Off Exchange Plan Documents 2025
Formulary
| DOCUMENTS | DOWNLOAD/ACCESS |
|---|---|
AdvanceHealth, BlueSignature Prosano, EverydayHealth, and PPO PremierHealth | |
ACA StandardHealth with Health Choice, and StandardHealth Plans | |
Portfolio and Portfolio HSA Plans |
Summary of Benefits and Coverage (SBC)
The Summary of Benefits and Coverage (SBC) provides a concise description of what services your plan covers along with what you will pay for covered benefits.
Plans Download EverydayHealth GoldEverydayHealth SilverPlans Download AdvanceHealth GoldAdvanceHealth SilverAdvanceHealth BronzePlans Download Portfolio BronzePlans Download PPO PremierHealth GoldPPO PremierHealth SilverPlans Download PPO Portfolio HSA GoldPlans Download StandardHealth GoldStandardHealth SilverStandardHealth BronzePlans Download PPO StandardHealth GoldPPO StandardHealth SilverPlans Download ACA StandardHealth Silver with Health Choice
Benefit Books
| HMO Base Off Exchange Benefit Book | |
| PPO Base Off Exchange Benefit Book | |
| HMO ACA StandardHealth with Health Choice Base Off Exchange Benefit Book |
DOCUMENTS DOWNLOAD/ACCESS HMO AdvanceHealth Bronze 9000 HMO AdvanceHealth Gold 4375 HMO AdvanceHealth Silver 6600 DOCUMENTS DOWNLOAD/ACCESS HMO EverydayHealth Gold 1300 HMO EverydayHealth Silver 5000 DOCUMENTS DOWNLOAD/ACCESS HMO Portfolio HSA Bronze 7050 DOCUMENTS DOWNLOAD/ACCESS HMO StandardHealth Bronze 7500 HMO StandardHealth Gold 1500 HMO StandardHealth Silver 5000 DOCUMENTS DOWNLOAD/ACCESS HMO StandardHealth with Health Choice Silver 5000 DOCUMENTS DOWNLOAD/ACCESS PPO Portfolio HSA Gold 2500 DOCUMENTS DOWNLOAD/ACCESS PPO StandardHealth Gold 1500 PPO StandardHealth Silver 5000 DOCUMENTS DOWNLOAD/ACCESS PPO PremierHealth Gold 1250 PPO PremierHealth Silver 3400