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Home > Broker > Plan Information > Schedules of Benefits and SBCs > Schedule of Benefits and SBCs - CT 2016

Schedules of Benefits and SBCs: Connecticut

Small Group effective 1/1/16

HMO - OFF EXCHANGE with Dental SOB SBC
Best Buy Tiered Copay OA HMO Hospital 3500 MD0000003754
Best Buy HSA OA HMO 2000 MD0000003750
Best Buy HSA OA HMO 3000 MD0000003753
Best Buy HSA OA HMO 6100 MD0000003756
Best Buy HSA OA HMO 2700 MD0000003752
Best Buy Tiered Copay OA HMO Hospital 2000 MD0000003751
Best Buy Tiered Copay OA HMO Hospital 4500 MD0000003755
Tiered Copay OA HMO 20/35 MD0000003757

PPO - OFF EXCHANGE with Dental SOB SBC
PPO Coinsurance 30% MD0000003777
Best Buy PPO 3 Free PCP 3000 MD0000003767
Best Buy PPO 3 Free PCP 1500 MD0000003759
Best Buy Tiered Copay PPO Hospital 3500 MD0000003770
Best Buy HSA PPO 6000 - CB MD0000003776
Best Buy HSA PPO 4000 - CB MD0000003772
Best Buy HSA PPO 2750 - CB MD0000003765
Best Buy HSA PPO 2000 MD0000003761
Best Buy HSA PPO 3000 MD0000003768
Best Buy Tiered Copay PPO Hospital 2000 - CB MD0000003762
Best Buy Tiered Copay PPO Hospital 3000 - CB MD0000003769
Best Buy HSA PPO 5500 MD0000003775
Tiered Copay PPO 20/35 MD0000003758
Best Buy Tiered Copay PPO Hospital 2000 MD0000003763
Best Buy Tiered Copay PPO Hospital 4500 MD0000003774
Best Buy Tiered Copay PPO Hospital 1500 - CB MD0000003760
Best Buy PPO 2500 - CB MD0000003764
Best Buy Tiered Copay PPO Hospital 2850 - CB MD0000003766
Best Buy Tiered Copay PPO 4000 - CB MD0000003773
Best Buy Tiered Copay PPO Hospital 3500 - CB MD0000003771