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Home > Members > ME 2016 Individual Market

Schedules of Benefits and SBCs: Maine

Individual Market effective 1/1/16

HMO - ON EXCHANGE without Dental SOB SBC
Gold HMO 1000 MD0000003653
Silver HMO MD0000003656
Best Buy HSA HMO 5000 MD0000003660
Bronze HMO 6000 MD0000003662
Maine's ChoiceSM Casco Silver HMO MD0000003784
Maine's ChoiceSM Sebago Silver HMO MD0000003788
Maine's ChoiceSM Pemaquid Silver HMO MD0000003794
Maine's ChoiceSM Gold HMO MD0000003798

HMO - ON EXCHANGE without Dental - AI/AN - $0 SOB SBC
HMO MD0000003645
HMO MD0000003645
HMO MD0000003645
HMO MD0000003645
Maine's ChoiceSM HMO MD0000003802
Maine's ChoiceSM HMO MD0000003802
Maine's ChoiceSM HMO MD0000003802
Maine's ChoiceSM HMO MD0000003802

HMO - ON EXCHANGE without Dental - AI/AN - LIMITED SOB SBC
Gold HMO 1000 MD0000003653
Silver HMO MD0000003656
Best Buy HSA HMO 5000 MD0000003660
Bronze HMO 6000 MD0000003662
Maine's ChoiceSM Casco Silver HMO MD0000003784
Maine's ChoiceSM Sebago Silver HMO MD0000003788
Maine's ChoiceSM Pemaquid Silver HMO MD0000003794
Maine's ChoiceSM Gold HMO MD0000003798

HMO - ON EXCHANGE without Dental - CSR - 73% SOB SBC
Silver HMO MD0000003655
Maine's ChoiceSM Casco Silver HMO MD0000003783
Maine's ChoiceSM Sebago Silver HMO MD0000003787
Maine's ChoiceSM Pemaquid Silver HMO MD0000003792

HMO - ON EXCHANGE without Dental - CSR - 87% SOB SBC
Silver HMO MD0000003652
Maine's ChoiceSM Casco Silver HMO MD0000003795
Maine's ChoiceSM Sebago Silver HMO MD0000003796
Maine's ChoiceSM Pemaquid Silver HMO MD0000003797

HMO - ON EXCHANGE without Dental - CSR - 94% SOB SBC
Silver HMO MD0000003651
Maine's ChoiceSM Casco Silver HMO MD0000003785
Maine's ChoiceSM Sebago Silver HMO MD0000003790
Maine's ChoiceSM Pemaquid Silver HMO MD0000003791

HMO - OFF EXCHANGE with Dental SOB SBC
Gold HMO 1000 MD0000003653
Silver HMO MD0000003656
Best Buy HSA HMO 5000 MD0000003660
Bronze HMO 6000 MD0000003662
Maine's ChoiceSM Casco Silver HMO MD0000003784
Maine's ChoiceSM Sebago Silver HMO MD0000003788
Maine's ChoiceSM Pemaquid Silver HMO MD0000003794
Maine's ChoiceSM Gold HMO MD0000003798

HMO - OFF EXCHANGE without Dental SOB SBC
Gold HMO 1000 MD0000003653
Silver HMO MD0000003656
Best Buy HSA HMO 5000 MD0000003660
Bronze HMO 6000 MD0000003662
Maine's ChoiceSM Casco Silver HMO MD0000003784
Maine's ChoiceSM Sebago Silver HMO MD0000003788
Maine's ChoiceSM Pemaquid Silver HMO MD0000003794
Maine's ChoiceSM Gold HMO MD0000003798

PPO - OFF EXCHANGE with Dental SOB SBC
Best Buy HSA PPO 5000 MD0000003673

PPO - OFF EXCHANGE without Dental SOB SBC
Best Buy HSA PPO 5000 MD0000003673