2024 Schedules of Benefits and SBCs: New Hampshire

Individual Market effective 1/1/24

HMO - OFF EXCHANGE with dental SOBSBC
NH Local Choice HMO Gold MD0000201040
NH Local Choice HMO Gold 1400 MD0000201034
NH Local Choice HMO Silver 2500 MD0000201052
NH Local Choice HMO Silver 3500 MD0000201056
NH Local Choice HMO Silver 4000 MD0000201053
NH Local Choice HMO Silver 5000 MD0000201054
NH Local Choice HMO Bronze 6500 MD0000201063
NH Local Choice HMO Bronze 7200 MD0000201064
NH Local Choice HMO Bronze 8000 MD0000201060
NH Local Choice HMO HSA Silver 3500 MD0000201055
NH Local Choice HMO HSA Bronze 6000 MD0000201042
HMO - OFF EXCHANGE without dental SOBSBC
NH Local Choice HMO Gold MD0000201040
NH Local Choice HMO Gold 1400 MD0000201034
NH Local Choice HMO Silver 2500 MD0000201023
NH Local Choice HMO Silver 3500 MD0000201024
NH Local Choice HMO Silver 4000 MD0000201039
NH Local Choice HMO Silver 5000 MD0000201041
NH Local Choice HMO Bronze 6500 MD0000201063
NH Local Choice HMO Bronze 7200 MD0000201064
NH Local Choice HMO Bronze 8000 MD0000201060
NH Local Choice HMO HSA Silver 3500 MD0000201055
NH Local Choice HMO HSA Bronze 6000 MD0000201042
NH Local HMO Gold 1500 Standard MD0000201043
NH Local HMO Silver 5900 Standard MD0000201027
NH Local HMO Bronze 7500 Standard MD0000201028
HMO - ON EXCHANGE without dental SOBSBC
NH Local Choice HMO Gold MD0000201040
NH Local Choice HMO Gold 1400 MD0000201034
NH Local Choice HMO Silver 2500 MD0000201023
NH Local Choice HMO Silver 3500 MD0000201024
NH Local Choice HMO Silver 4000 MD0000201039
NH Local Choice HMO Silver 5000 MD0000201041
NH Local Choice HMO Bronze 6500 MD0000201063
NH Local Choice HMO Bronze 7200 MD0000201064
NH Local Choice HMO Bronze 8000 MD0000201060
NH Local Choice HMO HSA Bronze 6000 MD0000201042
NH Local HMO Gold 1500 Standard MD0000201043
NH Local HMO Silver 5900 Standard MD0000201027
NH Local HMO Bronze 7500 Standard MD0000201028
HMO - ON EXCHANGE without dental - AI/AN - limitedSOBSBC
NH Local Choice HMO Gold MD0000201040
NH Local Choice HMO Gold 1400 MD0000201034
NH Local Choice HMO Silver 2500 MD0000201023
NH Local Choice HMO Silver 3500 MD0000201024
NH Local Choice HMO Silver 4000 MD0000201039
NH Local Choice HMO Silver 5000 MD0000201041
NH Local Choice HMO Bronze 6500 MD0000201063
NH Local Choice HMO Bronze 7200 MD0000201064
NH Local Choice HMO Bronze 8000 MD0000201060
NH Local Choice HMO Bronze 6000 MD0000201239
NH Local HMO Gold 1500 Standard MD0000201043
NH Local HMO Silver 5900 Standard MD0000201027
NH Local HMO Bronze 7500 Standard MD0000201028
HMO - ON EXCHANGE without dental - AI/AN - $0 costSOBSBC
NH Local Choice HMO CSR100 MD0000201062
NH Local Choice HMO CSR100 MD0000201062
NH Local Choice HMO CSR100 MD0000201062
NH Local Choice HMO CSR100 MD0000201062
NH Local Choice HMO CSR100 MD0000201062
NH Local Choice HMO CSR100 MD0000201062
NH Local Choice HMO CSR100 MD0000201062
NH Local Choice HMO CSR100 MD0000201062
NH Local Choice HMO CSR100 MD0000201062
NH Local Choice HMO CSR100 MD0000201062
NH Local HMO CSR100 MD0000201065
NH Local HMO CSR100 MD0000201065
NH Local HMO CSR100 MD0000201065
HMO - ON EXCHANGE without dental - CSR - 73%SOBSBC
NH Local Choice HMO Silver 2500 CSR73 MD0000201038
NH Local Choice HMO Silver 3000 CSR73 MD0000201031
NH Local Choice HMO Silver 2800 CSR73 MD0000201048
NH Local Choice HMO Silver 3400 CSR73 MD0000201029
NH Local HMO Silver 5700 Standard CSR73 MD0000201044
HMO - ON EXCHANGE without dental - CSR - 87%SOBSBC
NH Local Choice HMO Silver 1000 CSR87 MD0000201037
NH Local Choice HMO Silver Copay 1200 CSR87 MD0000201046
NH Local Choice HMO Silver 1100 CSR87 MD0000201050
NH Local Choice HMO Silver 1400 CSR87 MD0000201049
NH Local HMO Silver 700 Standard CSR87 MD0000201045
HMO - ON EXCHANGE without dental - CSR - 94%SOBSBC
NH Local Choice HMO Silver 300 CSR94 MD0000201036
NH Local Choice HMO Silver Copay 400 CSR94 MD0000201035
NH Local Choice HMO Silver 350 CSR94 MD0000201033
NH Local Choice HMO Silver 450 CSR94 MD0000201051
NH Local HMO Silver Standard CSR94 MD0000201047