2022 Non-Group (Individual) plans: Standard Platinum – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard High Gold – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) HMO 2000 Low – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard Silver Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard High Bronze Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) HMO 3500 – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) 2022 Health Connector for Business plans: Standard Platinum – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard High Gold – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) HMO 2000 Low – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard Silver Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard Low Silver HSA - Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard High Bronze Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) PPO 2000 – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) HMO 3500 – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) 2021 Non-Group (Individual) plans: Standard Platinum – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard High Gold – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) HMO 2000 Low – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard Silver Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard High Bronze Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) HMO 3500 – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) 2021 Health Connector for Business plans: Standard Platinum – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard High Gold – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) HMO 2000 Low – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard Silver Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard Low Silver HSA – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard High Bronze Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) HMO 3500 – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) PPO 2000 – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB)
