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For groups with up to 50 FTE. Full, tiered and select network plan options to suit employers’ needs. See our complete small group benefit design chart.
| Plan Name | Year | Overview | Documents | Administration Forms |
|---|---|---|---|---|
| Focus NetworkSM HMO | 2018 | Deductible, limited-network HMO plans featuring our high-performance network of providers. Lower premiums compared to full-network plans. PCP selection and referrals required. | How it WorksEmployer BrochureEmployee Brochure | Plan EnrollmentPre-RenewalChecklist |
| Core Coverage HMO Flex | 2018 | Full New England network HMO with copays for set numbers of medical/behavioral office visits. Other visits/services subject to deductible, then coinsurance. PCP/referrals required. Flex benefit provides member savings on general labs and day surgery. | Facilities BrochureFlex Flyer | Plan EnrollmentPre-RenewalChecklist |
| Best Buy HSA HMO Flex | 2018 | High-deductible (QHDHP) HMO plan. Access to our full network of New England providers and hospitals. PCP selection and referrals required. Flex benefit provides member savings on general labs and day surgery. Option to fund an HSA. | Facilities BrochureFlex Flyer | Plan EnrollmentPre-RenewalChecklist |
| Best Buy HMO Flex | 2018 | Deductible HMO plan with access to our full network of New England providers and hospitals. PCP selection and referrals required. Flex benefit provides member savings on general labs and day surgery. | Facilities BrochureFlex Flyer | Plan EnrollmentPre-RenewalChecklist |
| Affordable HMO Flex | 2018 | No-deductible HMO plan with access to our full network of New England providers and hospitals. PCP selection and referrals required. Flex benefit provides member savings on general labs and day surgery. | Facilities BrochureFlex Flyer | Plan EnrollmentPre-RenewalChecklist |
Benefits, coverage and member cost-sharing details for our plans.
Schedules of Benefits and SBCs: Massachusetts
Individual 2017
| HMO - ON EXCHANGE with Dental | SOB | SBC |
|---|---|---|
| Standard Platinum MD0000004319 | Show Standard Platinum SOB | Show Standard Platinum SBC |
| Standard Gold MD0000004320 | Show Standard Gold SOB | Show Standard Gold SBC |
| Standard Silver MD0000004321 | Show Standard Silver SOB | Show Standard Silver SBC |
| Standard Bronze MD0000004329 | Show Standard Bronze SOB | Show Standard Bronze SBC |
| Core Coverage HMO 1750 MD0000004330 | Show Core Coverage HMO 1750 SOB | Show Core Coverage HMO 1750 SBC |
| Best Buy HMO 2000 MD0000004359 | Show Best Buy HMO 2000 SOB | Show Best Buy HMO 2000 SBC |
| HMO - ON EXCHANGE with Dental - AI/AN - Limited | SOB | SBC |
|---|---|---|
| Standard Platinum MD0000004319 | Show Standard Platinum SOB | Show Standard Platinum SBC |
| Standard Gold MD0000004320 | Show Standard Gold SOB | Show Standard Gold SBC |
| Standard Silver MD0000004321 | Show Standard Silver SOB | Show Standard Silver SBC |
| Standard Bronze MD0000004329 | Show Standard Bronze SOB | Show Standard Bronze SBC |
| Core Coverage HMO 1750 MD0000004330 | Show Core Coverage HMO 1750 SOB | Show Core Coverage HMO 1750 SBC |
| Best Buy HMO 2000 MD0000004359 | Show Best Buy HMO 2000 SOB | Show Best Buy HMO 2000 SBC |
| HMO - ON EXCHANGE with Dental - AI/AN - $0 | SOB | SBC |
|---|---|---|
| HMO MD0000004328 | Show HMO SOB | Show HMO SBC |
| HMO MD0000004328 | Show HMO SOB | Show HMO SBC |
| HMO MD0000004328 | Show HMO SOB | Show HMO SBC |
| HMO MD0000004328 | Show HMO SOB | Show HMO SBC |
| HMO MD0000004328 | Show HMO SOB | Show HMO SBC |
| HMO MD0000004328 | Show HMO SOB | Show HMO SBC |
Individual 2018
| HMO - ON EXCHANGE with Dental | SOB | SBC |
|---|---|---|
| Standard Platinum MD0000004598 | Show Standard Platinum SOB | Show Standard Platinum SBC |
| Standard Gold MD0000004599 | Show Standard Gold SOB | Show Standard Gold SBC |
| Standard Silver MD0000004600 | Show Standard Silver SOB | Show Standard Silver SBC |
| Standard Bronze MD0000004601 | Show Standard Bronze SOB | Show Standard Bronze SBC |
| HMO - ON EXCHANGE with Dental - AI/AN - Limited | SOB | SBC |
|---|---|---|
| Standard Platinum MD0000004598 | Show Standard Platinum SOB | Show Standard Platinum SBC |
| Standard Gold MD0000004599 | Show Standard Gold SOB | Show Standard Gold SBC |
| Standard Silver MD0000004600 | Show Standard Silver SOB | Show Standard Silver SBC |
| Standard Bronze MD0000004601 | Show Standard Bronze SOB | Show Standard Bronze SBC |
| HMO - ON EXCHANGE with Dental - AI/AN - $0 | SOB | SBC |
|---|---|---|
| HMO MD0000004605 | Show HMO SOB | Show HMO SBC |
| HMO MD0000004605 | Show HMO SOB | Show HMO SBC |
| HMO MD0000004605 | Show HMO SOB | Show HMO SBC |
| HMO MD0000004605 | Show HMO SOB | Show HMO SBC |
Small Group 2017
| HMO - ON EXCHANGE with Dental | SOB | SBC |
|---|---|---|
| Standard Platinum MD0000004319 | Show Standard Platinum SOB | Show Standard Platinum SBC |
| Standard Gold MD0000004320 | Show Standard Gold SOB | Show Standard Gold SBC |
| Standard Silver MD0000004321 | Show Standard Silver SOB | Show Standard Silver SBC |
| Standard Bronze MD0000004329 | Show Standard Bronze SOB | Show Standard Bronze SBC |
| Core Coverage HMO 1750 MD0000004330 | Show Core Coverage HMO 1750 SOB | Show Core Coverage HMO 1750 SBC |
| Best Buy HMO 2000 MD0000004359 | Show Best Buy HMO 2000 SOB | Show Best Buy HMO 2000 SBC |
Small Group 2018
| HMO - ON EXCHANGE with Dental | SOB | SBC |
|---|---|---|
| Standard Platinum MD0000004598 | Show Standard Platinum SOB | Show Standard Platinum SBC |
| Standard Gold MD0000004599 | Show Standard Gold SOB | Show Standard Gold SBC |
| Standard Silver MD0000004600 | Show Standard Silver SOB | Show Standard Silver SBC |
| Standard Bronze MD0000004601 | Show Standard Bronze SOB | Show Standard Bronze SBC |
| PPO - OFF EXCHANGE without Dental | SOB | SBC |
|---|---|---|
| Affordable PPO 25 - FLEX MD0000004625 | Show Affordable PPO 25 - FLEX SOB | Show Affordable PPO 25 - FLEX SBC |
| Best Buy PPO 1000 - FLEX MD0000004626 | Show Best Buy PPO 1000 - FLEX SOB | Show Best Buy PPO 1000 - FLEX SBC |
| Best Buy PPO 500 - FLEX MD0000004627 | Show Best Buy PPO 500 - FLEX SOB | Show Best Buy PPO 500 - FLEX SBC |
| Best Buy PPO 1000 with Coinsurance - FLEX MD0000004628 | Show Best Buy PPO 1000 with Coinsurance - FLEX SOB | Show Best Buy PPO 1000 with Coinsurance - FLEX SBC |
| Best Buy PPO 2000 - FLEX MD0000004629 | Show Best Buy PPO 2000 - FLEX SOB | Show Best Buy PPO 2000 - FLEX SBC |
| Best Buy PPO 2000 with Coinsurance - FLEX MD0000004630 | Show Best Buy PPO 2000 with Coinsurance - FLEX SOB | Show Best Buy PPO 2000 with Coinsurance - FLEX SBC |