40 Square

Welcome to the 40 Square Rate Estimate Tool

Thank you for your potential interest in 40 Square Cooperative Solutions’ Health Plans! This tool is intended to provide individuals and families with an estimated cost of coverage for all 40 Square health plan offerings. The estimate is based on zip code and age only. Rates may vary down or up should you proceed with a full quote.

Open enrollment takes place November 1, 2018 through December 19, 2018. You will be able to receive a full quote during this timeframe. Coverage would begin on January 1, 2019.


Thank you again for your consideration! If you have any questions, please feel free to contact an agent, or the co-op directly at 844-205-9579 or via email at info@40Square.coop.

Step 1 - Enter Employer's Zip Code


Step 2 - Members to Estimate

Please enter the date of birth for each member you wish to estimate. Press the "Add New Member" to add additional members.

Dates must be in the form of m/d/yyyy (e.g. 9/9/1968)



NameDate of Birth 



Open enrollment takes place November 1, 2018 through December 19, 2018. You will be able to receive a full quote during this timeframe. Coverage would begin on January 1, 2019.



$1,500
Deductible
$2,500
Deductible
$3,500
Deductible*
$4,500
Deductible*
$5,500
Deductible*
$6,550
Deductible*
$7,900
Deductible
{{ item.name }} ${{ item.rates.r1 }} ${{ item.rates.r2 }} ${{ item.rates.r3 }} ${{ item.rates.r4 }} ${{ item.rates.r5 }} ${{ item.rates.r6 }} ${{ item.rates.r7 }}
Total Monthly Rate Estimate: ${{ total.r1 }} ${{ total.r2 }} ${{ total.r3 }} ${{ total.r4 }} ${{ total.r5 }} ${{ total.r6 }} ${{ total.r7 }}
*HSA Compatible Plan
      Return to 40Square.coop
Enter Email Address


  
 
 
$1,500
Deductible
$2,500
Deductible
$3,500
Deductible*
$4,500
Deductible*
$5,500
Deductible*
$6,550
Deductible*
$7,900
Deductible
Benefit In-Network In-Network In-Network In-Network In-Network In-Network In-Network

Annual Deductible

(Embedded)
  Individual $1,500 $2,500 $3,500 $4,500 $5,500 $6,500 $7,900
  Family $3,000 $5,000 $7,000 $9,000 $11,000 $13,100 $15,800

Benefit Percentage & Out-of-Pocket Maximum

(Embedded includes deductible, coinsurance, and co-pays)
Deductible and 20% except where noted below. Deductible and 25% except where noted below. Deductible and 20% except where noted below. Deductible and 20% except where noted below. Deductible and 25% except where noted below. Deductible and 30% except where noted below. Deductible then 100% covered except where noted below.
  Individual $3,000 $7,150 $4,500 $6,500 $6,750 $6,750 $7,900
  Family $6,000 $14,300 $9,000 $6,550 $13,500 $13,500 $15,800
Office Visits (Illness and Injury)
  Primary Care $40 $40 20% 20% 25% 30% Deductible then
  Specialist $75 $75 20% 20% 25% 30% 100% covered
  Retail Health Clinic $20 $20 20% 20% 25% 30%
  Urgent Care $50 $50 20% 20% 25% 30%
  E-visits $15 $15 20% 20% 25% 30%

Routine Preventative Care


Covered at 100%

Covered at 100%

Covered at 100%

Covered at 100%

Covered at 100%

Covered at 100%

Covered at 100%

Hospital and Professional Services

Inpatient, Outpatient, and Emergency Room
20% 25% 20% 20% 25% 30% Deductible then 100% covered
Prescription Drugs
Retail 31-Day Supply 31-Day Supply 20% 20% 25% 30% Deductible then
  Generic $10 $10 100% covered
  Formulary $40 $40
  Non-formulary $100 $100
Mail-Order 90-Day Supply 90-Day Supply 20% 20% 25% 30% Deductible then
  Generic $25 $25 100% covered
  Formulary $100 $100
  Non-formulary $250 $250
Specialty (per script) 20% to $350 25% to $350
Preventative Drugs are covered at a Copay
Benefit Out-of-Network

Benefit Percentage & Out-of-Pocket Maximum

(Includes deductible, coinsurance)

Deductible: Individual $10,000 and Family $20,000
Benefit Percentage: 50%
Maximum Out-of-Pocket: Individual $30,000 and Family $60,000