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Individual policy & schedule of benefits

To view the Individual Policy and Schedule of Benefits you are interested in, select the applicable plan name below.

You are now viewing 2025 plan year

View Plan year: 2024

On-Exchange

Silver 2025

Plan Individual Policy Schedule of benefits Effective date
Silver AH Individual Policy Schedule of Benefits 1/1/2025
Silver AH 73% CSR Individual Policy Schedule of Benefits 1/1/2025
Silver AH 87% CSR Individual Policy Schedule of Benefits 1/1/2025
Silver AH 94% CSR Individual Policy Schedule of Benefits 1/1/2025
Silver Value Individual Policy Schedule of Benefits 1/1/2025
Silver Value 73% CSR Individual Policy Schedule of Benefits 1/1/2025
Silver Value 87% CSR Individual Policy Schedule of Benefits 1/1/2025
Silver Value 94% CSR Individual Policy Schedule of Benefits 1/1/2025
Silver Standardized Individual Policy Schedule of Benefits 1/1/2025
Silver Standardized 73% CSR Individual Policy Schedule of Benefits 1/1/2025
Silver Standardized 87% CSR Individual Policy Schedule of Benefits 1/1/2025
Silver Standardized 94% CSR Individual Policy Schedule of Benefits 1/1/2025
Silver AH (0% - 20% FPL) Individual Policy Schedule of Benefits 1/1/2025
Silver AH (21% - 40% FPL) Individual Policy Schedule of Benefits 1/1/2025
Silver AH (41% - 60% FPL) Individual Policy Schedule of Benefits 1/1/2025
Silver AH (61% - 80% FPL) Individual Policy Schedule of Benefits 1/1/2025
Silver AH (81% - 100% FPL) Individual Policy Schedule of Benefits 1/1/2025
Silver AH (101% - 120% FPL) Individual Policy Schedule of Benefits 1/1/2025
Silver AH (121% - 138% FPL) Individual Policy Schedule of Benefits 1/1/2025

Bronze  2025

Plan Individual Policy Schedule of benefits Effective date
Bronze Value Individual Policy Schedule of Benefits 1/1/2025
Bronze Exp Standardized Individual Policy Schedule of Benefits 1/1/2025

Gold  2025

Plan Individual Policy Schedule of benefits Effective date
Gold Standardized Individual Policy Schedule of Benefits 1/1/2025

American Indian / Alaskan Native

Silver 2025

Plan Individual Policy Schedule of benefits Effective date
Silver AH AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Silver AH AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Silver Value AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Silver Value AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Silver Standardized AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Silver Standardized AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2025

Bronze 2025

Plan Individual Policy Schedule of benefits Effective date
Bronze Value AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Bronze Value AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Bronze Exp Standardized AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Bronze Exp Standardized AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2025

Gold 2025

Plan Individual Policy Schedule of benefits Effective date
Gold Standardized AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Gold Standardized AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2025

Off-Exchange

Silver 2025

Plan Individual Policy Schedule of benefits Effective date
Silver AH (monthly billing) Individual Policy Schedule of Benefits 1/1/2025
Silver AH (quarterly billing) Individual Policy Schedule of Benefits 1/1/2025
Silver Value Individual Policy Schedule of Benefits 1/1/2025
Silver Standardized Individual Policy Schedule of Benefits 1/1/2025

Bronze 2025

Plan Individual Policy Schedule of benefits Effective date
Bronze Value Individual Policy Schedule of Benefits 1/1/2025
Bronze Exp Standardized Individual Policy Schedule of Benefits 1/1/2025

Gold 2025

Plan Individual Policy Schedule of benefits Effective date
Gold Standardized Individual Policy Schedule of Benefits 1/1/2025

*CSR-Cost sharing reduction: A discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance, and copayments. You can get this reduction if you get health insurance through the Marketplace, your income is below a certain level and you choose a health plan from the Silver plan category. If you are a member of a federally recognized tribe, you may qualify for additional cost-sharing benefits.

Note: Policy ID may also be referenced as Certificate ID in other correspondence.