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Home > Members > ME 2020 Individual Market

Schedules of Benefits and SBCs: Maine

Individual Market effective 1/1/20

HMO - ON EXCHANGE without Dental SOB SBC
Maine's ChoiceSM HMO HSA Bronze 5000 MD0000005096
HMO Gold 1500 MD0000005097
HMO Silver 3000 MD0000005099
HMO Bronze 6500 MD0000005103
Maine's ChoiceSM HMO Silver 2700 MD0000005104
Maine's ChoiceSM HMO Silver 4500 MD0000005108
Maine's ChoiceSM HMO Silver 6200 MD0000005112
HMO HSA Bronze 5400 MD0000005117
HMO Catastrophic MD0000005120

HMO - ON EXCHANGE without Dental - AI/AN - $0 SOB SBC
Maine's ChoiceSM HMO MD0000005095
HMO MD0000005098
HMO MD0000005098
HMO MD0000005098
Maine's ChoiceSM HMO MD0000005095
Maine's ChoiceSM HMO MD0000005095
Maine's ChoiceSM HMO MD0000005095
HMO MD0000005098

HMO - ON EXCHANGE without Dental - AI/AN - LIMITED SOB SBC
Maine's ChoiceSM HMO HSA Bronze 5000 MD0000005096
HMO Gold 1500 MD0000005097
HMO Silver 3000 MD0000005099
HMO Bronze 6500 MD0000005103
Maine's ChoiceSM HMO Silver 2700 MD0000005104
Maine's ChoiceSM HMO Silver 4500 MD0000005108
Maine's ChoiceSM HMO Silver 6200 MD0000005112
HMO HSA Bronze 5400 MD0000005117

HMO - ON EXCHANGE without Dental - CSR - 73% SOB SBC
HMO Silver 3000 CSR73 MD0000005102
Maine's ChoiceSM HMO Silver 2700 CSR73 MD0000005107
Maine's ChoiceSM HMO Silver 4500 CSR73 MD0000005111
Maine's ChoiceSM HMO Silver 6200 CSR73 MD0000005115

HMO - ON EXCHANGE without Dental - CSR - 87% SOB SBC
HMO Silver 3000 CSR87 MD0000005101
Maine's ChoiceSM HMO Silver 2700 CSR87 MD0000005106
Maine's ChoiceSM HMO Silver 4500 CSR87 MD0000005110
Maine's ChoiceSM HMO Silver 6200 CSR87 MD0000005114

HMO - ON EXCHANGE without Dental - CSR - 94% SOB SBC
HMO Silver 3000 CSR94 MD0000005100
Maine's ChoiceSM HMO Silver 2700 CSR94 MD0000005105
Maine's ChoiceSM HMO Silver 4500 CSR94 MD0000005109
Maine's ChoiceSM HMO Silver 6200 CSR94 MD0000005113

HMO - OFF EXCHANGE with Dental SOB SBC
Maine's ChoiceSM HMO HSA Bronze 5000 MD0000005096
HMO Gold 1500 MD0000005097
HMO Silver 3000 MD0000005099
HMO Bronze 6500 MD0000005103
Maine's ChoiceSM HMO Silver 2700 MD0000005104
Maine's ChoiceSM HMO Silver 4500 MD0000005108
Maine's ChoiceSM HMO Silver 6200 MD0000005112
HMO HSA Bronze 5400 MD0000005117
HMO 5000 MD0000005118
Maine's ChoiceSM HMO 4500 MD0000005119
HMO Catastrophic MD0000005120

HMO - OFF EXCHANGE without Dental SOB SBC
Maine's ChoiceSM HMO HSA Bronze 5000 MD0000005096
HMO Gold 1500 MD0000005097
HMO Silver 3000 MD0000005099
HMO Bronze 6500 MD0000005103
Maine's ChoiceSM HMO Silver 2700 MD0000005104
Maine's ChoiceSM HMO Silver 4500 MD0000005108
Maine's ChoiceSM HMO Silver 6200 MD0000005112
HMO HSA Bronze 5400 MD0000005117
HMO 5000 MD0000005118
Maine's ChoiceSM HMO 4500 MD0000005119
HMO Catastrophic MD0000005120