Single $16,400 Family |
$8,500 Single $17,000 Family |
$4,500 Single $9,000 Family |
| Doctor Visit Copay (Family\ Internal) |
$0 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $65 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $45 per visit | $15 per visit |
| Doctor Visit Copay (Specialist) |
$0 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $95 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $60 per visit | $30 per visit |
| Urgent Care Visit Copay | $0 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $65 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $45 per visit | $15 per visit |
| Preventive Care | $0 (Once Per Year) | $0 (Once Per Year) | $0 (Once Per Year) | $0 (Once Per Year) |
| Laboratory fee Copay | $0 after the annual deductible | $40 per visit | $35 per visit | $15 per visit |
| Inpatient Fee | 0% after the annual deductible | 40% after the annual deductible | 30% after the annual deductible | 10% |
| Outpatient Fee | 0% after the annual deductible | 40% after the annual deductible | 30% after the annual deductible | 10% |
| Prescription Drug Fee | 0% after the annual deductible | $18/40% after $500 drug deductible | $15/$55/$85/30% after $500 drug deductible | $5/$15/$25/10% |
| Lifetime Maximum | Unlimited | Unlimited | Unlimited | Unlimited |
| Acupuncture Visit Copay | $0 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $65 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $45 per visit | $15 per visit |
| Emergency Room Visit Copay | 0% after the annual deductible | 40% after the annual deductible | $400 per visit after the annual deductible | $150 per visit |
| Ambulance | 0% after the annual deductible | 40% after the annual deductible | $250 per trip after the annual deductible | $150 per trip |
| Maternity Benefit (Inpatient) |
0% after the annual deductible | 40% after the annual deductible | 30% after the annual deductible | 10% |
| Maternity Benefit （Maternity Benefit） |
0% after the annual deductible | 40% after the annual deductible | 30% after the annual deductible | 10% |
| X Ray/Ultrasound | 0% after the annual deductible | 40% after the annual deductible | $70 per visit | $30 per visit |
| CT Scan/MRI Imaging | 0% after the annual deductible | 40% after the annual deductible | $300 after the annual deductible | 10% |
| Dental Insurance | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan |
| Vision Insurance | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan |
| Summary of Benefits(SBC) |
| # | The Cheapest Plan Bronze 60 HMO |
The Most Popular Plan Silver 70 HMO 2500/45 |
The Most Value Added Plan Gold 80 HMO |
The Most Expensive Plan Platinum 90 HMO | ,
|---|---|---|---|---|
| Best for | Limited Budget, favorable to hospital benefits | Frequent doctor visits and taking prescription drugs | Frequent doctor visits and taking prescription drugs | Major illness, Pregnant, Newborn Children |
| Annual Deductible | $6,300 Single $12,600 Family |
$2,500 Single $5,000 Family |
$0 Single $0 Family |
$0 Single $0 Family |
| Annual Out of Pocket Maximum | $8,200 Single $16,400 Family |
$8,200 Single $16,400 Family |
$8,200 Single $16,400 Family |
$4,500 Single $9,000 Family |
| Doctor Visit Copay (Family\ Internal) |
$65 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $45 per visit | $35 per visit | $15 per visit |
| Doctor Visit Copay (Specialist) |
$95 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $75 per visit | $65 per visit | $30 per visit |
| Urgent Care Visit Copay | $65 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $45 per visit | $35 per visit | $15 per visit |
| Preventive Care | $0 (Once Per Year) | $0 (Once Per Year) | $0 (Once Per Year) | $0 (Once Per Year) |
| Laboratory fee Copay | $40 per visit | $25 per visit after the annual deductible | $40 per visit | $15 per visit |
| Inpatient Fee | 40% after the annual deductible | 35% after the annual deductible | $600 Copay per day up to 5 days | $250 Copay per day up to 5 days |
| Outpatient Fee | 40% after the annual deductible | 35% after the annual deductible | $340/surgery | $125/surgery |
| Prescription Drug Fee | $18/40% after $500 drug deductible | $20(deductible waived)/$65/$65/35% after $350 drug deductible | $15/$55/$55/20% up to $250 per prescription | $5/$15/$15/10% up to $250 per prescription |
| Lifetime Maximum | Unlimited | Unlimited | Unlimited | Unlimited |
| Acupuncture Visit Copay | $65 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $45 per visit | $35 per visit | $15 per visit |
| Emergency Room Visit Copay | 40% after the annual deductible | $350 per visit after the annual deductible | $350 per visit | $150 per visit |
| Ambulance | 40% after the annual deductible | $250 per trip after the annual deductible | $250 per trip | $150 per trip |
| Maternity Benefit (Inpatient) |
40% after the annual deductible | 35% after the annual deductible | $600 Copay per day up to 5 days | $250 Copay per day up to 5 days |
| Maternity Benefit （Maternity Benefit） |
40% after the annual deductible | 35% after the annual deductible | $340/surgery | $125/surgery |
| X Ray/Ultrasound | 40% after the annual deductible | $70 per visit after the annual deductible | $75 per visit | $30 per visit |
| CT Scan/MRI Imaging | 40% after the annual deductible | $350 after the annual deductible | $150 per visit | $75 per visit |
| Dental Insurance | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan |
| Vision Insurance | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan |
| Summary of Benefits(SBC) |
| # | The Cheapest Plan Bronze 60 EPO |
The Most Popular Plan Silver 70 EPO Off Exchange |
The Most Value Added Plan Gold 80 EPO |
The Most Expensive Plan Platinum 90 EPO |
|---|---|---|---|---|
| Best for | Limited Budget, favorable to hospital benefits | Frequent doctor visits and taking prescription drugs | Frequent doctor visits and taking prescription drugs | Major illness, Pregnant, Newborn Children |
| Annual Deductible | $6,300 Single $12,600 Family |
$3,700 Single $7,400 Family |
$0 Single $0 Family |
$0 Single $0 Family |
| Annual Out of Pocket Maximum | $8,200 Single $16,400 Family |
$8,200 Single $16,400 Family |
$8,200 Single $16,400 Family |
$4,500 Single $9,000 Family |
| Doctor Visit Copay (Family\ Internal) |
$65 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $35 per visit | $35 per visit | $15 per visit |
| Doctor Visit Copay (Specialist) |
$95 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $70 per visit | $65 per visit | $30 per visit |
| Urgent Care Visit Copay | $65 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $35 per visit | $35 per visit | $15 per visit |
| Preventive Care | $0 (Once Per Year) | $0 (Once Per Year) | $0 (Once Per Year) | $0 (Once Per Year) |
| Laboratory fee Copay | $40 per visit | $40 per visit | $40 per visit | $15 per visit |
| Inpatient Fee | 40% after the annual deductible | 20% after the annual deductible | $600 Copay per day up to 5 days | $250 Copay per day up to 5 days |
| Outpatient Fee | 40% after the annual deductible | 20% | $300 per surgery | $100 per surgery |
| Prescription Drug Fee | $18/40% after $500 drug deductible | $15/$55/$85/20% after $10 drug deductible | $15/$55/$80/20% | $5/$15/$25/10% |
| Lifetime Maximum | Unlimited | Unlimited | Unlimited | Unlimited |
| Acupuncture Visit Copay | $65 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $35 per visit | $35 per visit | $15 per visit |
| Emergency Room Visit Copay | 40% after the annual deductible | $400 per visit | $350 per visit | $150 per visit |
| Ambulance | 40% after the annual deductible | $255 per trip | $250 per trip | $150 per trip |
| Maternity Benefit (Inpatient) |
40% after the annual deductible | 20% after the annual deductible | $600 Copay per day up to 5 days | $250 Copay per day up to 5 days |
| Maternity Benefit （Maternity Benefit） |
40% after the annual deductible | 20% | $300 per surgery | $100 per surgery |
| X Ray/Ultrasound | 40% after the annual deductible | $85 per visit | $75 per visit | $30 per visit |
| CT Scan/MRI Imaging | 40% after the annual deductible | $325 per visit | $150 per visit | $75 per visit |
| Dental Insurance | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan |
| Vision Insurance | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan |
| Summary of Benefits(SBC) |
| # | The Cheapest Plan Bronze 60 D HMO |
The Most Popular Plan Silver 70 Off-Exchange HMO |
The Most Value Added Plan Gold 80 D HMO |
The Most Expensive Plan Platinum 90 D HMO |
|---|---|---|---|---|
| Best for | Limited Budget, favorable to hospital benefits | Frequent doctor visits and taking prescription drugs | Frequent doctor visits and taking prescription drugs | Major illness, Pregnant, Newborn Children |
| Annual Deductible | $6,300 Single $12,600 Family |
$3,700 Single $7,400 Family |
$0 Single $0 Family |
$0 Single $0 Family |
| Annual Out of Pocket Maximum | $8,200 Single $16,400 Family |
$8,200 Single $16,400 Family |
$8,200 Single $16,400 Family |
$4,500 Single $9,000 Family |
| Doctor Visit Copay (Family\ Internal) |
$65 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $35 per visit | $35 per visit | $15 per visit |
| Doctor Visit Copay (Specialist) |
$95 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $70 per visit | $65 per visit | $30 per visit |
| Urgent Care Visit Copay | $65 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $35 per visit | $35 per visit | $15 per visit |
| Preventive Care | $0 (Once Per Year) | $0 (Once Per Year) | $0 (Once Per Year) | $0 (Once Per Year) |
| Laboratory fee Copay | $40 per visit | $40 per visit | $40 per visit | $15 per visit |
| Inpatient Fee | 40% after the annual deductible | 20% after the annual deductible | $600 Copay per day up to 5 days | $250 Copay per day up to 5 days |
| Outpatient Fee | 40% after the annual deductible | 20% after the annual deductible | $300/surgery | $100/surgery |
| Prescription Drug Fee | $18/40% after $500 drug deductible | $15/$55/$85/20% after the $10 drug deductible | $15/$55/$80/20% | $5/$15/$25/10% |
| Lifetime Maximum | Unlimited | Unlimited | Unlimited | Unlimited |
| Acupuncture Visit Copay | $65 per visit (1st 3 visits not subject to annual deductible，then subject to the deductible after that) | $35 per visit | $35 per visit | $15 per visit |
| Emergency Room Visit Copay | 40% after the annual deductible | $400 per visit | $350 per visit | $150 per visit |
| Ambulance | 40% after the annual deductible | $255 per trip | $250 per trip | $150 per trip |
| Maternity Benefit (Inpatient) |
40% after the annual deductible | 20% after the annual deductible | $600 Copay per day up to 5 days | $250 Copay per day up to 5 days |
| Maternity Benefit （Maternity Benefit） |
40% after the annual deductible | 20% after the annual deductible | $300/surgery | $100/surgery |
| X Ray/Ultrasound | 40% after the annual deductible | $85 per visit | $75 per visit | $30 per visit |
| CT Scan/MRI Imaging | 40% after the annual deductible | $325 per visit | $150 per visit | $75 per visit |
| Dental Insurance | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan |
| Vision Insurance | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan |
| Summary of Benefits(SBC) |
| # | Premium Assistance Plan Silver 73 HMO |
Premium Assistance Plan Silver 87 HMO |
Premium Assistance Plan Silver 94 HMO |
|
|---|---|---|---|---|
| Best for | Must qualify the income guidelines | Must qualify the income guidelines | Must qualify the income guidelines | |
| Annual Deductible | $3,700 Single $7,400 Family |
$800 Single $1,600 Family |
$75 Single $150 Family |
|
| Annual Out of Pocket Maximum | $6,300 Single $12,600 Family |
$2,850 Single $5,700 Family |
$800 Single $1,600 Family |
|
| Doctor Visit Copay (Family\ Internal) |
$35 per visit | $15 per visit | $5 per visit | |
| Doctor Visit Copay (Specialist) |
$70 per visit | $25 per visit | $8 per visit | |
| Urgent Care Visit Copay | $35 per visit | $15 per visit | $5 per visit | |
| Preventive Care | $0 (Once Per Year) | $0 (Once Per Year) | $0 (Once Per Year) | |
| Laboratory fee Copay | $40 per visit | $20 per visit | $8 per visit | |
| Inpatient Fee | 20% after the annual deductible | 15% after the annual deductible | 10% after the annual deductible | |
| Outpatient Fee | 20% | 15% | 10% | |
| Prescription Drug Fee | $15/$55/$85/20% after $10 drug deductible | $5/$25/$45/15% | $3/$10/$15/10% | |
| Lifetime Maximum | Unlimited | Unlimited | Unlimited | |
| Acupuncture Visit Copay | $35 per visit | $15 per visit | $5 per visit | |
| Emergency Room Visit Copay | $400 per visit | $150 per visit | $50 per visit | |
| Ambulance | $250 per trip | $75 per trip | $30 per trip | |
| Maternity Benefit (Inpatient) |
20% after the annual deductible | 15% after the annual deductible | 10% after the annual deductible | |
| Maternity Benefit (Outpatient) |
20% | 15% | 10% | |
| X Ray/Ultrasound | $85 per visit | $40 per visit | $8 per visit | |
| CT Scan/MRI Imaging | $325 per visit | $100 per visit | $50 per visit | |
| Dental Insurance | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding dental Plan | |
| Vision Insurance | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | Available free to applicants who are age 18 and below; Applicants who are age 19 and above may pay additional fee for adding vision Plan | |
| Summary of Benefits(SBC) |
