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Home > Broker > Plan Information > Schedules of Benefits and SBCs > Schedule of Benefits and SBCs - ME 2018

Schedules of Benefits and SBCs: Maine

Small Group effective 1/1/18

HMO - OFF EXCHANGE with Dental SOB SBC
Maine Difference HMO 1500 MD0000004546
Maine Difference HMO 2500 MD0000004547
Maine Difference HMO 3150 MD0000004548
Maine Difference HMO 3150 MD0000004548
Maine Difference HMO 4500 MD0000004549
Maine Difference HMO 4500 MD0000004549
Maine Difference HMO 5000 MD0000004550
Maine Difference HMO 5000 MD0000004550
Core Coverage HMO 5000 MD0000004551
Best Buy HSA HMO 2800 MD0000004561
Best Buy HSA HMO 3500 MD0000004562
Best Buy HSA HMO 4750 MD0000004563
Best Buy HSA HMO 5300 MD0000004564
Best Buy HSA HMO 6250 MD0000004565
Maine's ChoiceSM HMO 1250 MD0000004572
Maine's ChoiceSM HMO 2000 MD0000004573
Maine's ChoiceSM HMO 3500 MD0000004574
Maine's ChoiceSM Best Buy HSA HMO 3000 MD0000004575
Maine's ChoiceSM Best Buy HSA HMO 4000 MD0000004576
Core Coverage HMO 5000 MD0000004551

HMO - OFF EXCHANGE without Dental SOB SBC
Maine Difference HMO 1500 MD0000004546
Maine Difference HMO 2500 MD0000004547
Maine Difference HMO 3150 MD0000004548
Maine Difference HMO 3150 MD0000004548
Maine Difference HMO 4500 MD0000004549
Maine Difference HMO 4500 MD0000004549
Maine Difference HMO 5000 MD0000004550
Maine Difference HMO 5000 MD0000004550
Core Coverage HMO 5000 MD0000004551
Best Buy HSA HMO 2800 MD0000004561
Best Buy HSA HMO 3500 MD0000004562
Best Buy HSA HMO 4750 MD0000004563
Best Buy HSA HMO 5300 MD0000004564
Best Buy HSA HMO 6250 MD0000004565
Maine's ChoiceSM HMO 1250 MD0000004572
Maine's ChoiceSM HMO 2000 MD0000004573
Maine's ChoiceSM HMO 3500 MD0000004574
Maine's ChoiceSM Best Buy HSA HMO 3000 MD0000004575
Maine's ChoiceSM Best Buy HSA HMO 4000 MD0000004576
Core Coverage HMO 5000 MD0000004551

POS - OFF EXCHANGE with Dental SOB SBC
POS 2000 MD0000004552
POS 3500 MD0000004553
POS 3500 MD0000004553
POS 5500 MD0000004554
POS 5500 MD0000004554
HSA POS 3250 MD0000004570
HSA POS 5550 MD0000004571

POS - OFF EXCHANGE without Dental SOB SBC
POS 2000 MD0000004552
POS 3500 MD0000004553
POS 3500 MD0000004553
POS 5500 MD0000004554
POS 5500 MD0000004554
HSA POS 3250 MD0000004570
HSA POS 5550 MD0000004571

PPO - OFF EXCHANGE with Dental SOB SBC
PPO 1500 MD0000004555
PPO 2500 MD0000004556
PPO 3150 MD0000004557
PPO 3150 MD0000004557
PPO 4500 MD0000004558
PPO 4500 MD0000004558
PPO 5000 MD0000004559
PPO 5000 MD0000004559
Core Coverage PPO 3000 MD0000004560
Core Coverage PPO 3000 MD0000004560
Best Buy HSA PPO 2800 MD0000004566
Best Buy HSA PPO 3500 MD0000004567
Best Buy HSA PPO 4750 MD0000004568
Best Buy HSA PPO 5300 MD0000004569

PPO - OFF EXCHANGE without Dental SOB SBC
PPO 1500 MD0000004555
PPO 2500 MD0000004556
PPO 3150 MD0000004557
PPO 3150 MD0000004557
PPO 4500 MD0000004558
PPO 4500 MD0000004558
PPO 5000 MD0000004559
PPO 5000 MD0000004559
Core Coverage PPO 3000 MD0000004560
Core Coverage PPO 3000 MD0000004560
Best Buy HSA PPO 2800 MD0000004566
Best Buy HSA PPO 3500 MD0000004567
Best Buy HSA PPO 4750 MD0000004568
Best Buy HSA PPO 5300 MD0000004569