2023 Small Group Plan Documents

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HMO Core

Core plans feature lower monthly premiums with higher out-of-pocket costs for covered services. These plans generally include higher copayments and annual deductibles, and sometimes feature coinsurance that applies to covered services.

Plan Name Benefit Summary SBC EOC Rx Rider
HMO Core 2000 PDF PDF N/A N/A
HMO Core 2000 Copay PDF PDF N/A N/A
HMO Core 2500 PDF PDF N/A N/A
HMO Core 3000 PDF PDF N/A N/A
HMO Silver A PDF PDF N/A N/A

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage

HMO Essential

Essential plans feature intermediate pricing for both monthly premiums and out-of- pocket costs.

Plan Name Benefit Summary SBC EOC Rx Rider
HMO Essential 500 PDF PDF N/A N/A
HMO Essential 1000 PDF PDF N/A N/A
HMO Essential 2000 PDF PDF N/A N/A
HMO Essential 3000 PDF PDF N/A N/A
HMO Essential 4000 PDF PDF N/A N/A
HMO Essential 5000 PDF PDF N/A N/A
HMO Gold PDF PDF N/A N/A

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage

HMO Premium

Premium plans have higher monthly premiums, but lower out-of-pocket costs for covered services. These plans feature low copayments, and typically do not include deductibles.

Plan Name Benefit Summary SBC EOC Rx Rider
HMO Choice Plus PDF PDF N/A N/A
HMO Platinum A PDF PDF N/A N/A

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage

HMO Thrive

Thrive Plans feature modest premiums with low out-of-pocket expenses for routine and maintenance care paired with significant cost-share for non-routine services. This product line features a zero deductible option.

Plan Name Benefit Summary SBC EOC Rx Rider
HMO Thrive Bronze PDF PDF N/A N/A
HMO Thrive Gold 2000 PDF PDF N/A N/A
HMO Thrive Platinum Copay PDF PDF N/A N/A
HMO Thrive Silver 3000 PDF PDF N/A N/A

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage

HMO Wise

Wise plans feature lower monthly premiums with higher out-of-pocket costs for covered services. They require full payment of their deductible before most services are covered. They are typically paired with Health Savings Account that can be used by the member to pay for health related expenses and deductibles.

Plan Name Benefit Summary SBC EOC Rx Rider
HMO Bronze 2 HDHP PDF PDF N/A N/A
HMO Silver 2000 HDHP PDF PDF N/A N/A
HMO Wise 3000/10% HDHP PDF PDF N/A N/A
HMO Wise Max 2000 HDHP PDF PDF N/A N/A
HMO Wise Max 3000 HDHP PDF PDF N/A N/A
HMO Wise Saver 3450 HDHP PDF PDF N/A N/A

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage

PPO Essential

Essential plans feature intermediate pricing for both monthly premiums and out-of- pocket costs.

Plan Name Benefit Summary SBC EOC Rx Rider
PPO Essential 500 National PDF PDF N/A N/A
PPO Essential 1000 National PDF PDF N/A N/A
PPO Essential 2000 National PDF PDF N/A N/A
PPO Essential 3000 National PDF PDF N/A N/A
PPO Essential 5000 National PDF PDF N/A N/A

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage

PPO Thrive

Thrive Plans feature modest premiums with low out-of-pocket expenses for routine and maintenance care paired with significant cost-share for non-routine services. This product line features a zero deductible option.

Plan Name Benefit Summary SBC EOC Rx Rider
PPO Thrive Bronze National PDF PDF N/A N/A
PPO Thrive Silver 3000 National PDF PDF N/A N/A

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage

PPO Wise

Wise plans feature lower monthly premiums with higher out-of-pocket costs for covered services. These plans generally include higher copayments and annual deductibles that apply to covered services.

Plan Name Benefit Summary SBC EOC Rx Rider
PPO Wise 3000/10% National HDHP PDF PDF N/A N/A
PPO Wise Max 2000 National HDHP PDF PDF N/A N/A
PPO Wise Max 3000 National HDHP PDF PDF N/A N/A
PPO Wise Saver 3450 National HDHP PDF PDF N/A N/A

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage

PPO Core

Core plans feature lower monthly premiums with higher out-of-pocket costs for covered services. These plans generally include higher copayments and annual deductibles, and sometimes feature coinsurance that applies to covered services.

Plan Name Benefit Summary SBC EOC Rx Rider
PPO Core 2000 Copay National PDF PDF N/A N/A
PPO Core 2000 National PDF PDF N/A N/A
PPO Silver A National PDF PDF N/A N/A

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage