Plan documents

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2021 plan year

Gold Simple PPO 0/0/25 (Available in all counties except Lancaster)

Benefit contracts	Summary of benefits and coverage (SBCs)	Highlight sheet
On Pennie	On Pennie	On Pennie On Pennie - Spanish
On Pennie - Zero Cost Share	On Pennie - Zero Cost Share	On Pennie - Zero Cost Share
On Pennie - Limited Cost Share	On Pennie - Limited Cost Share	On Pennie - Limited Cost Share
Off Pennie	Off Pennie	Off Pennie

Gold PPO Choice 2000/0/30 (Available in Lancaster county)

Benefit contracts	Summary of benefits and coverage (SBCs)	Highlight sheet
On Pennie	On Pennie	On Pennie On Pennie - Spanish
On Pennie - Zero Cost Share	On Pennie - Zero Cost Share	On Pennie - Zero Cost Share
On Pennie - Limited Cost Share	On Pennie - Limited Cost Share	On Pennie - Limited Cost Share
Off Pennie	Off Pennie	Off Pennie

Gold Valley Advantage EPO 2150/10/20 (Available in Lehigh and Northampton counties)

Benefit contracts	Summary of benefits and coverage (SBCs)	Highlight sheet
On Pennie	On Pennie	On Pennie On Pennie - Spanish
On Pennie - Zero Cost Share	On Pennie - Zero Cost Share	On Pennie - Zero Cost Share
On Pennie - Limited Cost Share	On Pennie - Limited Cost Share	On Pennie - Limited Cost Share
Off Pennie	Off Pennie	Off Pennie

Gold PPO 2150/10/20 (Available in all counties except Lancaster)

Benefit contracts	Summary of benefits and coverage (SBCs)	Highlight sheet
On Pennie	On Pennie	On Pennie On Pennie - Spanish
On Pennie - Zero Cost Share	On Pennie - Zero Cost Share	On Pennie - Zero Cost Share
On Pennie - Limited Cost Share	On Pennie - Limited Cost Share	On Pennie - Limited Cost Share
Off Pennie	Off Pennie	Off Pennie

Silver PPO Choice 3950/20/35 (Available in Lancaster county)

Benefit contracts	Summary of benefits and coverage (SBCs)	Highlight sheet
Off Pennie	Off Pennie	Off Pennie On Pennie - Spanish

Benefit contracts

Summary of benefits and coverage (SBCs)

Highlight sheet

Off Pennie

On Pennie - Spanish

Silver PPO Choice 4000/20/35 (Available in Lancaster county)

Benefit contracts	Summary of benefits and coverage (SBCs)	Highlight sheet
On Pennie	On Pennie	On Pennie On Pennie - Spanish
On Pennie - Zero Cost Share	On Pennie - Zero Cost Share	On Pennie - Zero Cost Share
On Pennie - Limited Cost Share	On Pennie - Limited Cost Share	On Pennie - Limited Cost Share
On Pennie - 73% CSR	On Pennie - 73% CSR	On Pennie - 73% CSR On Pennie - 73% CSR Spanish
On Pennie - 87% CSR	On Pennie - 87% CSR	On Pennie - 87% CSR On Pennie - 87% CSR Spanish
On Pennie - 94% CSR	On Pennie - 94% CSR	On Pennie - 94% CSR On Pennie - 94% CSR Spanish
Off Pennie	Off Pennie	Off Pennie

Silver Valley Advantage EPO 5950/20/40 (Available in Lehigh and Northampton counties)

Benefit contracts	Summary of benefits and coverage (SBCs)	Highlight sheet
Off Pennie	Off Pennie	Off Pennie Off Pennie - Spanish

Benefit contracts

Summary of benefits and coverage (SBCs)

Highlight sheet

Off Pennie

Off Pennie - Spanish

Silver Valley Advantage EPO 6000/20/40 (Available in Lehigh and Northampton counties)

Benefit contracts	Summary of benefits and coverage (SBCs)	Highlight sheet
On Pennie	On Pennie	On Pennie On Pennie - Spanish
On Pennie - Zero Cost Share	On Pennie - Zero Cost Share	On Pennie - Zero Cost Share
On Pennie - Limited Cost Share	On Pennie - Limited Cost Share	On Pennie - Limited Cost Share
On Pennie - 73% CSR	On Pennie - 73% CSR	On Pennie - 73% CSR On Pennie - 73% CSR Spanish
On Pennie - 87% CSR	On Pennie - 87% CSR	On Pennie - 87% CSR On Pennie - 87% CSR Spanish
On Pennie - 94% CSR	On Pennie - 94% CSR	On Pennie - 94% CSR On Pennie - 94% CSR Spanish
Off Pennie	Off Pennie	Off Pennie

Silver PPO 5950/20/40 (Available in all counties except Lancaster)

Benefit contracts	Summary of benefits and coverage (SBCs)	Highlight sheet
Off Pennie	Off Pennie	Off Pennie On Pennie - Spanish

Benefit contracts

Summary of benefits and coverage (SBCs)

Highlight sheet

Off Pennie

On Pennie - Spanish

Silver PPO 6000/20/40 (Available in all counties except Lancaster)

Benefit contracts	Summary of benefits and coverage (SBCs)	Highlight sheet
On Pennie	On Pennie	On Pennie On Pennie - Spanish
On Pennie - Zero Cost Share	On Pennie - Zero Cost Share	On Pennie - Zero Cost Share
On Pennie - Limited Cost Share	On Pennie - Limited Cost Share	On Pennie - Limited Cost Share
On Pennie - 73% CSR	On Pennie - 73% CSR	On Pennie - 73% CSR On Pennie - 73% CSR Spanish
On Pennie - 87% CSR	On Pennie - 87% CSR	On Pennie - 87% CSR On Pennie - 87% CSR Spanish
On Pennie - 94% CSR	On Pennie - 94% CSR	On Pennie - 94% CSR On Pennie - 94% CSR Spanish
Off Pennie	Off Pennie	Off Pennie

Bronze PPO Choice 7100/0/50 (Available in Lancaster county)

Benefit contracts	Summary of benefits and coverage (SBCs)	Highlight sheet
On Pennie	On Pennie	On Pennie On Pennie - Spanish
On Pennie - Zero Cost Share	On Pennie - Zero Cost Share	On Pennie - Zero Cost Share
On Pennie - Limited Cost Share	On Pennie - Limited Cost Share	On Pennie - Limited Cost Share
Off Pennie	Off Pennie	Off Pennie

Bronze Valley Advantage EPO 8000/0/50 (Available in Lehigh and Northampton counties)

Benefit contracts	Summary of benefits and coverage (SBCs)	Highlight sheet
On Pennie	On Pennie	On Pennie On Pennie - Spanish
On Pennie - Zero Cost Share	On Pennie - Zero Cost Share	On Pennie - Zero Cost Share
On Pennie - Limited Cost Share	On Pennie - Limited Cost Share	On Pennie - Limited Cost Share
Off Pennie	Off Pennie	Off Pennie

Bronze PPO 8000/0/50 (Available in all counties except Lancaster)

Benefit contracts	Summary of benefits and coverage (SBCs)	Highlight sheet
On Pennie	On Pennie	On Pennie On Pennie - Spanish
On Pennie - Zero Cost Share	On Pennie - Zero Cost Share	On Pennie - Zero Cost Share
On Pennie - Limited Cost Share	On Pennie - Limited Cost Share	On Pennie - Limited Cost Share
Off Pennie	Off Pennie	Off Pennie

Bronze HMO 8000/0/50 (Available in all 21 counties)

Subscriber agreements	Summary of benefits and coverage (SBCs)	Highlight sheet
Off Pennie	Off Pennie	Off Pennie Off Pennie -Spanish

Subscriber agreements

Summary of benefits and coverage (SBCs)

Highlight sheet

Off Pennie

Off Pennie -Spanish

Catastrophic PPO 8550/0/75 (Available in all 21 counties)

Benefit Contracts

Summary of Benefits and Coverage (SBCs)

Highlight sheet

On Pennie

On Pennie - Spanish

Off Pennie

Catastrophic HMO 8550/0/75 (Available in all 21 counties)

Subscriber agreements	Summary of benefits and coverage (SBCs)	Highlight sheet
Off Pennie	Off Pennie	Off Pennie Off Pennie - Spanish

Subscriber agreements

Summary of benefits and coverage (SBCs)

Highlight sheet

Off Pennie

Off Pennie - Spanish

Dental Plans (Available in all counties)

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

Vision Plans (Available in all counties)

Highlight sheet
Vision Essential Plan

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Warning

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Plan documents

2021 plan year

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Gold Simple PPO 0/0/25 (Available in all counties except Lancaster)

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Gold PPO Choice 2000/0/30 (Available in Lancaster county)

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Gold Valley Advantage EPO 2150/10/20 (Available in Lehigh and Northampton counties)

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Gold PPO 2150/10/20 (Available in all counties except Lancaster)

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Silver PPO Choice 3950/20/35 (Available in Lancaster county)

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Silver PPO Choice 4000/20/35 (Available in Lancaster county)

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Silver Valley Advantage EPO 5950/20/40 (Available in Lehigh and Northampton counties)

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Silver Valley Advantage EPO 6000/20/40 (Available in Lehigh and Northampton counties)

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Silver PPO 5950/20/40 (Available in all counties except Lancaster)

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Silver PPO 6000/20/40 (Available in all counties except Lancaster)

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Bronze PPO Choice 7100/0/50 (Available in Lancaster county)

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Bronze Valley Advantage EPO 8000/0/50 (Available in Lehigh and Northampton counties)

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Bronze PPO 8000/0/50 (Available in all counties except Lancaster)

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Bronze HMO 8000/0/50 (Available in all 21 counties)

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Catastrophic PPO 8550/0/75 (Available in all 21 counties)

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Catastrophic HMO 8550/0/75 (Available in all 21 counties)

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Dental Plans (Available in all counties)

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Vision Plans (Available in all counties)

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