The amounts shown are what the member pays
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| Plan Type – All HMO | Ambetter Essential Care 1 | Ambetter Essential Care 2 HSA | BlueCross Pathway X Guided 37TC | BlueCross Pathway X Guided HSA 37TO | Kaiser HSA 6,200/40% |
| Plan Name | Ambetter Essential Care 1 | Ambetter Essential Care 2 HSA | BlueCross 37TC | BlueCross HSA 37TO | Kaiser 6,200/40% |
| Metal Level | Bronze | Bronze HSA | Bronze | Bronze HSA | Bronze HSA |
| Preventive Care government list |
100% Coverage – Member pays Nothing; List of Covered Services | ||||
| Deductible Individual / Family |
$7,900 / $15,800 | $6550/$13100 | $6,750 / $13,500 | $6,700 / $13,400 | $6,200 / $12,40000 |
| Coinsurance | Deductibe then 0% | Deductibe then 0% | Deductibe then 40% | Deductible then 0% | Deductible then 40% |
| Maximum Out of Pocket Individual / Family |
$7,900 / $15,800 | $6,550 / $13,100 | $7,900 / $15,800 | $6,700 / $13,400 | $6,550 / $13,100 |
| Dr Office Copay PCP/Specialist/UrgentCare | Deductible then 0% | Deductible then 0% | Deductible then 40% | Deductible then 0% | Deductible then 40% |
| All Lab / X-rays & Imaging | Deductible then 0% | Deductible then 0% | Deductible then $500 / 40% | Deductible then 0% | Deductible then 40% |
| Emergency Room | Deductible then 0% | Deductible then 0% | Deductible then $500 / 40% | Deductible then 0% | Deductible then 40% |
| Inpatient / Outpatient Hospital & Surgery |
Deductible then 0% | Deductible then 0% | Deductible then $500 / 40% | Deductible then 0% | Deductible then 40% |
| Rx Deductible | Tier 1 No Ded; Tier 2,3, 4 Med Ded | Medical Deductible | Medical Deductible | Medical Deductible | Medical Deductible |
| Rx Copays | $20 / Med Deductible then 0% | Medical Deductible then 0% | Med Deductible then 25%/35%/45%/45% | Medical Deductible then 0% | Medical Deductible then 50% |
| Benefits shown are for services at In-Network Providers. There is No Coverage for Out of Network Providers, except for Emergencies | ||||
| Rates shown for Ambetter & BlueCross residents of counties: Cherokee, Cobb, Dekalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, & Henry | ||||
| Rates shown for Kaiser residents of counties: Clayton, Cobb, DeKalb, Fulton, Gwinnett and Henry – Other Kaiser counties are 10% higher | ||||
| For rates in other counties please use the “Online Quotes” link on the 2019 Recommended Plans page | ||||
| Rates shown are for non-tobacco users, within + / – $5; regular tobacco user rates will be approx. 15% higher. Regular use = 4 or more times per week on average in the last 6 week on average in the last 6 months. | ||||
| Please see plan brochure for a complete listing of benefit details, plan limitations and exclusions. |
Add the rate for the age of each family member to be insured. There is no family discount.
| Ambetter Essential Care 1 | Ambetter Essential Care 2 HSA | BlueCross 37TC | BlueCross HSA 37TO | Kaiser HSA 6,200/40% | |
| Per Child Age 0-14 | $237 | $245 | $188 | $194 | $252 |
| Age 15 | $259 | $268 | $206 | $212 | $275 |
| Age 16 | $267 | $276 | $212 | $218 | $284 |
| Age 17 | $275 | $284 | $218 | $225 | $292 |
| Age 18 | $283 | $293 | $225 | $232 | $301 |
| Age 19 | $292 | $302 | $232 | $239 | $310 |
| Age 20 | $301 | $311 | $239 | $246 | $320 |
| Age 21-24 | $310 | $321 | $246 | $254 | $330 |
| Age 25 | $311 | $322 | $247 | $254 | $330 |
| Age 26 | $317 | $328 | $252 | $260 | $337 |
| Age 27 | $325 | $337 | $259 | $266 | $346 |
| Age 28 | $337 | $349 | $268 | $276 | $358 |
| Age 29 | $347 | $359 | $276 | $284 | $369 |
| Age 30 | $353 | $365 | $280 | $289 | $375 |
| Age 31 | $359 | $372 | $286 | $294 | $382 |
| Age 32 | $367 | $379 | $292 | $300 | $390 |
| Age 33 | $371 | $384 | $295 | $304 | $395 |
| Ambetter Essential Care 1 | Ambetter Essential Care 2 HSA | BlueCross 37TC | BlueCross HSA 37TO | Kaiser HSA 6,200/40% | |
| Age 34 | $377 | $390 | $299 | $308 | $400 |
| Age 35 | $379 | $393 | $302 | $310 | $403 |
| Age 36 | $381 | $394 | $303 | $312 | $405 |
| Age 37 | $384 | $397 | $305 | $314 | $408 |
| Age 38 | $387 | $400 | $307 | $316 | $411 |
| Age 39 | $391 | $405 | $311 | $320 | $416 |
| Age 40 | $396 | $410 | $315 | $324 | $421 |
| Age 41 | $404 | $418 | $321 | $330 | $429 |
| Age 42 | $411 | $425 | $327 | $336 | $437 |
| Age 43 | $421 | $435 | $335 | $344 | $447 |
| Age 44 | $433 | $448 | $345 | $355 | $461 |
| Age 45 | $448 | $463 | $356 | $366 | $476 |
| Age 46 | $465 | $481 | $370 | $380 | $494 |
| Age 47 | $485 | $502 | $385 | $397 | $515 |
| Age 48 | $507 | $525 | $403 | $415 | $539 |
| Age 49 | $529 | $547 | $420 | $433 | $562 |
| Age 50 | $554 | $573 | $441 | $453 | $589 |
| Age 51 | $578 | $599 | $460 | $473 | $615 |
| Age 52 | $605 | $627 | $481 | $495 | $644 |
| Age 53 | $632 | $655 | $503 | $518 | $672 |
| Ambetter Essential Care 1 | Ambetter Essential Care 2 HSA | BlueCross 37TC | BlueCross HSA 37TO | Kaiser HSA 6,200/40% | |
| Age 54 | $662 | $685 | $527 | $542 | $704 |
| Age 55 | $691 | $715 | $549 | $566 | $735 |
| Age 56 | $723 | $749 | $575 | $592 | $769 |
| Age 57 | $756 | $782 | $601 | $619 | $804 |
| Age 58 | $790 | $818 | $628 | $647 | $840 |
| Age 59 | $807 | $835 | $642 | $661 | $858 |
| Age 60 | $841 | $871 | $669 | $689 | $895 |
| Age 61 | $871 | $902 | $693 | $713 | $926 |
| Age 62 | $891 | $922 | $708 | $729 | $947 |
| Age 63 | $915 | $947 | $728 | $749 | $973 |
| Age 64 | $930 | $962 | $739 | $761 | $989 |
