2021 Standard and Cost Share Reduction plans – Wisconsin

Gold

• Gold Option A 58326WI0090001-00 & 58326WI0090001-01
• Gold Option B 58326WI0090012-00 & 58326WI0090012-01
• Gold Option C 58326WI0090013-00 & 58326WI0090013-01

Silver

• Silver Option A 58326WI0090002-00& 58326WI0090002-01
  • Silver Option A CSR 94% 58326WI0090002-06– Only on Marketplace
  • Silver Option A CSR 87% 58326WI0090002-05– Only on Marketplace
  • Silver Option A CSR 73% 58326WI0090002-04– Only on Marketplace

• Silver Option B 58326WI0090015-00 & 58326WI0090015-01
  • Silver Option B CSR 94% 58326WI0090015-06– Only on Marketplace
  • Silver Option B CSR 87% 58326WI0090015-05– Only on Marketplace
  • Silver Option B CSR 73% 58326WI0090015-04– Only on Marketplace

• Silver Option C 58326WI0090016-00 & 58326WI0090016-01
  • Silver Option C CSR 94% 58326WI0090016-06– Only on Marketplace
  • Silver Option C CSR 87% 58326WI0090016-05– Only on Marketplace
  • Silver Option C CSR 73% 58326WI0090016-04– Only on Marketplace

Bronze

• Bronze Option A 58326WI0090006-00 & 58326WI0090006-01
• Bronze Option B 58326WI0090018-00 & 58326WI0090018-01
• Bronze Option C 58326WI0090019-00 & 58326WI0090019-01