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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 2024 plan year

View Plan year: 2023

On-Exchange

Silver 2024

Plan Individual Policy Schedule of benefits Effective date
Silver Premier Suitcase Individual Policy Schedule of Benefits 1/1/2024
Silver Premier Suitcase 73% CSR Individual Policy Schedule of Benefits 1/1/2024
Silver Premier Suitcase 87% CSR Individual Policy Schedule of Benefits 1/1/2024
Silver Premier Suitcase 94% CSR Individual Policy Schedule of Benefits 1/1/2024
Silver AH Individual Policy Schedule of Benefits 1/1/2024
Silver AH 73% CSR Individual Policy Schedule of Benefits 1/1/2024
Silver AH 87% CSR Individual Policy Schedule of Benefits 1/1/2024
Silver AH 94% CSR Individual Policy Schedule of Benefits 1/1/2024
Silver AH (0% - 20% FPL) Individual Policy Schedule of Benefits 1/1/2024
Silver AH (21% - 40% FPL) Individual Policy Schedule of Benefits 1/1/2024
Silver AH (41% - 60% FPL) Individual Policy Schedule of Benefits 1/1/2024
Silver AH (61% - 80% FPL) Individual Policy Schedule of Benefits 1/1/2024
Silver AH (81% - 100% FPL) Individual Policy Schedule of Benefits 1/1/2024
Silver AH (101% - 120% FPL) Individual Policy Schedule of Benefits 1/1/2024
Silver AH (121% - 138% FPL) Individual Policy Schedule of Benefits 1/1/2024
Silver Classic Suitcase Individual Policy Schedule of Benefits 1/1/2024
Silver Classic Suitcase 73% CSR Individual Policy Schedule of Benefits 1/1/2024
Silver Classic Suitcase 87% CSR Individual Policy Schedule of Benefits 1/1/2024
Silver Classic Suitcase 94% CSR Individual Policy Schedule of Benefits 1/1/2024
Silver Value Individual Policy Schedule of Benefits 1/1/2024
Silver Value 73% CSR Individual Policy Schedule of Benefits 1/1/2024
Silver Value 87% CSR Individual Policy Schedule of Benefits 1/1/2024
Silver Value 94% CSR Individual Policy Schedule of Benefits 1/1/2024
Silver Standardized Individual Policy Schedule of Benefits 1/1/2024
Silver Standardized 73% CSR Individual Policy Schedule of Benefits 1/1/2024
Silver Standardized 87% CSR Individual Policy Schedule of Benefits 1/1/2024
Silver Standardized 94% CSR Individual Policy Schedule of Benefits 1/1/2024

Bronze  2024

Plan Individual Policy Schedule of benefits Effective date
Bronze Value Individual Policy Schedule of Benefits 1/1/2024
Bronze Exp Standardized Individual Policy Schedule of Benefits 1/1/2024

Gold  2024

Plan Individual Policy Schedule of benefits Effective date
Gold Standardized Individual Policy Schedule of Benefits 1/1/2024

American Indian / Alaskan Native

Silver 2024

Plan Individual Policy Schedule of benefits Effective date
Silver Premier Suitcase AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Silver Premier Suitcase AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Silver AH AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Silver AH AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Silver Classic Suitcase AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Silver Classic Suitcase AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Silver Value AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Silver Value AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Silver Standardized AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Silver Standardized AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024

Bronze 2024

Plan Individual Policy Schedule of benefits Effective date
Bronze Value AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Bronze Value AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Bronze Exp Standardized AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Bronze Exp Standardized AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024

Gold 2024

Plan Individual Policy Schedule of benefits Effective date
Gold Standardized AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Gold Standardized AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024

Off-Exchange

Silver 2024

Plan Individual Policy Schedule of benefits Effective date
Silver Premier Suitcase (quarterly billing) Individual Policy Schedule of Benefits 1/1/2024
Silver Premier Suitcase (monthly billing) Individual Policy Schedule of Benefits 1/1/2024
Silver AH (monthly billing) Individual Policy Schedule of Benefits 1/1/2024
Silver AH (quarterly billing) Individual Policy Schedule of Benefits 1/1/2024
Silver Classic Suitcase (quarterly billing) Individual Policy Schedule of Benefits 1/1/2024
Silver Classic Suitcase (monthly billing) Individual Policy Schedule of Benefits 1/1/2024
Silver Value Individual Policy Schedule of Benefits 1/1/2024
Silver Standardized Individual Policy Schedule of Benefits 1/1/2024

Bronze 2024

Plan Individual Policy Schedule of benefits Effective date
Bronze Value Individual Policy Schedule of Benefits 1/1/2024
Bronze Exp Standardized Individual Policy Schedule of Benefits 1/1/2024

Gold 2024

Plan Individual Policy Schedule of benefits Effective date
Gold Standardized Individual Policy Schedule of Benefits 1/1/2024

*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.