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Home > Members > NH 2018 Individual Market

Schedules of Benefits and SBCs: New Hampshire

Individual Market effective 1/1/18

HMO - ON EXCHANGE without Dental SOB SBC
ElevateHealth Gold 1000 MD0000004482
ElevateHealth Silver 3500 MD0000004485

HMO - ON EXCHANGE without Dental - AI/AN - $0 SOB SBC
ElevateHealth MD0000004483
ElevateHealth MD0000004486

HMO - ON EXCHANGE without Dental - AI/AN - LIMITED SOB SBC
ElevateHealth Silver 3500 MD0000004485
ElevateHealth Gold 1000 MD0000004482

HMO - ON EXCHANGE without Dental - CSR - 73% SOB SBC
ElevateHealth Silver 3000 MD0000004488

HMO - ON EXCHANGE without Dental - CSR - 87% SOB SBC
ElevateHealth Silver 1500 MD0000004489

HMO - ON EXCHANGE without Dental - CSR - 94% SOB SBC
ElevateHealth Silver 375 MD0000004490

HMO - OFF EXCHANGE with Dental SOB SBC
ElevateHealth Options Gold 1000 MD0000004480
ElevateHealth Options Silver 3000 MD0000004481
ElevateHealth Gold 1000 MD0000004482
ElevateHealth Bronze 7000 MD0000004484
ElevateHealth Silver 3500 MD0000004485

HMO - OFF EXCHANGE without Dental SOB SBC
ElevateHealth Options Gold 1000 MD0000004480
ElevateHealth Options Silver 3000 MD0000004481
ElevateHealth Gold 1000 MD0000004482
ElevateHealth Bronze 7000 MD0000004484
ElevateHealth Silver 3500 MD0000004485

HMO - OFF EXCHANGE without Dental - AI/AN - $0 PAP SOB SBC
ElevateHealth MD0000004487

HMO - OFF EXCHANGE without Dental - CSR - 94% PAP SOB SBC
ElevateHealth Silver Premium Assistance Plan MD0000004491