2017 Plans Index

 

 

 

Individual Plans Summary of Benefits and Coverage (SBC) Certificate of Coverage (COC) *Pediatric Dental Benefits Rider
Basic — HMO      
Silver Basic 4000 PDF icon PDF icon  
Silver Basic 4000 with Pediatric Dental PDF icon PDF icon PDF icon
Gold Basic 2000 PDF icon PDF icon  
Gold Basic 2000 with Pediatric Dental PDF icon PDF icon PDF icon
Basic Saver — HMO      
Bronze Basic Saver 5000 PDF icon PDF icon  
Bronze Basic Saver 5000 with Pediatric Dental PDF icon PDF icon PDF icon
Silver Basic Saver 3500 PDF icon PDF icon  
Silver Basic Saver 3500 with Pediatric Dental PDF icon PDF icon PDF icon
Classic — POS      
Silver Classic PDF icon PDF icon  
Silver Classic 250 PDF icon PDF icon  
Silver Classic 500 PDF icon PDF icon  
Silver Classic 2700 PDF icon PDF icon  
Silver Classic 4000 PDF icon PDF icon  
Silver Classic 4000-I PDF icon PDF icon  
Silver Classic 4000 with Pediatric Dental PDF icon PDF icon PDF icon
Silver Classic Value PDF icon PDF icon  
Silver Classic Value Plus PDF icon PDF icon  
Gold Classic PDF icon PDF icon  
Gold Classic 2000 PDF icon PDF icon  
Gold Classic 2000-I PDF icon PDF icon  
Gold Classic 2000 with Pediatric Dental PDF icon PDF icon PDF icon
Classic Saver — POS      
Bronze Classic Saver PDF icon PDF icon  
Bronze Classic Saver 5000 PDF icon PDF icon  
Bronze Classic Saver 5000-I PDF icon PDF icon  
Bronze Classic Saver 5000 with Pediatric Dental PDF icon PDF icon PDF icon
Silver Classic Saver PDF icon PDF icon  
Silver Classic Saver 500 PDF icon PDF icon  
Silver Classic Saver 1000 PDF icon PDF icon  
Silver Classic Saver 2500 PDF icon PDF icon  
Silver Classic Saver 3500 PDF icon PDF icon  
Silver Classic Saver 3500-I PDF icon PDF icon  
Silver Classic Saver 3500 with Pediatric Dental PDF icon PDF icon PDF icon
Catastrophic      
Catastrophic PDF icon PDF icon  
Catastrophic with Pediatric Dental PDF icon PDF icon PDF icon
Preferred Provider Organization (PPO)      
Silver PDF icon PDF icon  
Silver 250 PDF icon PDF icon  
Silver 500 PDF icon PDF icon  
Silver 2700 PDF icon PDF icon  
Silver 4000 PDF icon PDF icon  
Silver 4000-I PDF icon PDF icon  
Silver Value PDF icon PDF icon  
Silver Value Plus PDF icon PDF icon  
Gold PDF icon PDF icon  
Gold 2000 PDF icon PDF icon  
Gold 2000-I PDF icon PDF icon  
Group Plans Evidence of Coverage (EOC) *Pediatric Dental Benefits Rider
Classic — POS    
Bronze Classic 4500 HSA PDF icon  
Bronze Classic 4500 HSA with Pediatric Dental PDF icon PDF icon
Bronze Classic 6550 HSA PDF icon  
Bronze Classic 6550 HSA with Pediatric Dental PDF icon PDF icon
Silver Classic 2000-I PDF icon  
Silver Classic 2000-I with Pediatric Dental PDF icon PDF icon
Silver Classic 2000-2 PDF icon  
Silver Classic 2000-2 with Pediatric Dental PDF icon PDF icon
Silver Classic 3000 PDF icon  
Silver Classic 3000 with Pediatric Dental PDF icon PDF icon
Silver Classic HSA 2600 PDF icon  
Silver Classic HSA 2600 with Pediatric Dental PDF icon PDF icon
Silver Classic HSA 3000 PDF icon  
Silver Classic HSA 3000 with Pediatric Dental PDF icon PDF icon
Silver Classic HSA 3600 PDF icon  
Silver Classic HSA 3600 with Pediatric Dental PDF icon PDF icon
Gold Classic 1000-I PDF icon  
Gold Classic 1000-1 with Pediatric Dental PDF icon PDF icon
Gold Classic 1000-2 PDF icon  
Gold Classic 1000-2 with Pediatric Dental PDF icon PDF icon
Gold Classic 1500 PDF icon  
Gold Classic 1500 with Pediatric Dental PDF icon PDF icon
Gold Classic HSA 1500 PDF icon  
Gold Classic HSA 1500 with Pediatric Dental PDF icon PDF icon
Platinum Classic 250 PDF icon  
Platinum Classic 250 with Pediatric Dental PDF icon PDF icon
Platinum Classic 500 PDF icon  
Platinum Classic 500 with Pediatric Dental PDF icon PDF icon
Enhanced — PPO    
Bronze Enhanced HSA 4500 PDF icon  
Bronze Enhanced HSA 4500 with Pediatric Dental PDF icon PDF icon
Bronze Enhanced HSA 6550 PDF icon  
Bronze Enhanced HSA 6550 with Pediatric Dental PDF icon PDF icon
Silver Enhanced 2000-I PDF icon  
Silver Enhanced 2000-I with Pediatric Dental PDF icon PDF icon
Silver Enhanced 2000-2 PDF icon  
Silver Enhanced 2000-2 with Pediatric Dental PDF icon PDF icon
Silver Enhanced 3000 PDF icon  
Silver Enhanced 3000 with Pediatric Dental PDF icon PDF icon
Silver Enhanced HSA 2600 PDF icon  
Silver Enhanced HSA 2600 with Pediatric Dental PDF icon PDF icon
Silver Enhanced HSA 3000 PDF icon  
Silver Enhanced HSA 3000 with Pediatric Dental PDF icon PDF icon
Silver Enhanced HSA 3600 PDF icon  
Silver Enhanced HSA 3600 with Pediatric Dental PDF icon PDF icon
Gold Enhanced 1000-I PDF icon  
Gold Enhanced 1000-I with Pediatric Dental PDF icon PDF icon
Gold Enhanced 1000-2 PDF icon  
Gold Enhanced 1000-2 with Pediatric Dental PDF icon PDF icon
Gold Enhanced 1500 PDF icon  
Gold Enhanced 1500 with Pediatric Dental PDF icon PDF icon
Gold Enhanced HSA 1500 PDF icon  
Gold Enhanced HSA 1500 with Pediatric Dental PDF icon PDF icon
Platinum Enhanced 250 PDF icon  
Platinum Enhanced 250 with Pediatric Dental PDF icon PDF icon
Platinum Enhanced 500 PDF icon  
Platinum Enhanced 500 with Pediatric Dental PDF icon PDF icon
Grandfathered    
POS Flex Choice PDF icon  
POS Preferred Choice PDF icon  
POS Right Choice PDF icon  
PPO Complete PDF icon  
PPO Performance PDF icon  
Non-Grandfathered    
HMO Flex Choice PDF icon  
HMO Preferred Choice PDF icon  
HMO Right Choice PDF icon  
POS Flex Choice PDF icon  
POS Preferred Choice PDF icon  
POS Right Choice PDF icon  
PPO Complete PDF icon  
PPO Performance PDF icon  
Transitional    
POS Flex Choice PDF icon  
POS Preferred Choice PDF icon  
POS Right Choice PDF icon  
PPO Complete PDF icon  
PPO Performance PDF icon