2027 Schedules of Benefits and SBCs: Massachusetts

Individual Market effective 1/1/27

HMO - ON EXCHANGE with dental SOBSBC
Standard Platinum - Flex MD0000201791
Standard High Gold MD0000201793
Standard Silver II MD0000201795
Standard High Bronze HSA - Flex MD0000201799
HMO 2000 Value II - Flex MD0000201801
Basic Buy MD0000201914
HMO - OFF EXCHANGE with dental SOBSBC
Standard Platinum - Flex MD0000201791
Standard High Gold MD0000201793
Standard Silver MD0000201794
Standard Low Silver HSA - Flex MD0000201798
Standard High Bronze HSA - Flex MD0000201799
HMO 2000 Value II - Flex MD0000201801
Basic Buy MD0000201914
HMO 25 - Flex MD0000201848
HMO 1000 - Flex MD0000201849
HMO 1500 - Flex MD0000201850
HMO 2000 - Flex MD0000201851
HMO 2500 - Flex MD0000201852
HMO 3000 - Flex MD0000201853
HMO 4000 - Flex MD0000201854
HMO 5000 - Flex MD0000201855
HMO HSA 2000 - Flex MD0000201856
HMO HSA 3000 - Flex MD0000201857
HMO HSA 3400 - Flex MD0000201858
HMO HSA 4000 - Flex MD0000201859
Focus Network HMO 1000 MD0000201860
Focus Network HMO 2000 MD0000201861
Focus Network HMO 3000 MD0000201862
Focus Network HMO 4000 MD0000201863
HMO 2500 Value - Flex MD0000201877
HMO 3000 Value - Flex MD0000201878
HMO 4000 Value - Flex MD0000201879
ChoiceNet HMO 1000 MD0000201880
ChoiceNet HMO 2000 MD0000201881
ChoiceNet HMO 3000 MD0000201882
HMO - ON EXCHANGE with dental - AI/AN - LimitedSOBSBC
Standard Platinum - Flex MD0000201791
Standard High Gold MD0000201793
Standard Silver II MD0000201795
Standard High Bronze - Flex MD0000201800
HMO 2000 Value II - Flex MD0000201801
HMO - ON EXCHANGE with dental - AI/AN - $0 CostSOBSBC
HMO MD0000201792
HMO MD0000201792
HMO MD0000201792
HMO MD0000201792
HMO MD0000201792
HMO - ON EXCHANGE with dental - CSR - 87%SOBSBC
Standard ConnectorCare 2 MD0000201796
HMO - ON EXCHANGE with dental - CSR - 73%SOBSBC
Standard ConnectorCare 3 MD0000201797
PPO - OFF EXCHANGE with dental SOBSBC
PPO Access HSA 3000 II - Flex MD0000201802
PPO Access 25 - Flex MD0000201864
PPO Access 1000 - Flex MD0000201865
PPO Access 2000 - Flex MD0000201866
PPO Access 2000 Value - Flex MD0000201867
PPO Access 3000 - Flex MD0000201868
PPO Access 4000 - Flex MD0000201869
PPO Access 5000 - Flex MD0000201870
PPO Access HSA 3000 - Flex MD0000201871
PPO Access HSA 5000 - Flex MD0000201872
EPO - OFF EXCHANGE with dental SOBSBC
National Access EPO 1500 MD0000201873
National Access EPO 2500 MD0000201874
National Access EPO 3500 MD0000201875
National Access EPO HSA 4500 MD0000201876