Plan Documents

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2020 Plan Year

Gold PPO 2150/10/20

Benefit Contracts	Summary of Benefits and Coverage (SBCs)	Highlight Sheet
Standard (no Cost Share Reduction)	Standard (no Cost Share Reduction)	Standard (no Cost Share Reduction)
Zero Cost Share	Zero Cost Share	Zero Cost Share
Limited Cost Share	Limited Cost Share	Limited Cost Share
Off Marketplace	Off Marketplace	Off Marketplace

Silver PPO 5950/20/40

Benefit Contracts	Summary of Benefits and Coverage (SBCs)	Highlight Sheet
Off Marketplace	Off Marketplace	Off Marketplace

Silver PPO 6000/20/40

Benefit Contracts	Summary of Benefits and Coverage (SBCs)	Highlight Sheet
Standard (no Cost Share Reduction)	Standard (no Cost Share Reduction)	Standard (no Cost Share Reduction)
Zero Cost Share	Zero Cost Share	Zero Cost Share
Limited Cost Share	Limited Cost Share	Limited Cost Share
73% AV Level Cost Share Reduction	73% AV Level Cost Share Reduction	73% AV Level Cost Share Reduction
87% AV Level Cost Share Reduction	87% AV Level Cost Share Reduction	87% AV Level Cost Share Reduction
94% AV Level Cost Share Reduction	94% AV Level Cost Share Reduction	94% AV Level Cost Share Reduction
Off Marketplace	Off Marketplace	Off Marketplace

Bronze PPO 8000/0/60

Benefit Contracts	Summary of Benefits and Coverage (SBCs)	Highlight Sheet
Standard (no Cost Share Reduction)	Standard (no Cost Share Reduction)	Standard (no Cost Share Reduction)
Zero Cost Share	Zero Cost Share	Zero Cost Share
Limited Cost Share	Limited Cost Share	Limited Cost Share
Off Marketplace	Off Marketplace	Off Marketplace

Bronze HMO 8000/0/60

Benefit Contracts	Summary of Benefits and Coverage (SBCs)	Highlight Sheet
Off Marketplace	Off Marketplace	Off Marketplace

Catastrophic PPO 8150/0/75

Benefit Contracts	Summary of Benefits and Coverage (SBCs)	Highlight Sheet
Off Marketplace	Off Marketplace	Off Marketplace

Catastrophic HMO 8150/0/75

Benefit Contracts	Summary of Benefits and Coverage (SBCs)	Highlight Sheet
Off Marketplace	Off Marketplace	Off Marketplace

Dental Plans

Highlight Sheet
Dental Select Basic
Dental PPO Loyalty Plan
Dental PPO Care Plan
Dental PPO Standard Plan
Dental PPO Premium Plan

Dental PPO Loyalty Plan

Highlight Sheet
On Marketplace
Off Marketplace

Dental PPO Care Plan

Highlight Sheet
On Marketplace

Dental PPO Standard Plan

Highlight Sheet
Off Marketplace

Dental PPO Premium Plan

Highlight Sheet
Off Marketplace

Vision Plans

Highlight Sheet
Vision Essential Plan

2019 Plan Year

Gold PPO 2000/10/20

Benefit Contracts	Summary of Benefits and Coverage (SBCs)
Standard (no Cost Share Reduction)	Standard (no Cost Share Reduction)
Zero Cost Share	Zero Cost Share
Limited Cost Share	Limited Cost Share
Off Marketplace	Off Marketplace

Silver PPO 4950/10/30

Benefit Contracts	Summary of Benefits and Coverage (SBCs)
Off Marketplace	Off Marketplace

Silver PPO 5000/10/30

Benefit Contracts	Summary of Benefits and Coverage (SBCs)
Standard (no Cost Share Reduction)	Standard (no Cost Share Reduction)
Zero Cost Share	Zero Cost Share
Limited Cost Share	Limited Cost Share
73% AV Level Cost Share Reduction	73% AV Level Cost Share Reduction
87% AV Level Cost Share Reduction	87% AV Level Cost Share Reduction
94% AV Level Cost Share Reduction	94% AV Level Cost Share Reduction
Off Marketplace	Off Marketplace

Bronze PPO 7350/0/60

Benefit Contracts	Summary of Benefits and Coverage (SBCs)
Standard (no Cost Share Reduction)	Standard (no Cost Share Reduction)
Zero Cost Share	Zero Cost Share
Limited Cost Share	Limited Cost Share
Off Marketplace	Off Marketplace

Bronze HMO 7350/0/60

Benefit Contracts	Summary of Benefits and Coverage (SBCs)
Off Marketplace	Off Marketplace

Catastrophic PPO 7900/0/75

Benefit Contracts	Summary of Benefits and Coverage (SBCs)
Off Marketplace	Off Marketplace

Catastrophic HMO 7900/0/75

Benefit Contracts	Summary of Benefits and Coverage (SBCs)
Off Marketplace	Off Marketplace

Dental Plans

Highlight Sheet
Dental Select Basic
Dental PPO Loyalty Plan
Dental PPO Care Plan
Dental PPO Standard Plan
Dental PPO Premium Plan

Dental PPO Loyalty Plan

Highlight Sheet
On Marketplace
Off Marketplace

Dental PPO Care Plan

Highlight Sheet
Off Marketplace

Dental PPO Standard Plan

Highlight Sheet
Off Marketplace

Dental PPO Premium Plan

Highlight Sheet
Off Marketplace

Vision Plans

Highlight Sheet
Vision Essential Plan

Complementary Content

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