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Home > Members > ME 2019 Individual Market

Schedules of Benefits and SBCs: Maine

Individual Market effective 1/1/19

HMO - ON EXCHANGE without Dental SOB SBC
HMO Gold 1500 MD0000004883
HMO HSA Bronze 5400 MD0000004885
HMO Bronze 6500 MD0000004886
HMO Silver 2500 MD0000004887
Maine's ChoiceSM HMO Silver 2500 Casco MD0000004891
Maine's ChoiceSM HMO Silver 4500 Pemaquid MD0000004896
Maine's ChoiceSM HMO HSA Bronze 5000 MD0000004900

HMO - ON EXCHANGE without Dental - AI/AN - $0 SOB SBC
HMO MD0000004884
HMO MD0000004884
HMO MD0000004884
HMO MD0000004884
Maine's ChoiceSM HMO MD0000004895
Maine's ChoiceSM HMO MD0000004895
Maine's ChoiceSM HMO MD0000004895

HMO - ON EXCHANGE without Dental - AI/AN - LIMITED SOB SBC
HMO Gold 1500 MD0000004883
HMO HSA Bronze 5400 MD0000004885
HMO Bronze 6500 MD0000004886
HMO Silver 2500 MD0000004887
Maine's ChoiceSM HMO Silver 2500 Casco MD0000004891
Maine's ChoiceSM HMO Silver 4500 Pemaquid MD0000004896
Maine's ChoiceSM HMO HSA Bronze 5000 MD0000004900

HMO - ON EXCHANGE without Dental - CSR - 73% SOB SBC
HMO Silver 2500 CSR73 MD0000004890
Maine's ChoiceSM HMO Silver 2500 Casco CSR73 MD0000004894
Maine's ChoiceSM HMO Silver 4500 Pemaquid CSR73 MD0000004899

HMO - ON EXCHANGE without Dental - CSR - 87% SOB SBC
HMO Silver 2500 CSR87 MD0000004889
Maine's ChoiceSM HMO Silver 2500 Casco CSR87 MD0000004893
Maine's ChoiceSM HMO Silver 4500 Pemaquid CSR87 MD0000004898

HMO - ON EXCHANGE without Dental - CSR - 94% SOB SBC
HMO Silver 2500 CSR94 MD0000004888
Maine's ChoiceSM HMO Silver 2500 Casco CSR94 MD0000004892
Maine's ChoiceSM HMO Silver 4500 Pemaquid CSR94 MD0000004897

HMO - OFF EXCHANGE with Dental SOB SBC
HMO Gold 1500 MD0000004883
HMO HSA Bronze 5400 MD0000004885
HMO Bronze 6500 MD0000004886
HMO Silver 2500 MD0000004887
Maine's ChoiceSM HMO Silver 2500 Casco MD0000004891
Maine's ChoiceSM HMO Silver 4500 Pemaquid MD0000004896
Maine's ChoiceSM HMO HSA Bronze 5000 MD0000004900
Maine's ChoiceSM HMO Silver 4000 MD0000004901
HMO Silver 5000 MD0000004902

HMO - OFF EXCHANGE without Dental SOB SBC
HMO Gold 1500 MD0000004883
HMO HSA Bronze 5400 MD0000004885
HMO Bronze 6500 MD0000004886
HMO Silver 2500 MD0000004887
Maine's ChoiceSM HMO Silver 2500 Casco MD0000004891
Maine's ChoiceSM HMO Silver 4500 Pemaquid MD0000004896
Maine's ChoiceSM HMO HSA Bronze 5000 MD0000004900
Maine's ChoiceSM HMO Silver 4000 MD0000004901
HMO Silver 5000 MD0000004902