On Exchange Zero Cost Plan Documents 2025

Plans available through the Health Insurance Marketplace or Healthcare.gov. to American Indians/Native Alaskans who earn less than 300% of the Federal Poverty Level (FPL).

Plan Year:

Formulary

DOCUMENTS	DOWNLOAD/ACCESS
AdvanceHealth, BlueSignature Prosano, EverydayHealth, and PPO PremierHealth	Search Online Download (Opens in a new tab)
ACA StandardHealth with Health Choice, and StandardHealth Plans	Search Online Download (Opens in a new tab)
Portfolio and Portfolio HSA Plans	Search Online Download (Opens in a new tab)

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 Gold	Summary of Benefits (Opens in a new tab)
EverydayHealth Gold Limited	Summary of Benefits (Opens in a new tab)
EverydayHealth Silver	Summary of Benefits (Opens in a new tab)
EverydayHealth Silver Limited	Summary of Benefits (Opens in a new tab)
EverydayHealth Silver 4	Summary of Benefits (Opens in a new tab)
EverydayHealth Silver 5	Summary of Benefits (Opens in a new tab)
EverydayHealth Silver 6	Summary of Benefits (Opens in a new tab)

Plans	Download
AdvanceHealth Gold	Summary of Benefits (Opens in a new tab)
AdvanceHealth Gold Limited	Summary of Benefits (Opens in a new tab)
AdvanceHealth Silver	Summary of Benefits (Opens in a new tab)
AdvanceHealth Silver Limited	Summary of Benefits (Opens in a new tab)
AdvanceHealth Bronze	Summary of Benefits (Opens in a new tab)
AdvanceHealth Bronze Limited	Summary of Benefits (Opens in a new tab)
AdvanceHealth Silver 4	Summary of Benefits (Opens in a new tab)
AdvanceHealth Silver 5	Summary of Benefits (Opens in a new tab)
AdvanceHealth Silver 6	Summary of Benefits (Opens in a new tab)

Plans Download
Portfolio Bronze
Summary of Benefits (Opens in a new tab)
Portfolio Bronze Limited
Summary of Benefits (Opens in a new tab)

Plans	Download
Portfolio Bronze	Summary of Benefits (Opens in a new tab)
Portfolio Bronze Limited	Summary of Benefits (Opens in a new tab)

Plans	Download
PPO PremierHealth Gold	Summary of Benefits (Opens in a new tab)
PPO PremierHealth Gold Limited	Summary of Benefits (Opens in a new tab)
PPO PremierHealth Silver	Summary of Benefits (Opens in a new tab)
PPO PremierHealth Silver Limited	Summary of Benefits (Opens in a new tab)
PPO PremierHealth Silver 4	Summary of Benefits (Opens in a new tab)
PPO PremierHealth Silver 5	Summary of Benefits (Opens in a new tab)
PPO PremierHealth Silver 6	Summary of Benefits (Opens in a new tab)

Plans Download
PPO Portfolio Gold Limited
Summary of Benefits (Opens in a new tab)
PPO Portfolio HSA Gold
Summary of Benefits (Opens in a new tab)

Plans	Download
PPO Portfolio Gold Limited	Summary of Benefits (Opens in a new tab)
PPO Portfolio HSA Gold	Summary of Benefits (Opens in a new tab)

Plans	Download
StandardHealth Gold	Summary of Benefits (Opens in a new tab)
StandardHealth Gold Limited	Summary of Benefits (Opens in a new tab)
StandardHealth Silver	Summary of Benefits (Opens in a new tab)
StandardHealth Silver Limited	Summary of Benefits (Opens in a new tab)
StandardHealth Bronze	Summary of Benefits (Opens in a new tab)
StandardHealth Bronze Limited	Summary of Benefits (Opens in a new tab)
StandardHealth Silver 4	Summary of Benefits (Opens in a new tab)
StandardHealth Silver 5	Summary of Benefits (Opens in a new tab)
StandardHealth Silver 6	Summary of Benefits (Opens in a new tab)

Plans	Download
PPO StandardHealth Gold	Summary of Benefits (Opens in a new tab)
PPO StandardHealth Gold Limited	Summary of Benefits (Opens in a new tab)
PPO StandardHealth Silver	Summary of Benefits (Opens in a new tab)
PPO StandardHealth Silver Limited	Summary of Benefits (Opens in a new tab)
PPO StandardHealth Silver 4	Summary of Benefits (Opens in a new tab)
PPO StandardHealth Silver 5	Summary of Benefits (Opens in a new tab)
PPO StandardHealth Silver 6	Summary of Benefits (Opens in a new tab)

Plans	Download
ACA StandardHealth Silver with Health Choice	Summary of Benefits (Opens in a new tab)
ACA StandardHealth Silver Limited with Health Choice	Summary of Benefits (Opens in a new tab)
ACA StandardHealth Silver 2 with Health Choice	Summary of Benefits (Opens in a new tab)
ACA StandardHealth Silver 4 with Health Choice	Summary of Benefits (Opens in a new tab)
ACA StandardHealth Silver 5 with Health Choice	Summary of Benefits (Opens in a new tab)
ACA StandardHealth Silver 6 with Health Choice	Summary of Benefits (Opens in a new tab)

Benefit Books


HMO Base On Exchange Benefit Book	Base Benefit Book (Opens in a new tab)
PPO Base On Exchange Benefit Book	Base Benefit Book (Opens in a new tab)
HMO ACA StandardHealth with Health Choice Base On Exchange Benefit Book	Base Benefit Book (Opens in a new tab)

DOCUMENTS DOWNLOAD/ACCESS
HMO ACA AdvanceHealth with Health Choice ZCS
Plan Attachment (Opens in a new tab)
DOCUMENTS DOWNLOAD/ACCESS
HMO AdvanceHealth ZCS
Plan Attachment (Opens in a new tab)
DOCUMENTS DOWNLOAD/ACCESS
HMO EverydayHealth ZCS
Plan Attachment (Opens in a new tab)
DOCUMENTS DOWNLOAD/ACCESS
HMO Portfolio ZCS
Plan Attachment (Opens in a new tab)
DOCUMENTS DOWNLOAD/ACCESS
HMO StandardHealth ZCS
Plan Attachment (Opens in a new tab)
DOCUMENTS DOWNLOAD/ACCESS
PPO PremierHealth ZCS
Plan Attachment (Opens in a new tab)
DOCUMENTS DOWNLOAD/ACCESS
PPO Portfolio ZCS
Plan Attachment (Opens in a new tab)
DOCUMENTS DOWNLOAD/ACCESS
PPO StandardHealth ZCS
Plan Attachment (Opens in a new tab)