Schedules of Benefits and SBCs: Maine

Individual Market effective 1/1/22

HMO - OFF EXCHANGE with Dental	SOB	SBC
HMO Gold 1500 Clear Choice MD0000100377	Show HMO Gold 1500 Clear Choice SOB	Show HMO Gold 1500 Clear Choice SBC

RX: RX0000100263 Vision: VS0000100127
HMO Bronze 7500 Clear Choice MD0000100380	Show HMO Bronze 7500 Clear Choice SOB	Show HMO Bronze 7500 Clear Choice SBC

RX: RX0000100265 Vision: VS0000100130
HMO Bronze 8700 Clear Choice MD0000100382	Show HMO Bronze 8700 Clear Choice SOB	Show HMO Bronze 8700 Clear Choice SBC

RX: RX0000100266 Vision: VS0000100130
HMO HSA Bronze 5900 Clear Choice MD0000100384	Show HMO HSA Bronze 5900 Clear Choice SOB	Show HMO HSA Bronze 5900 Clear Choice SBC

RX: RX0000100267 Vision: VS0000100149
HMO HSA Bronze 7000 Clear Choice MD0000100386	Show HMO HSA Bronze 7000 Clear Choice SOB	Show HMO HSA Bronze 7000 Clear Choice SBC

RX: RX0000100268 Vision: VS0000100131
HMO HSA Silver 3500 Clear Choice MD0000100387	Show HMO HSA Silver 3500 Clear Choice SOB	Show HMO HSA Silver 3500 Clear Choice SBC

RX: RX0000100269 Vision: VS0000100131
HMO HSA Silver 4500 Clear Choice MD0000100388	Show HMO HSA Silver 4500 Clear Choice SOB	Show HMO HSA Silver 4500 Clear Choice SBC

RX: RX0000100270 Vision: VS0000100131
Maine's Choice Plus℠ HMO Gold 1500 Clear Choice MD0000100390	Show Maine's Choice Plus℠ HMO Gold 1500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Gold 1500 Clear Choice SBC

RX: RX0000100271 Vision: VS0000100127
Maine's Choice Plus℠ HMO Bronze 7500 Clear Choice MD0000100393	Show Maine's Choice Plus℠ HMO Bronze 7500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Bronze 7500 Clear Choice SBC

RX: RX0000100272 Vision: VS0000100130
Maine's Choice Plus℠ HMO HSA Bronze 5900 Clear Choice MD0000100395	Show Maine's Choice Plus℠ HMO HSA Bronze 5900 Clear Choice SOB	Show Maine's Choice Plus℠ HMO HSA Bronze 5900 Clear Choice SBC

RX: RX0000100273 Vision: VS0000100149
Maine's Choice Plus℠ HMO HSA Silver 3500 Clear Choice MD0000100396	Show Maine's Choice Plus℠ HMO HSA Silver 3500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO HSA Silver 3500 Clear Choice SBC

RX: RX0000100274 Vision: VS0000100131
Maine's Choice Plus℠ HMO HSA Silver 4500 Clear Choice MD0000100397	Show Maine's Choice Plus℠ HMO HSA Silver 4500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO HSA Silver 4500 Clear Choice SBC

RX: RX0000100275 Vision: VS0000100131
HMO Catastrophic 8700 Clear Choice MD0000100398	Show HMO Catastrophic 8700 Clear Choice SOB	Show HMO Catastrophic 8700 Clear Choice SBC

RX: RX0000100276 Vision: VS0000100135
HMO Silver 3500 Clear Choice MD0000100399	Show HMO Silver 3500 Clear Choice SOB	Show HMO Silver 3500 Clear Choice SBC

RX: RX0000100277 Vision: VS0000100130
Maine's Choice Plus℠ HMO Silver 3500 Clear Choice MD0000100405	Show Maine's Choice Plus℠ HMO Silver 3500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Silver 3500 Clear Choice SBC

RX: RX0000100281 Vision: VS0000100130
HMO Silver 5500 Clear Choice MD0000100411	Show HMO Silver 5500 Clear Choice SOB	Show HMO Silver 5500 Clear Choice SBC

RX: RX0000100285 Vision: VS0000100147
Maine's Choice Plus℠ HMO Silver 5500 Clear Choice MD0000100416	Show Maine's Choice Plus℠ HMO Silver 5500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Silver 5500 Clear Choice SBC

RX: RX0000100289 Vision: VS0000100147
HMO Bronze 8000 MD0000100463	Show HMO Bronze 8000 SOB	Show HMO Bronze 8000 SBC

RX: RX0000100312 Vision: VS0000100130
Maine's Choice Plus℠ HMO HSA Bronze 6250 MD0000100464	Show Maine's Choice Plus℠ HMO HSA Bronze 6250 SOB	Show Maine's Choice Plus℠ HMO HSA Bronze 6250 SBC

RX: RX0000100313 Vision: VS0000100131
Maine's Choice Plus℠ HMO Silver 4250 MD0000100470	Show Maine's Choice Plus℠ HMO Silver 4250 SOB	Show Maine's Choice Plus℠ HMO Silver 4250 SBC

RX: RX0000100296 Vision: VS0000100130

HMO - OFF EXCHANGE without Dental	SOB	SBC
HMO Gold 1500 Clear Choice MD0000100377	Show HMO Gold 1500 Clear Choice SOB	Show HMO Gold 1500 Clear Choice SBC

RX: RX0000100263 Vision: VS0000100127
HMO Bronze 7500 Clear Choice MD0000100380	Show HMO Bronze 7500 Clear Choice SOB	Show HMO Bronze 7500 Clear Choice SBC

RX: RX0000100265 Vision: VS0000100130
HMO Bronze 8700 Clear Choice MD0000100382	Show HMO Bronze 8700 Clear Choice SOB	Show HMO Bronze 8700 Clear Choice SBC

RX: RX0000100266 Vision: VS0000100130
HMO HSA Bronze 5900 Clear Choice MD0000100384	Show HMO HSA Bronze 5900 Clear Choice SOB	Show HMO HSA Bronze 5900 Clear Choice SBC

RX: RX0000100267 Vision: VS0000100149
HMO HSA Bronze 7000 Clear Choice MD0000100386	Show HMO HSA Bronze 7000 Clear Choice SOB	Show HMO HSA Bronze 7000 Clear Choice SBC

RX: RX0000100268 Vision: VS0000100131
HMO HSA Silver 3500 Clear Choice MD0000100387	Show HMO HSA Silver 3500 Clear Choice SOB	Show HMO HSA Silver 3500 Clear Choice SBC

RX: RX0000100269 Vision: VS0000100131
HMO HSA Silver 4500 Clear Choice MD0000100388	Show HMO HSA Silver 4500 Clear Choice SOB	Show HMO HSA Silver 4500 Clear Choice SBC

RX: RX0000100270 Vision: VS0000100131
Maine's Choice Plus℠ HMO Gold 1500 Clear Choice MD0000100390	Show Maine's Choice Plus℠ HMO Gold 1500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Gold 1500 Clear Choice SBC

RX: RX0000100271 Vision: VS0000100127
Maine's Choice Plus℠ HMO Bronze 7500 Clear Choice MD0000100393	Show Maine's Choice Plus℠ HMO Bronze 7500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Bronze 7500 Clear Choice SBC

RX: RX0000100272 Vision: VS0000100130
Maine's Choice Plus℠ HMO HSA Bronze 5900 Clear Choice MD0000100395	Show Maine's Choice Plus℠ HMO HSA Bronze 5900 Clear Choice SOB	Show Maine's Choice Plus℠ HMO HSA Bronze 5900 Clear Choice SBC

RX: RX0000100273 Vision: VS0000100149
Maine's Choice Plus℠ HMO HSA Silver 3500 Clear Choice MD0000100396	Show Maine's Choice Plus℠ HMO HSA Silver 3500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO HSA Silver 3500 Clear Choice SBC

RX: RX0000100274 Vision: VS0000100131
Maine's Choice Plus℠ HMO HSA Silver 4500 Clear Choice MD0000100397	Show Maine's Choice Plus℠ HMO HSA Silver 4500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO HSA Silver 4500 Clear Choice SBC

RX: RX0000100275 Vision: VS0000100131
HMO Catastrophic 8700 Clear Choice MD0000100398	Show HMO Catastrophic 8700 Clear Choice SOB	Show HMO Catastrophic 8700 Clear Choice SBC

RX: RX0000100276 Vision: VS0000100135
HMO Silver 3500 Clear Choice MD0000100401	Show HMO Silver 3500 Clear Choice SOB	Show HMO Silver 3500 Clear Choice SBC

RX: RX0000100277 Vision: VS0000100130
Maine's Choice Plus℠ HMO Silver 3500 Clear Choice MD0000100407	Show Maine's Choice Plus℠ HMO Silver 3500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Silver 3500 Clear Choice SBC

RX: RX0000100281 Vision: VS0000100130
HMO Silver 5500 Clear Choice MD0000100575	Show HMO Silver 5500 Clear Choice SOB	Show HMO Silver 5500 Clear Choice SBC

RX: RX0000100285 Vision: VS0000100147
Maine's Choice Plus℠ HMO Silver 5500 Clear Choice MD0000100576	Show Maine's Choice Plus℠ HMO Silver 5500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Silver 5500 Clear Choice SBC

RX: RX0000100289 Vision: VS0000100147
HMO Bronze 8000 MD0000100463	Show HMO Bronze 8000 SOB	Show HMO Bronze 8000 SBC

RX: RX0000100312 Vision: VS0000100130
Maine's Choice Plus℠ HMO HSA Bronze 6250 MD0000100464	Show Maine's Choice Plus℠ HMO HSA Bronze 6250 SOB	Show Maine's Choice Plus℠ HMO HSA Bronze 6250 SBC

RX: RX0000100313 Vision: VS0000100131
Maine's Choice Plus℠ HMO Silver 4250 MD0000100471	Show Maine's Choice Plus℠ HMO Silver 4250 SOB	Show Maine's Choice Plus℠ HMO Silver 4250 SBC

RX: RX0000100296 Vision: VS0000100130

HMO - ON EXCHANGE without Dental	SOB	SBC
HMO Gold 1500 Clear Choice MD0000100377	Show HMO Gold 1500 Clear Choice SOB	Show HMO Gold 1500 Clear Choice SBC

RX: RX0000100263 Vision: VS0000100127
HMO Bronze 7500 Clear Choice MD0000100380	Show HMO Bronze 7500 Clear Choice SOB	Show HMO Bronze 7500 Clear Choice SBC

RX: RX0000100265 Vision: VS0000100130
HMO Bronze 8700 Clear Choice MD0000100382	Show HMO Bronze 8700 Clear Choice SOB	Show HMO Bronze 8700 Clear Choice SBC

RX: RX0000100266 Vision: VS0000100130
HMO HSA Bronze 5900 Clear Choice MD0000100384	Show HMO HSA Bronze 5900 Clear Choice SOB	Show HMO HSA Bronze 5900 Clear Choice SBC

RX: RX0000100267 Vision: VS0000100149
HMO HSA Bronze 7000 Clear Choice MD0000100386	Show HMO HSA Bronze 7000 Clear Choice SOB	Show HMO HSA Bronze 7000 Clear Choice SBC

RX: RX0000100268 Vision: VS0000100131
Maine's Choice Plus℠ HMO Gold 1500 Clear Choice MD0000100390	Show Maine's Choice Plus℠ HMO Gold 1500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Gold 1500 Clear Choice SBC

RX: RX0000100271 Vision: VS0000100127
Maine's Choice Plus℠ HMO Bronze 7500 Clear Choice MD0000100393	Show Maine's Choice Plus℠ HMO Bronze 7500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Bronze 7500 Clear Choice SBC

RX: RX0000100272 Vision: VS0000100130
Maine's Choice Plus℠ HMO HSA Bronze 5900 Clear Choice MD0000100395	Show Maine's Choice Plus℠ HMO HSA Bronze 5900 Clear Choice SOB	Show Maine's Choice Plus℠ HMO HSA Bronze 5900 Clear Choice SBC

RX: RX0000100273 Vision: VS0000100149
HMO Catastrophic 8700 Clear Choice MD0000100398	Show HMO Catastrophic 8700 Clear Choice SOB	Show HMO Catastrophic 8700 Clear Choice SBC

RX: RX0000100276 Vision: VS0000100135
HMO Silver 3500 Clear Choice MD0000100401	Show HMO Silver 3500 Clear Choice SOB	Show HMO Silver 3500 Clear Choice SBC

RX: RX0000100277 Vision: VS0000100130
Maine's Choice Plus℠ HMO Silver 3500 Clear Choice MD0000100407	Show Maine's Choice Plus℠ HMO Silver 3500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Silver 3500 Clear Choice SBC

RX: RX0000100281 Vision: VS0000100130
HMO Silver 5500 Clear Choice MD0000100575	Show HMO Silver 5500 Clear Choice SOB	Show HMO Silver 5500 Clear Choice SBC

RX: RX0000100285 Vision: VS0000100147
Maine's Choice Plus℠ HMO Silver 5500 Clear Choice MD0000100576	Show Maine's Choice Plus℠ HMO Silver 5500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Silver 5500 Clear Choice SBC

RX: RX0000100289 Vision: VS0000100147
HMO Bronze 8000 MD0000100463	Show HMO Bronze 8000 SOB	Show HMO Bronze 8000 SBC

RX: RX0000100312 Vision: VS0000100130
Maine's Choice Plus℠ HMO HSA Bronze 6250 MD0000100464	Show Maine's Choice Plus℠ HMO HSA Bronze 6250 SOB	Show Maine's Choice Plus℠ HMO HSA Bronze 6250 SBC

RX: RX0000100313 Vision: VS0000100131
Maine's Choice Plus℠ HMO Silver 4250 MD0000100471	Show Maine's Choice Plus℠ HMO Silver 4250 SOB	Show Maine's Choice Plus℠ HMO Silver 4250 SBC

RX: RX0000100296 Vision: VS0000100130

HMO - ON EXCHANGE without Dental - AI/AN - Limited	SOB	SBC
HMO Gold 1500 Clear Choice MD0000100377	Show HMO Gold 1500 Clear Choice SOB	Show HMO Gold 1500 Clear Choice SBC

RX: RX0000100263 Vision: VS0000100127
HMO Bronze 7500 Clear Choice MD0000100380	Show HMO Bronze 7500 Clear Choice SOB	Show HMO Bronze 7500 Clear Choice SBC

RX: RX0000100265 Vision: VS0000100130
HMO Bronze 8700 Clear Choice MD0000100382	Show HMO Bronze 8700 Clear Choice SOB	Show HMO Bronze 8700 Clear Choice SBC

RX: RX0000100266 Vision: VS0000100130
HMO HSA Bronze 5900 Clear Choice MD0000100384	Show HMO HSA Bronze 5900 Clear Choice SOB	Show HMO HSA Bronze 5900 Clear Choice SBC

RX: RX0000100267 Vision: VS0000100149
HMO HSA Bronze 7000 Clear Choice MD0000100386	Show HMO HSA Bronze 7000 Clear Choice SOB	Show HMO HSA Bronze 7000 Clear Choice SBC

RX: RX0000100268 Vision: VS0000100131
Maine's Choice Plus℠ HMO Gold 1500 Clear Choice MD0000100390	Show Maine's Choice Plus℠ HMO Gold 1500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Gold 1500 Clear Choice SBC

RX: RX0000100271 Vision: VS0000100127
Maine's Choice Plus℠ HMO Bronze 7500 Clear Choice MD0000100393	Show Maine's Choice Plus℠ HMO Bronze 7500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Bronze 7500 Clear Choice SBC

RX: RX0000100272 Vision: VS0000100130
Maine's Choice Plus℠ HMO HSA Bronze 5900 Clear Choice MD0000100395	Show Maine's Choice Plus℠ HMO HSA Bronze 5900 Clear Choice SOB	Show Maine's Choice Plus℠ HMO HSA Bronze 5900 Clear Choice SBC

RX: RX0000100273 Vision: VS0000100149
HMO Silver 3500 Clear Choice MD0000100401	Show HMO Silver 3500 Clear Choice SOB	Show HMO Silver 3500 Clear Choice SBC

RX: RX0000100277 Vision: VS0000100130
Maine's Choice Plus℠ HMO Silver 3500 Clear Choice MD0000100407	Show Maine's Choice Plus℠ HMO Silver 3500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Silver 3500 Clear Choice SBC

RX: RX0000100281 Vision: VS0000100130
HMO Silver 5500 Clear Choice MD0000100575	Show HMO Silver 5500 Clear Choice SOB	Show HMO Silver 5500 Clear Choice SBC

RX: RX0000100285 Vision: VS0000100147
Maine's Choice Plus℠ HMO Silver 5500 Clear Choice MD0000100576	Show Maine's Choice Plus℠ HMO Silver 5500 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Silver 5500 Clear Choice SBC

RX: RX0000100289 Vision: VS0000100147
HMO Bronze 8000 MD0000100463	Show HMO Bronze 8000 SOB	Show HMO Bronze 8000 SBC

RX: RX0000100312 Vision: VS0000100130
Maine's Choice Plus℠ HMO HSA Bronze 6250 MD0000100464	Show Maine's Choice Plus℠ HMO HSA Bronze 6250 SOB	Show Maine's Choice Plus℠ HMO HSA Bronze 6250 SBC

RX: RX0000100313 Vision: VS0000100131
Maine's Choice Plus℠ HMO Silver 4250 MD0000100471	Show Maine's Choice Plus℠ HMO Silver 4250 SOB	Show Maine's Choice Plus℠ HMO Silver 4250 SBC

RX: RX0000100296 Vision: VS0000100130

HMO - ON EXCHANGE without Dental - AI/AN - $0	SOB	SBC
HMO MD0000100378	Show HMO SOB	Show HMO SBC

RX: RX0000100264 Vision: VS0000100128
HMO MD0000100378	Show HMO SOB	Show HMO SBC

RX: RX0000100264 Vision: VS0000100128
HMO MD0000100378	Show HMO SOB	Show HMO SBC

RX: RX0000100264 Vision: VS0000100128
HMO MD0000100378	Show HMO SOB	Show HMO SBC

RX: RX0000100264 Vision: VS0000100128
HMO MD0000100378	Show HMO SOB	Show HMO SBC

RX: RX0000100264 Vision: VS0000100128
Maine's Choice Plus℠ HMO MD0000100391	Show Maine's Choice Plus℠ HMO SOB	Show Maine's Choice Plus℠ HMO SBC

RX: RX0000100264 Vision: VS0000100128
Maine's Choice Plus℠ HMO MD0000100391	Show Maine's Choice Plus℠ HMO SOB	Show Maine's Choice Plus℠ HMO SBC

RX: RX0000100264 Vision: VS0000100128
Maine's Choice Plus℠ HMO MD0000100391	Show Maine's Choice Plus℠ HMO SOB	Show Maine's Choice Plus℠ HMO SBC

RX: RX0000100264 Vision: VS0000100128
HMO MD0000100378	Show HMO SOB	Show HMO SBC

RX: RX0000100264 Vision: VS0000100128
Maine's Choice Plus℠ HMO MD0000100391	Show Maine's Choice Plus℠ HMO SOB	Show Maine's Choice Plus℠ HMO SBC

RX: RX0000100264 Vision: VS0000100128
HMO MD0000100378	Show HMO SOB	Show HMO SBC

RX: RX0000100264 Vision: VS0000100128
Maine's Choice Plus℠ HMO MD0000100391	Show Maine's Choice Plus℠ HMO SOB	Show Maine's Choice Plus℠ HMO SBC

RX: RX0000100264 Vision: VS0000100128
HMO MD0000100378	Show HMO SOB	Show HMO SBC

RX: RX0000100264 Vision: VS0000100128
Maine's Choice Plus℠ HMO MD0000100391	Show Maine's Choice Plus℠ HMO SOB	Show Maine's Choice Plus℠ HMO SBC

RX: RX0000100264 Vision: VS0000100128
Maine's Choice Plus℠ HMO MD0000100391	Show Maine's Choice Plus℠ HMO SOB	Show Maine's Choice Plus℠ HMO SBC

RX: RX0000100264 Vision: VS0000100128

HMO - ON EXCHANGE without Dental - CSR - 94%	SOB	SBC
HMO Silver 3500 CSR94 Clear Choice MD0000100402	Show HMO Silver 3500 CSR94 Clear Choice SOB	Show HMO Silver 3500 CSR94 Clear Choice SBC

RX: RX0000100278 Vision: VS0000100136
Maine's Choice Plus℠ HMO Silver 3500 CSR94 Clear Choice MD0000100408	Show Maine's Choice Plus℠ HMO Silver 3500 CSR94 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Silver 3500 CSR94 Clear Choice SBC

RX: RX0000100282 Vision: VS0000100132
HMO Silver 5500 CSR94 Clear Choice MD0000100413	Show HMO Silver 5500 CSR94 Clear Choice SOB	Show HMO Silver 5500 CSR94 Clear Choice SBC

RX: RX0000100286 Vision: VS0000100132
Maine's Choice Plus℠ HMO Silver 5500 CSR94 Clear Choice MD0000100418	Show Maine's Choice Plus℠ HMO Silver 5500 CSR94 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Silver 5500 CSR94 Clear Choice SBC

RX: RX0000100290 Vision: VS0000100142
Maine's Choice Plus℠ HMO Silver 4250 CSR94 MD0000100472	Show Maine's Choice Plus℠ HMO Silver 4250 CSR94 SOB	Show Maine's Choice Plus℠ HMO Silver 4250 CSR94 SBC

RX: RX0000100319 Vision: VS0000100132

HMO - ON EXCHANGE without Dental - CSR - 87%	SOB	SBC
HMO Silver 3500 CSR87 Clear Choice MD0000100403	Show HMO Silver 3500 CSR87 Clear Choice SOB	Show HMO Silver 3500 CSR87 Clear Choice SBC

RX: RX0000100279 Vision: VS0000100137
Maine's Choice Plus℠ HMO Silver 3500 CSR87 Clear Choice MD0000100409	Show Maine's Choice Plus℠ HMO Silver 3500 CSR87 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Silver 3500 CSR87 Clear Choice SBC

RX: RX0000100283 Vision: VS0000100140
HMO Silver 5500 CSR87 Clear Choice MD0000100414	Show HMO Silver 5500 CSR87 Clear Choice SOB	Show HMO Silver 5500 CSR87 Clear Choice SBC

RX: RX0000100287 Vision: VS0000100133
Maine's Choice Plus℠ HMO Silver 5500 CSR87 Clear Choice MD0000100419	Show Maine's Choice Plus℠ HMO Silver 5500 CSR87 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Silver 5500 CSR87 Clear Choice SBC

RX: RX0000100291 Vision: VS0000100140
Maine's Choice Plus℠ HMO Silver 4250 CSR87 MD0000100473	Show Maine's Choice Plus℠ HMO Silver 4250 CSR87 SOB	Show Maine's Choice Plus℠ HMO Silver 4250 CSR87 SBC

RX: RX0000100320 Vision: VS0000100140

HMO - ON EXCHANGE without Dental - CSR - 73%	SOB	SBC
HMO Silver 3500 CSR73 Clear Choice MD0000100404	Show HMO Silver 3500 CSR73 Clear Choice SOB	Show HMO Silver 3500 CSR73 Clear Choice SBC

RX: RX0000100280 Vision: VS0000100161
Maine's Choice Plus℠ HMO Silver 3500 CSR73 Clear Choice MD0000100410	Show Maine's Choice Plus℠ HMO Silver 3500 CSR73 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Silver 3500 CSR73 Clear Choice SBC

RX: RX0000100284 Vision: VS0000100141
HMO Silver 5500 CSR73 Clear Choice MD0000100415	Show HMO Silver 5500 CSR73 Clear Choice SOB	Show HMO Silver 5500 CSR73 Clear Choice SBC

RX: RX0000100288 Vision: VS0000100162
Maine's Choice Plus℠ HMO Silver 5500 CSR73 Clear Choice MD0000100420	Show Maine's Choice Plus℠ HMO Silver 5500 CSR73 Clear Choice SOB	Show Maine's Choice Plus℠ HMO Silver 5500 CSR73 Clear Choice SBC

RX: RX0000100292 Vision: VS0000100141
Maine's Choice Plus℠ HMO Silver 4250 CSR73 MD0000100474	Show Maine's Choice Plus℠ HMO Silver 4250 CSR73 SOB	Show Maine's Choice Plus℠ HMO Silver 4250 CSR73 SBC

RX: RX0000100321 Vision: VS0000100141

Harvard Pilgrim Member information

Are your meds covered?

New to Medicare?

Medicare plan options

Coaching just for you

Save more

Your Activity Summary

Save time and money

Individual Market effective 1/1/22

Individual & family plans

Are your meds covered?

Medicare plans

New to Medicare?

Aging

Medicare plan options

Behavioral health

Family & maternal health

Individual support

Coaching just for you

Health coaching

Mindfulness

Pharmacy

Wellness

Save more

Discounts & savings

Documents & forms

Your Activity Summary

Emergency room alternatives

Financial tools

Health education

Save time and money

Help

Prior authorizations

Reimbursements

Individual Market effective 1/1/22