| NRH - OFF EXCHANGE with dental | SOB | SBC |
|---|---|---|
ElevateHealth Network HMO Gold 2000/20% Open Access with RxD MD0000201803 | ||
ElevateHealth Network HMO Silver 3000/35% Open Access MD0000201804 | ||
ElevateHealth Network HMO Silver 4000/35% Open Access with RxD MD0000201805 | ||
ElevateHealth Network HMO Silver 5000/30% Open Access with RxD MD0000201806 | ||
ElevateHealth Network HMO Silver 6000/30% Open Access with RxD MD0000201807 | ||
ElevateHealth Network HMO Silver 7000/30% Open Access MD0000201808 | ||
ElevateHealth Network HMO HSA Silver 5000/10% Open Access with Preventive Rx MD0000201809 | ||
ElevateHealth Network HMO HSA Bronze 7500/20% Open Access with Preventive Rx MD0000201810 | ||
ElevateHealth Options HMO Gold 1000/10% Open Access with RxD MD0000201811 | ||
ElevateHealth Options HMO Silver 3500/20% Open Access MD0000201812 | ||
HMO Platinum 250/10% - LP Open Access MD0000201813 | ||
HMO Gold 1500/20% - LP Open Access with RxD MD0000201814 | ||
HMO Gold 2000/0% - LP Open Access with RxD MD0000201815 | ||
HMO Gold 2000/20% - LP Open Access with RxD MD0000201816 | ||
HMO Gold 2700/10% - LP Open Access with RxD MD0000201817 | ||
HMO Gold 3000/0% - LP Open Access w/RxD MD0000201818 | ||
HMO Silver 3000/35% - LP Open Access MD0000201819 | ||
HMO Gold 3500/0% - LP Open Access with RxD MD0000201820 | ||
HMO Gold 4000/0% - LP Open Access MD0000201821 | ||
HMO Silver 4000/20% - LP Open Access with RxD MD0000201822 | ||
HMO Silver 5000/30% - LP Open Access with RxD MD0000201823 | ||
HMO Silver 6000/30% - LP Open Access with RxD MD0000201824 | ||
HMO Silver 7000/30% - LP Open Access MD0000201825 | ||
HMO HSA Silver 3500/20% Open Access with Preventive Rx MD0000201826 | ||
HMO HSA Silver 5000/10% Open Access with Preventive Rx MD0000201827 | ||
HMO HSA Bronze 7500/20% Open Access with Preventive Rx MD0000201828 |
| EPO - OFF EXCHANGE with dental | SOB | SBC |
|---|---|---|
National Access EPO Platinum 250/10% MD0000201829 | ||
National Access EPO Gold 1500/20% with RxD MD0000201830 | ||
National Access EPO Gold 2000/20% with RxD MD0000201831 | ||
National Access EPO Gold 2700/10% with RxD MD0000201832 | ||
National Access EPO Gold 3000/0% with RxD MD0000201833 | ||
National Access EPO Silver 4000/20% with RxD MD0000201834 | ||
National Access EPO Silver 5000/30% with RxD MD0000201835 | ||
National Access EPO Silver 6000/30% with RxD MD0000201836 | ||
National Access EPO HSA Bronze 7500/20% with Preventive Rx MD0000201837 | ||
National Access EPO HSA Silver 3500/20% with Preventive Rx MD0000201838 | ||
National Access EPO HSA Silver 5000/10% with Preventive Rx MD0000201839 |
| PPO - OFF EXCHANGE with dental | SOB | SBC |
|---|---|---|
PPO Access Platinum 250/10% - LP MD0000201840 | ||
PPO Access Gold 1500/20% - LP with RxD MD0000201841 | ||
PPO Access Gold 2000/20% - LP with RxD MD0000201842 | ||
PPO Access Gold 2700/10% - LP with RxD MD0000201843 | ||
PPO Access Gold 3000/0% - LP with RxD MD0000201844 | ||
PPO Access Silver 4000/20% - LP with RxD MD0000201845 | ||
PPO Access HSA Silver 3500/20% with Preventive Rx MD0000201846 | ||
PPO Access HSA Silver 5000/10% with Preventive Rx MD0000201847 |