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Documents Cultivate 2022

Cultivate Plan Documents

Plan Year:

Formulary

DOCUMENTS	DOWNLOAD/ACCESS
Formulary – Cultivate Plans	Search Online

Benefit Books

Documents	Download
Group PPO Base Benefit Book Off Exchange	Base Benefit Book
Group HMO Base Benefit Book Off Exchange	Base Benefit Book
Group PPO January Rider	Rider
Group HMO January Rider	Rider
PPO Cultivate Gold 3250	Plan Attachment
PPO Cultivate Silver 5250	Plan Attachment
PPO Cultivate Bronze 7250	Plan Attachment
HMO Cultivate Gold 3250	Plan Attachment
HMO Cultivate Silver 5250	Plan Attachment
HMO Cultivate Bronze 7250	Plan Attachment

Summary of Benefits and Coverage (SBC)

The Summary of Benefits and Coverage (SBC) provides a concise description of what services your plan covers along with what you will pay for covered benefits.

Plans	Download
Cultivate PPO Gold 3250 - Statewide PPO Network	Summary of Benefits
Cultivate PPO Silver 5250 - Statewide PPO Network	Summary of Benefits
Cultivate PPO Bronze 7250 - Statewide PPO Network	Summary of Benefits
Cultivate PPO Gold 3250 - PimaConnect Network	Summary of Benefits
Cultivate PPO Silver 5250 - PimaConnect Network	Summary of Benefits
Cultivate PPO Bronze 7250 - PimaConnect Network	Summary of Benefits
Cultivate PPO Gold 3250 - Alliance Network	Summary of Benefits
Cultivate PPO Silver 5250 - Alliance Network	Summary of Benefits
Cultivate PPO Bronze 7250 - Alliance Network	Summary of Benefits
Cultivate HMO Gold 3250 - Statewide HMO Network	Summary of Benefits
Cultivate HMO Silver 5250 - Statewide HMO Network	Summary of Benefits
Cultivate HMO Bronze 7250 - Statewide HMO Network	Summary of Benefits
Cultivate HMO Gold 3250 - PimaConnect Network	Summary of Benefits
Cultivate HMO Silver 5250 - PimaConnect Network	Summary of Benefits
Cultivate HMO Bronze 7250 - PimaConnect Network	Summary of Benefits
Cultivate HMO Gold 3250 - Alliance Network	Summary of Benefits
Cultivate HMO Silver 5250 - Alliance Network	Summary of Benefits
Cultivate HMO Bronze 7250 - Alliance Network	Summary of Benefits