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Home > Members > MA 2017 Individual Market

Schedules of Benefits and SBCs: Massachusetts

Individual Market effective 1/1/17

HMO - ON EXCHANGE with Dental SOB SBC
Standard Platinum MD0000004319
Standard Gold MD0000004320
Standard Silver MD0000004321
Standard Bronze MD0000004329
Core Coverage HMO 1750 MD0000004330
Best Buy HMO 2000 MD0000004359

HMO - ON EXCHANGE with Dental - AI/AN - $0 SOB SBC
HMO MD0000004328
HMO MD0000004328
HMO MD0000004328
HMO MD0000004328
HMO MD0000004328
HMO MD0000004328

HMO - ON EXCHANGE with Dental - AI/AN - LIMITED SOB SBC
Standard Platinum MD0000004319
Standard Gold MD0000004320
Standard Silver MD0000004321
Standard Bronze MD0000004329
Core Coverage HMO 1750 MD0000004330
Best Buy HMO 2000 MD0000004359

HMO - OFF EXCHANGE with Dental SOB SBC
Affordable HMO 25 MD0000004360
Focus Network MA- Affordable HMO 25 MD0000004362
Best Buy HMO 1000 MD0000004363
Core Coverage HMO 3000 MD0000004365
Best Buy HMO 3000 MD0000004367
Best Buy HMO 2000 with Coinsurance MD0000004369
Best Buy HMO 1000 with Coinsurance MD0000004371
Best Buy HSA HMO 2000 MD0000004373
Best Buy HSA HMO 3000 MD0000004375
Best Buy HSA HMO 3100 MD0000004377
Best Buy HSA HMO 2000 with Coinsurance MD0000004381
Affordable HMO 40 MD0000004383
Focus Network MA- Best Buy HSA HMO 3100 MD0000004378
Standard Platinum MD0000004319
Standard Gold MD0000004320
Standard Silver MD0000004321
Standard Bronze MD0000004329
Core Coverage HMO 1750 MD0000004330
Best Buy HMO 2000 MD0000004359

HMO - OFF EXCHANGE without Dental SOB SBC
Affordable HMO 25 MD0000004360
Focus Network MA- Affordable HMO 25 MD0000004362
Best Buy HMO 1000 MD0000004363
Core Coverage HMO 3000 MD0000004365
Best Buy HMO 3000 MD0000004367
Best Buy HMO 2000 with Coinsurance MD0000004369
Best Buy HMO 1000 with Coinsurance MD0000004371
Best Buy HSA HMO 2000 MD0000004373
Best Buy HSA HMO 3000 MD0000004375
Best Buy HSA HMO 3100 MD0000004377
Best Buy HSA HMO 2000 with Coinsurance MD0000004381
Affordable HMO 40 MD0000004383
Focus Network MA- Best Buy HSA HMO 3100 MD0000004378
Core Coverage HMO 1750 MD0000004330
Best Buy HMO 2000 MD0000004359

PPO - OFF EXCHANGE with Dental SOB SBC
Affordable PPO 25 MD0000004361
Best Buy PPO 1000 MD0000004364
Best Buy PPO 2000 MD0000004366
Best Buy PPO 3000 MD0000004368
Best Buy PPO 2000 with Coinsurance MD0000004370
Best Buy PPO 1000 with Coinsurance MD0000004372
Best Buy HSA PPO 2000 MD0000004374
Best Buy HSA PPO 3000 MD0000004376
Best Buy HSA PPO 3100 MD0000004379
Best Buy HSA PPO 4500 MD0000004382
Affordable PPO 40 MD0000004384

PPO - OFF EXCHANGE without Dental SOB SBC
Affordable PPO 25 MD0000004361
Best Buy PPO 1000 MD0000004364
Best Buy PPO 2000 MD0000004366
Best Buy PPO 3000 MD0000004368
Best Buy PPO 2000 with Coinsurance MD0000004370
Best Buy PPO 1000 with Coinsurance MD0000004372
Best Buy HSA PPO 2000 MD0000004374
Best Buy HSA PPO 3000 MD0000004376
Best Buy HSA PPO 3100 MD0000004379
Best Buy HSA PPO 4500 MD0000004382
Affordable PPO 40 MD0000004384