2025 Schedules of Benefits and SBCs: Maine

Small group effective 1/1/25

HMO - OFF EXCHANGE with dental SOBSBC
Clear Choice HMO Gold 1500 MD0000201461
Clear Choice HMO Gold 2500 MD0000201462
Clear Choice HMO Silver 3500 MD0000201463
Clear Choice HMO Silver 4200 MD0000201465
Clear Choice HMO Bronze 7500 MD0000201466
Clear Choice HMO Bronze 9200 MD0000201467
HMO Silver 5700 MD0000201499
Clear Choice HMO HSA Silver 3500 MD0000201468
Clear Choice HMO HSA Silver 4500 MD0000201483
Clear Choice HMO HSA Bronze 6300 MD0000201469
Clear Choice HMO HSA Bronze 7200 MD0000201471
HMO HSA Bronze 5500 MD0000201473
Clear Choice Maine's Choice Plus HMO Gold 1500 MD0000201502
Clear Choice Maine's Choice Plus HMO Gold 2500 MD0000201503
Clear Choice Maine's Choice Plus HMO Silver 3500 MD0000201504
Clear Choice Maine's Choice Plus HMO Silver 4200 MD0000201512
Clear Choice Maine's Choice Plus HMO Silver 4200 w/ Pedi Dental MD0000201538
Clear Choice Maine's Choice Plus HMO Bronze 7500 MD0000201537
Maine's Choice Plus HMO Silver 5700 MD0000201535
Clear Choice Maine's Choice Plus HMO HSA Silver 3500 MD0000201506
Clear Choice Maine's Choice Plus HMO HSA Silver 4500 MD0000201507
Clear Choice Maine's Choice Plus HMO HSA Bronze 6300 MD0000201495
Clear Choice Maine's Choice Plus HMO HSA Bronze 7200 MD0000201513
Maine's Choice Plus HMO HSA Bronze 5500 MD0000201520
PPO - OFF EXCHANGE with dental SOBSBC
Clear Choice PPO Access Gold 1500 MD0000201500
Clear Choice PPO Access Gold 2500 MD0000201515
Clear Choice PPO Access Silver 3500 MD0000201516
Clear Choice PPO Access Silver 4200 MD0000201531
Clear Choice PPO Access Bronze 9200 MD0000201523
PPO Access Silver 5700 MD0000201532
Clear Choice PPO Access HSA Silver 3500 MD0000201485
Clear Choice PPO Access HSA Silver 4500 MD0000201488
Clear Choice PPO Access HSA Bronze 6300 MD0000201489
Clear Choice PPO Access HSA Bronze 7200 MD0000201490
PPO Access HSA Bronze 5500 MD0000201508
POS - OFF EXCHANGE with dental SOBSBC
Clear Choice POS Silver 3500 MD0000201486
Clear Choice POS Silver 4200 MD0000201491
Clear Choice POS Bronze 7500 MD0000201487
POS Silver 5700 MD0000201501
Clear Choice POS HSA Silver 4500 MD0000201492
Clear Choice POS HSA Bronze 6300 MD0000201494
Clear Choice POS HSA Bronze 7200 MD0000201493