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Home > Broker > Plan Information > Schedules of Benefits and SBCs > Schedule of Benefits and SBCs - CT 2017

Schedules of Benefits and SBCs: Connecticut

Small Group effective 1/1/17

HMO - OFF EXCHANGE with Dental SOB SBC
HMO Copay 25/35 MD0000004204
Best Buy HMO Hospital 4000 MD0000004211
Best Buy HMO Hospital 2000 MD0000004212
Best Buy HSA HMO 6100 MD0000004215
Best Buy HSA HMO 3000 MD0000004216

PPO - OFF EXCHANGE with Dental SOB SBC
PPO Copay 25/35 MD0000004205
Best Buy PPO 1500 MD0000004206
Best Buy PPO 3500 MD0000004207
Best Buy PPO Hospital 3500 MD0000004208
Best Buy PPO Hospital 2000 MD0000004209
Best Buy PPO Hospital 4500 MD0000004210
Best Buy HSA PPO 5500 MD0000004213
Best Buy HSA PPO 2600 MD0000004214
Best Buy HSA PPO 2600 90/70 MD0000004217
Best Buy PPO 3 Free 3000 MD0000004218
Best Buy PPO 3 Free 4000 MD0000004219
Best Buy PPO 5000 MD0000004220
Best Buy HSA PPO 2800 - CB MD0000004221
Best Buy HSA PPO 5000 - CB MD0000004222
Best Buy HSA PPO 6500 - CB MD0000004223
Best Buy PPO Hospital 1500 - CB MD0000004224
Best Buy PPO Hospital 2000 - CB MD0000004225
Best Buy PPO 2500 - CB MD0000004226
Best Buy PPO Hospital 5000 - CB MD0000004227
Best Buy PPO 3000 - CB MD0000004228
Best Buy PPO Hospital 3750 - CB MD0000004229
Best Buy PPO 4000 - CB MD0000004230
Best Buy HSA PPO 3500 MD0000004231