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Home > Members > NH 2016 Individual Market

Schedules of Benefits and SBCs: New Hampshire

Individual Market effective 1/1/16

HMO - ON EXCHANGE without Dental SOB SBC
Harvard Pilgrim New Hampshire Network HMO Gold MD0000003681
Harvard Pilgrim ElevateHealth Gold HSA HMO MD0000003687
Harvard Pilgrim ElevateHealth Silver HSA HMO MD0000003699
New Hampshire Network Silver HMO Premium MD0000003694
ElevateHealth Silver HMO MD0000003706
ElevateHealth Bronze HMO MD0000003727
ElevateHealth Gold HMO MD0000003684
Harvard Pilgrim ElevateHealth Bronze HSA HMO MD0000003726
New Hampshire Network Bronze HSA HMO MD0000003716

HMO - ON EXCHANGE without Dental - AI/AN - $0 SOB SBC
Harvard Pilgrim Health Care New Hampshire Network MD0000003731
Harvard Pilgrim Health Care ElevateHealth MD0000003732
Harvard Pilgrim Health Care ElevateHealth MD0000003732
Harvard Pilgrim Health Care New Hampshire Network MD0000003850
Harvard Pilgrim Health Care ElevateHealth MD0000003851
Harvard Pilgrim Health Care ElevateHealth MD0000003732
Harvard Pilgrim Health Care ElevateHealth MD0000003732
Harvard Pilgrim Health Care ElevateHealth MD0000003732
Harvard Pilgrim Health Care New Hampshire Network MD0000003731

HMO - ON EXCHANGE without Dental - AI/AN - LIMITED SOB SBC
Harvard Pilgrim New Hampshire Network HMO Gold MD0000003681
Harvard Pilgrim ElevateHealth Gold HSA HMO MD0000003687
New Hampshire Network Silver HMO Premium MD0000003694
ElevateHealth Silver HMO MD0000003706
ElevateHealth Bronze HMO MD0000003727
ElevateHealth Gold HMO MD0000003684
Harvard Pilgrim ElevateHealth Bronze HSA HMO MD0000003726
New Hampshire Network Bronze HSA HMO MD0000003716
Harvard Pilgrim ElevateHealth Silver HSA HMO MD0000003699

HMO - ON EXCHANGE without Dental - CSR - 73% SOB SBC
Harvard Pilgrim ElevateHealth Silver HSA HMO MD0000003696
New Hampshire Network Silver HMO Premium MD0000003689
ElevateHealth Silver HMO MD0000003700

HMO - ON EXCHANGE without Dental - CSR - 87% SOB SBC
Harvard Pilgrim ElevateHealth Silver HSA HMO MD0000003679
New Hampshire Network Silver HMO Premium MD0000003680
ElevateHealth Silver HMO MD0000003682

HMO - ON EXCHANGE without Dental - CSR - 94% SOB SBC
Harvard Pilgrim ElevateHealth Silver HSA HMO MD0000003674
New Hampshire Network Silver HMO Premium MD0000003675
ElevateHealth Silver HMO MD0000003677

HMO - OFF EXCHANGE with Dental SOB SBC
Harvard Pilgrim New Hampshire Network HMO Gold MD0000003681
Harvard Pilgrim ElevateHealth Gold HSA HMO MD0000003687
Harvard Pilgrim ElevateHealth Silver HSA HMO MD0000003699
New Hampshire Network Silver HMO Premium MD0000003694
ElevateHealth Silver HMO MD0000003706
ElevateHealth Bronze HMO MD0000003727
ElevateHealth Gold HMO MD0000003684
Harvard Pilgrim ElevateHealth Bronze HSA HMO MD0000003726
New Hampshire Network Bronze HSA HMO MD0000003716

HMO - OFF EXCHANGE without Dental SOB SBC
Harvard Pilgrim New Hampshire Network HMO Gold MD0000003681
Harvard Pilgrim ElevateHealth Gold HSA HMO MD0000003687
Harvard Pilgrim ElevateHealth Silver HSA HMO MD0000003699
New Hampshire Network Silver HMO Premium MD0000003694
ElevateHealth Silver HMO MD0000003706
ElevateHealth Bronze HMO MD0000003727
ElevateHealth Gold HMO MD0000003684
Harvard Pilgrim ElevateHealth Bronze HSA HMO MD0000003726
New Hampshire Network Bronze HSA HMO MD0000003716

HMO - OFF EXCHANGE without Dental - AI/AN - $0 PAP SOB SBC
Harvard Pilgrim New Hampshire Network HMO MD0000003801
Harvard Pilgrim ElevateHealth Silver HMO MD0000003799

HMO - OFF EXCHANGE without Dental - CSR - 94% PAP SOB SBC
New Hampshire Network Silver HMO Premium MD0000003676
ElevateHealth Silver HMO MD0000003800