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
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
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
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
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 |