2019 Individual Plans

 

Individual Plans Summary of Benefits and Coverage (SBC) Coverage Policy *Pediatric Dental Benefits Rider Benefit Summary
Basic — HMO        
Silver Basic 6500 PDF icon PDF icon   PDF icon
Silver Basic 6500 with Pediatric Dental PDF icon PDF icon PDF icon PDF icon
Gold Basic 2000 PDF icon PDF icon   PDF icon
Gold Basic 2000 with Pediatric Dental PDF icon PDF icon PDF icon PDF icon
Basic Saver — HMO Summary of Benefits and Coverage (SBC) Coverage Policy  *Pediatric Dental Benefits Rider  Benefit Summary 
Bronze Basic Saver 5000 PDF icon PDF icon   PDF icon
Bronze Basic Saver 5000 with Pediatric Dental PDF icon PDF icon PDF icon PDF icon
Silver Basic Saver 4000 PDF icon PDF icon   PDF icon
Silver Basic Saver 4000 with Pediatric Dental PDF icon PDF icon PDF icon PDF icon
Classic — POS Summary of Benefits and Coverage (SBC)  Coverage Policy   *Pediatric Dental Benefits Rider   Benefit Summary
Silver Classic PDF icon PDF icon   PDF icon
Silver Classic 635 PDF icon PDF icon   PDF icon
Silver Classic 650 PDF icon PDF icon   PDF icon
Silver Classic 3500 PDF icon PDF icon   PDF icon
Silver Classic 6500 PDF icon PDF icon   PDF icon
Silver Classic 6500-I PDF icon PDF icon   PDF icon
Silver Classic 6500 with Pediatric Dental PDF icon PDF icon PDF icon PDF icon
Gold Classic PDF icon PDF icon   PDF icon
Gold Classic 2000 PDF icon PDF icon   PDF icon
Gold Classic 2000-I PDF icon PDF icon   PDF icon
Gold Classic 2000 with Pediatric Dental PDF icon PDF icon PDF icon PDF icon
Classic Saver — POS Summary of Benefits and Coverage (SBC)   Coverage Policy   *Pediatric Dental Benefits Rider   Benefit Summary
Bronze Classic Saver PDF icon PDF icon   PDF icon
Bronze Classic Saver 5000 PDF icon PDF icon   PDF icon
Bronze Classic Saver 5000-I PDF icon PDF icon   PDF icon
Bronze Classic Saver 5000 with Pediatric Dental PDF icon PDF icon PDF icon PDF icon
Silver Classic Saver PDF icon PDF icon   PDF icon
Silver Classic Saver 575 PDF icon PDF icon   PDF icon
Silver Classic Saver 950 PDF icon PDF icon   PDF icon
Silver Classic Saver 2000 PDF icon PDF icon   PDF icon
Silver Classic Saver 4000 PDF icon PDF icon   PDF icon
Silver Classic Saver 4000-I PDF icon PDF icon   PDF icon
Silver Classic Saver 4000 with Pediatric Dental PDF icon PDF icon PDF icon PDF icon
Catastrophic Summary of Benefits and Coverage (SBC)   Coverage Policy   *Pediatric Dental Benefits Rider   Benefit Summary
Catastrophic PDF icon PDF icon   PDF icon
Catastrophic with Pediatric Dental PDF icon PDF icon PDF icon PDF icon
Preferred Provider Organization (PPO) Summary of Benefits and Coverage (SBC)   Coverage Policy   *Pediatric Dental Benefits Rider   Benefit Summary
Silver PDF icon PDF icon   PDF icon
Silver 635 PDF icon PDF icon   PDF icon
Silver 650 PDF icon PDF icon   PDF icon
Silver 3500 PDF icon PDF icon   PDF icon
Silver 6500 PDF icon PDF icon   PDF icon
Silver 6500-I PDF icon PDF icon   PDF icon
Silver Saver PDF icon PDF icon   PDF icon
Silver Saver 575 PDF icon PDF icon   PDF icon
Silver Saver 950 PDF icon PDF icon   PDF icon
Silver Saver 2000 PDF icon PDF icon   PDF icon
Silver Saver 4000 PDF icon PDF icon   PDF icon
Silver Saver 4000-I PDF icon PDF icon   PDF icon
Gold PDF icon PDF icon   PDF icon
Gold 2000 PDF icon PDF icon   PDF icon
Gold 2000-I PDF icon PDF icon   PDF icon