You May Qualify For Tax Credits!
FEDERAL POVERTY LEVEL: To qualify for a premium tax credit, your household income must be less than 400% of the Federal Poverty Level. The size of your family and your adjusted gross income determine your Federal Poverty Level
ESTIMATED MONTHLY PREMIUM: If you qualify for a premium tax credit, your health insurance premium will be reduced each month. This is your insurance premium BEFORE the tax credit is applied, and is based on the health insurance plan outlined below:
ESTIMATED TAX CREDIT / SUBSIDY: The premium tax credit can be paid directly to your health insurance company each month, immediately reducing your monthly health insurance premium.
Based on your “estimated monthly premium” and “estimated tax credit”this is your new monthly health insurance premium, assuming your purchase the standard health plan shown here. Keep in mind that you can purchase a less expensive health plan that can save you even more money, or you can purchase a more comprehensive health plan that will cost you more.
STANDARD HEALTH PLAN
Insurance Carrier: Select Health
Provider Network: Select Value
Medical Deductible: $1000/$2500
Out of Pocket Maximum: $5800/$11600
Doctor Visit – Primary Care: $25 After Deductible
Doctor Visit – Specialist: $50 After Deductible
Instacare/Urgent Care Visit: $50 After Deductible
Emergency Room Visit: $500 After Deductible
Prescription Deductible: $1000 Per Person
Prescription Co Pay: $10/25%/50%
Maternity: 50% After Deductible