Harvard Pilgrim Health Care - Schedule of Benefits and SBCs

Broker Home | About Us | Contact Us | Find a Doctor

	Plan Information
	Medicare Advantage

	CDH/SmartSpend Info Center

	Schedules of Benefits and SBCs

	Administrative Forms
	Marketing Materials
	Medicare Options

Text Size

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

Small Group effective 1/1/16

HMO - ON EXCHANGE without Dental

SOB

SBC

ElevateHealth HMO 2000 MD0000003690

ElevateHealth HMO 4000 MD0000003714

ElevateHealth HSA HMO 6250 MD0000003725

Best Buy Tiered Copayment HMO LP 2000 MD0000003691

ElevateHealth HMO 3000 Low Option MD0000003704

ElevateHealth HSA HMO 3000 MD0000003698

Best Buy Tiered Copayment HMO LP 3000 Low Option MD0000003703

Best Buy Tiered Copayment HMO LP 4000 MD0000003715

Best Buy HSA HMO 6250 MD0000003724

Best Buy HSA HMO 3000 MD0000003697

HMO - OFF EXCHANGE with Dental

SOB

SBC

ElevateHealth HMO 3000 MD0000003705

Best Buy Tiered Copayment HMO LP 3500 MD0000003707

Best Buy Tiered Copayment HMO LP 4000 MD0000003713

Best Buy Tiered Copayment HMO LP 1250 MD0000003683

ElevateHealth HSA HMO 6250 MD0000003725

ElevateHealth HSA HMO 4000 MD0000003710

ElevateHealth HSA HMO 5000 MD0000003720

ElevateHealth HMO 5000 MD0000003718

ElevateHealth HMO 2000 MD0000003690

ElevateHealth HMO 4000 MD0000003714

ElevateHealth HSA HMO 3000 MD0000003698

NH Core Coverage 3000 MD0000003701

Best Buy HSA HMO 3000 MD0000003697

Best Buy Tiered Copayment HMO LP 2000 MD0000003691

Best Buy Tiered Copayment HMO LP 3000 MD0000003702

Best Buy Tiered Copayment HMO LP 3000 Low Option MD0000003703

Best Buy Tiered Copayment HMO LP 4000 MD0000003715

Best Buy Tiered Copayment HMO LP 4000 Low Option MD0000003708

Best Buy Tiered Copayment HMO LP 5000 MD0000003719

ElevateHealth HMO 3000 Low Option MD0000003704

ElevateHealth HMO 4000 Low Option MD0000003709

Best Buy Tiered Copayment HMO 1250 NetOption LP MD0000003728

Best Buy HSA HMO 4000 MD0000003711

Best Buy HSA HMO 5000 MD0000003721

Best Buy HSA HMO 6250 MD0000003724

ElevateHealth HSA HMO 2600 MD0000003779

Best Buy HSA HMO 2600 MD0000003780

HMO - OFF EXCHANGE without Dental

SOB

SBC

ElevateHealth HMO 2000 MD0000003690

ElevateHealth HMO 3000 MD0000003705

ElevateHealth HMO 4000 MD0000003714

ElevateHealth HMO 5000 MD0000003718

ElevateHealth HSA HMO 3000 MD0000003698

NH Core Coverage 3000 MD0000003701

Best Buy HSA HMO 3000 MD0000003697

ElevateHealth HSA HMO 4000 MD0000003710

ElevateHealth HSA HMO 5000 MD0000003720

ElevateHealth HSA HMO 6250 MD0000003725

Best Buy Tiered Copayment HMO LP 1250 MD0000003683

Best Buy Tiered Copayment HMO LP 2000 MD0000003691

Best Buy Tiered Copayment HMO LP 3000 MD0000003702

Best Buy Tiered Copayment HMO LP 3500 MD0000003707

Best Buy Tiered Copayment HMO LP 4000 MD0000003713

Best Buy Tiered Copayment HMO LP 3000 Low Option MD0000003703

Best Buy Tiered Copayment HMO LP 4000 MD0000003715

Best Buy Tiered Copayment HMO LP 4000 Low Option MD0000003708

Best Buy Tiered Copayment HMO LP 5000 MD0000003719

ElevateHealth HMO 3000 Low Option MD0000003704

ElevateHealth HMO 4000 Low Option MD0000003709

Best Buy Tiered Copayment HMO 1250 NetOption LP MD0000003728

Best Buy HSA HMO 4000 MD0000003711

Best Buy HSA HMO 5000 MD0000003721

Best Buy HSA HMO 6250 MD0000003724

ElevateHealth HSA HMO 2600 MD0000003779

Best Buy HSA HMO 2600 MD0000003780

PPO - OFF EXCHANGE with Dental

SOB

SBC

Best Buy HSA PPO 3000 MD0000003740

Best Buy HSA PPO 4000 MD0000003743

Best Buy HSA PPO 4250 MD0000003744

Best Buy HSA PPO 5000 MD0000003747

Best Buy HSA PPO 6250 MD0000003748

Best Buy Tiered Copayment PPO LP 1250 MD0000003733

Best Buy Tiered Copayment PPO LP 2000 MD0000003735

Best Buy Tiered Copayment PPO LP 3000 MD0000003739

Best Buy Tiered Copayment PPO LP 4000 MD0000003742

Best Buy Tiered Copayment PPO LP 5000 MD0000003746

Best Buy HSA PPO 2600 MD0000003781

PPO - OFF EXCHANGE without Dental

SOB

SBC

Best Buy HSA PPO 3000 MD0000003740

Best Buy HSA PPO 4000 MD0000003743

Best Buy HSA PPO 4250 MD0000003744

Best Buy HSA PPO 5000 MD0000003747

Best Buy HSA PPO 6250 MD0000003748

Best Buy Tiered Copayment PPO LP 1250 MD0000003733

Best Buy Tiered Copayment PPO LP 2000 MD0000003735

Best Buy Tiered Copayment PPO LP 3000 MD0000003739

Best Buy Tiered Copayment PPO LP 4000 MD0000003742

Best Buy Tiered Copayment PPO LP 5000 MD0000003746

Best Buy HSA PPO 2600 MD0000003781

HPHC Home | Privacy and Disclaimer Statements