2026 Schedules of Benefits and SBCs: New Hampshire
Small group effective 1/1/26
Some plans pending regulatory approval. If a document doesn't display, please check back soon.
| NRH - OFF EXCHANGE with dental | SOB | SBC |
|---|---|---|
ElevateHealth Network HMO Gold 2000/20% Open Access with RxD MD0000201623 | ||
ElevateHealth Network HMO Silver 3000/0% Open Access with RxD MD0000201624 | ||
ElevateHealth Network HMO Silver 3000/35% Open Access with RxD MD0000201625 | ||
ElevateHealth Network HMO Silver 4000/35% Open Access with RxD MD0000201626 | ||
ElevateHealth Network HMO Silver 5000/0% Open Access with RxD MD0000201627 | ||
ElevateHealth Network HMO Silver 5000/30% Open Access with RxD MD0000201628 | ||
ElevateHealth Network HMO Silver 6000/30% Open Access with RxD MD0000201657 | ||
ElevateHealth Network HMO Silver 7000/30% Open Access MD0000201658 | ||
ElevateHealth Network HMO HSA Silver 3500/20% Open Access with Preventive Rx MD0000201629 | ||
ElevateHealth Network HMO HSA Silver 5000/10% Open Access with Preventive Rx MD0000201630 | ||
ElevateHealth Network HMO HSA Bronze 7500/0% Open Access with Preventive Rx MD0000201631 | ||
ElevateHealth Options HMO Gold 1000/10% Open Access with RxD MD0000201632 | ||
ElevateHealth Options HMO Silver 3000/15% Open Access with RxD MD0000201633 | ||
HMO Platinum 250/10% - LP Open Access MD0000201634 | ||
HMO Gold 1500/20% - LP Open Access with RxD MD0000201635 | ||
HMO Gold 2000/0% - LP Open Access with RxD MD0000201636 | ||
HMO Gold 2000/0% - LP Open Access MD0000201637 | ||
HMO Gold 2000/20% - LP Open Access with RxD MD0000201643 | ||
HMO Gold 2700/10% - LP Open Access with RxD MD0000201644 | ||
HMO Gold 3000/0% - LP Open Access MD0000201645 | ||
HMO Silver 3000/35% - LP Open Access with RxD MD0000201646 | ||
HMO Gold 3500/0% - LP Open Access with RxD MD0000201647 | ||
HMO Gold 4000/0% - LP Open Access MD0000201659 | ||
HMO Silver 4000/20% - LP Open Access with RxD MD0000201648 | ||
HMO Silver 5000/0% - LP Open Access MD0000201660 | ||
HMO Silver 5000/30% - LP Open Access with RxD MD0000201649 | ||
HMO Silver 6000/30% - LP Open Access with RxD MD0000201650 | ||
HMO Silver 7000/30% - LP Open Access MD0000201661 | ||
HMO HSA Silver 3500/20% Open Access with Preventive Rx MD0000201638 | ||
HMO HSA Silver 5000/10% Open Access with Preventive Rx MD0000201639 | ||
HMO HSA Bronze 7500/0% Open Access with Preventive Rx MD0000201640 |
| PPO - OFF EXCHANGE with dental | SOB | SBC |
|---|---|---|
PPO Access Platinum 250/10% - LP MD0000201641 | ||
PPO Access Gold 1500/20% - LP with RxD MD0000201642 | ||
PPO Access Gold 2000/20% - LP with RxD MD0000201651 | ||
PPO Access Gold 2700/10% - LP with RxD MD0000201652 | ||
PPO Access Gold 3000/0% - LP MD0000201653 | ||
PPO Access Silver 4000/20% - LP with RxD MD0000201654 | ||
PPO Access Silver 5000/0% - LP MD0000201655 | ||
PPO Access Silver 5000/30% - LP with RxD MD0000201656 | ||
PPO Access Silver 6000/30% - LP with RxD MD0000201662 | ||
PPO Access HSA Silver 3500/20% with Preventive Rx MD0000201663 | ||
PPO Access HSA Silver 5000/10% with Preventive Rx MD0000201664 | ||
PPO Access HSA Bronze 7500/0% with Preventive Rx MD0000201665 |