2019 Recommended Plan Benefits and Rates

1B 2B 3B 4B 5B 6B 1A 2A 3A 4A 5A 1C 2C
Plan Type – All HMO Ambetter Balanced Care #11 Ambetter Balanced Care #4 BlueCross Pathway X Guided 37UB BlueCross Pathway X Guided 37UV Kaiser 5000/50 Kaiser 4700/35 Ambetter Essential Care 1 Ambetter Essential Care 2 HAS BlueCross Pathway X Guided 37TC BlueCross Pathway X Guided HAS 37TO Kaiser HAS $6,200/40% Ambetter Secure Care 1 Kaiser Gold 1500/20
Plan Name Ambetter Balance Care 11 Ambetter Balanced Care 4 BlueCross Pathway X Guided 37UB BlueCross Pathway X Guided 37UV Kaiser GA Signature 5000/50 Kaiser GA Signature 4700/35 Ambetter Essential Care 1 Ambetter Essential Care 2 HAS BlueCross Pathway X Guided 37TC BlueCross Pathway X Guided HAS 37T0 Kaiser GA Signature 6200/40% Ambetter Secure Care 1 Kaiser GA Signature Gold 1500/20
Metal Level Silver Silver                  Bronze Bronze HAS Bronze Bronze HAS Bronze HAS Gold Gold
Preventive Care
government list		 100% Coverage – Member Pays Nothing; List of Covered Services 100% Coverage – Member pays Nothing; List of Covered Services 100% Coverage – List of Covered Services
Deductible
Individual / Family		 $6,000 / $12,000 $7,050 / $14,100 $5,300 / $10,600 $4,950 / $9,900 $5,000 / $10,000 $4,700 / $9,400 $7,900 / $15,800 $6550/$13100 $6,750 / $13,500 $6,700 / $13,400 $6,200 / $12,40000 $1,000 / $2,000 $1,500 / $3,000
Coinsurance Deductible then 40% Deductible then 0% Deductible then 50% Deductible then 35% Deductibe then 35% Deductible then 35% Deductibe then 0% Deductibe then 0% Deductibe then 40% Deductible then 0% Deductible then 40% Deductibe then 20% Deductibe then 30%
Maximum Out of Pocket
Individual / Family
(Includes Medical Ded, Rx Ded, Coinsurance and Copays)		 $7,900/$15,800 $7,050 / $14,100 $7,900 / $15,800 $6,500 / $13,000 $7,350 / $14,700 $7,350 / $14,700 $7,900 / $15,800 $6,550 / $13,100 $7,900 / $15,800 $6,700 / $13,400 $6,550 / $13,100 $6,350 / $12,700 $5,000 / $10,000
Dr Office Copay               PCP/Specialist/UrgentCare $30/$60/$100 $30/$60/$100 $35/ Ded then 25%/ Ded then $50 $35/ Ded then 35%/ Ded – $50 then 35% $50 – max 2/ $70- max 2/ $100 $35/$65/ $100 Deductible then 0% Deductible then 0% Deductibe then 40% Deductible then 0% Deductible then 40% Deductibe then 20% $20/$40/$75
All Lab / X-rays & Imaging Deductible then 40% Deductible then 0% Deductible then $300 / 50% Deductible then $500 / 50% Deductibe then $550 Deductible then 35% Deductible then 0% Deductible then 0% Deductible then $500 / 40% Deductible then 0% Deductible then 40% Deductibe then 20% Deductibe then 30%
Emergency Room Deductible then 40% Deductible then 0% Deductible then $500 / 25% Deductible then $500 / 35% Deductibe then 35% Deductible then 35% Deductible then 0% Deductible then 0% Deductible then $500 / 40% Deductible then 0% Deductible then 40% Deductibe then $250 Deductibe then 30%
Inpatient / Outpatient
Hospital & Surgery		 Deductible then 40% Deductible then 0% Deductible then 50% Deductible then $500 / 50% Deductibe then 35% Deductible then 35% Deductible then 0% Deductible then 0% Deductible then $500 / 40% Deductible then 0% Deductible then 40% Deductible then 20% Deductibe then 30%
Rx Deductible Tier 1-2 No Ded; Tier 3,4 Medical Ded 40% Tiers 1-2 No Ded; Tiers 3-4 Med Ded 0% Tiers 1,2 No Ded; Tiers 3, 4 Med Ded 40% Tiers 1,2 No Ded;  Tiers 3, 4 Med Ded 40% Tier 1 – 2 No Ded; Tier 3, 4,5 $1,500 Ded Tier 1-2 No Ded; Tier 3,4,5 Med Ded Tier 1 No Ded; Tier 2,3, 4 Med Ded Medical Deductible Medical Deductible Medical Deductible Medical Deductible Tier 1 No Ded; Tier 2,3, 4  $500 Ded Tier 1 -2 No Deductible Tier 3, 4, 5 $500 Ded
Rx Copays ** $20/$50/Med Ded then 40% $15/$50/ Med Ded 0%/0% $10/ $40/ Med Ded 40%/ 40% $10/ $40 / Med Ded 40%/ 40% $5/$35 $1,500 Ded 50%/50%/50% $5/$15 Med Ded $45/50%/50% $20 / Med Deductible then 0% Medical Deductible then 0% Med Deductible then 25%/35%/45%/45% Medical Deductible then 0% Medical Deductible then 50% $10/$25/$75/30% $5/$10/$30/45%/45%
Benefits shown are for services at In-Network Providers. There is No Coverage for Out of Network Providers, except for Emergencies
Please see plan brochure for a complete listing of benefit details, plan limitations and exclusions.
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 months.
Rates shown are for residents of counties:  Cherokee, Cobb, Dekalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, & Henry
For rates in other counties please use the “View Online Quotes for All ACA Plans” link on the 2019 Recommended Plans page
Add the rate for the age of each family member to be insured. There is no family discount. Add the rate for the age of each family member to be insured. There is no family discount. Add the rate for the age of each family member to be insured. There is no family discount.
Ambetter Balanced Care #11 Ambetter Balanced Care #4 BlueCross 37UB BlueCross 37UV Kaiser 5000/50 Kaiser 4700/35 Ambetter Essential Care 1 Ambetter Essential Care 2 HAS BlueCross 37TC BlueCross HAS 37TO Kaiser HAS $6,200/40% Ambetter Secure Care 1 Kaiser Gold 1500/20
1.05152 1.01114 1.05571 0.97655 1.20186 0.90096 0.93242 0.71634 0.73731 0.95794 1.12644 1.33142
Per Child Age 0-14 $263 $277 $266 $278 $257 $316 $237 $245 $188 $194 $252 $296 $350
Age 15 $287 $302 $290 $303 $280 $345 $259 $268 $206 $212 $275 $323 $382
Age 16 $296 $311 $299 $312 $289 $356 $267 $276 $212 $218 $284 $333 $394
Age 17 $305 $321 $308 $322 $298 $367 $275 $284 $218 $225 $292 $344 $406
Age 18 $314 $330 $317 $331 $307 $377 $283 $293 $225 $232 $301 $354 $418
Age 19 $324 $341 $328 $342 $316 $389 $292 $302 $232 $239 $310 $365 $431
Age 20 $334 $351 $338 $353 $326 $401 $301 $311 $239 $246 $320 $376 $445
Age 21-24 $344 $362 $348 $363 $336 $413 $310 $321 $246 $254 $330 $387 $458
Age 25 $345 $363 $349 $364 $337 $415 $311 $322 $247 $254 $330 $389 $459
Age 26 $352 $370 $356 $372 $344 $423 $317 $328 $252 $260 $337 $397 $469
Age 27 $361 $380 $365 $381 $353 $434 $325 $337 $259 $266 $346 $407 $481
Age 28 $374 $393 $378 $395 $365 $449 $337 $349 $268 $276 $358 $421 $498
Age 29 $385 $405 $389 $406 $376 $463 $347 $359 $276 $284 $369 $434 $513
Age 30 $391 $411 $395 $412 $381 $469 $353 $365 $280 $289 $375 $441 $520
Age 31 $399 $420 $403 $421 $390 $480 $359 $372 $286 $294 $382 $449 $531
Age 32 $407 $428 $412 $430 $397 $489 $367 $379 $292 $300 $390 $458 $542
Age 33 $412 $433 $417 $435 $402 $495 $371 $384 $295 $304 $395 $464 $549
Age 34 $418 $440 $423 $441 $408 $502 $377 $390 $299 $308 $400 $471 $557
Age 35 $421 $443 $426 $444 $411 $506 $379 $393 $302 $310 $403 $474 $561
Age 36 $423 $445 $428 $447 $413 $508 $381 $394 $303 $312 $405 $476 $563
Age 37 $426 $448 $431 $450 $416 $512 $384 $397 $305 $314 $408 $480 $567
Age 38 $429 $451 $434 $453 $419 $516 $387 $400 $307 $316 $411 $483 $571
Age 39 $434 $456 $439 $458 $424 $522 $391 $405 $311 $320 $416 $489 $578
Age 40 $440 $463 $445 $465 $430 $529 $396 $410 $315 $324 $421 $496 $586
Age 41 $448 $471 $453 $473 $437 $538 $404 $418 $321 $330 $429 $505 $596
Age 42 $456 $479 $461 $481 $445 $548 $411 $425 $327 $336 $437 $514 $607
Age 43 $467 $491 $472 $493 $456 $561 $421 $435 $335 $344 $447 $526 $622
Age 44 $481 $506 $486 $508 $470 $578 $433 $448 $345 $355 $461 $542 $640
Age 45 $497 $523 $503 $525 $485 $597 $448 $463 $356 $366 $476 $560 $662
Age 46 $516 $543 $522 $545 $504 $620 $465 $481 $370 $380 $494 $581 $687
Age 47 $538 $566 $544 $568 $525 $647 $485 $502 $385 $397 $515 $606 $716
Age 48 $563 $592 $569 $594 $550 $677 $507 $525 $403 $415 $539 $634 $750
Age 49 $587 $617 $594 $620 $573 $705 $529 $547 $420 $433 $562 $661 $782
Age 50 $615 $647 $622 $649 $601 $739 $554 $573 $441 $453 $589 $693 $819
Age 51 $642 $675 $649 $678 $627 $772 $578 $599 $460 $473 $615 $723 $855
Age 52 $672 $707 $679 $709 $656 $808 $605 $627 $481 $495 $644 $757 $895
Age 53 $702 $738 $710 $741 $686 $844 $632 $655 $503 $518 $672 $791 $935
$0 $0 $0 $0 $0 $0 $0 $0 $0 $0
Age 54 $735 $773 $743 $776 $718 $883 $662 $685 $527 $542 $704 $828 $979
Age 55 $767 $807 $776 $810 $749 $922 $691 $715 $549 $566 $735 $864 $1,021
Age 56 $803 $844 $812 $848 $784 $965 $723 $749 $575 $592 $769 $905 $1,069
Age 57 $839 $882 $848 $886 $819 $1,008 $756 $782 $601 $619 $804 $945 $1,117
Age 58 $877 $922 $887 $926 $856 $1,054 $790 $818 $628 $647 $840 $988 $1,168
Age 59 $896 $942 $906 $946 $875 $1,077 $807 $835 $642 $661 $858 $1,009 $1,193
Age 60 $934 $982 $944 $986 $912 $1,123 $841 $871 $669 $689 $895 $1,052 $1,244
Age 61 $967 $1,017 $978 $1,021 $944 $1,162 $871 $902 $693 $713 $926 $1,089 $1,287
Age 62 $989 $1,040 $1,000 $1,044 $966 $1,189 $891 $922 $708 $729 $947 $1,114 $1,317
Age 63 $1,016 $1,068 $1,027 $1,073 $992 $1,221 $915 $947 $728 $749 $973 $1,144 $1,353
Age 64 $1,032 $1,085 $1,043 $1,089 $1,008 $1,240 $930 $962 $739 $761 $989 $1,162 $1,374
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