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Documents Off Exchange 2022

Off Exchange Plan Documents 2022

Plans available through AZBlue or authorized brokers.

Plan Year:

Formulary

DOCUMENTS	DOWNLOAD/ACCESS
AdvanceHealth, Cultivate, EverydayHealth, Individual PPO, and TrueHealth Plans	Search Online Download (pdf) (Opens in a new tab)
Portfolio Plans	Search Online Download (pdf) (Opens in a new tab)

Benefit Books

Documents	Download
HMO Base Off Exchange	Base Benefit Book (Opens in a new tab)
PPO Base Off Exchange	Base Benefit Book (Opens in a new tab)
HMO January	Rider (Opens in a new tab)
PPO January	Rider (Opens in a new tab)
HMO AdvanceHealth Gold 4750	Plan Attachment (Opens in a new tab)
HMO AdvanceHealth Silver 8000	Plan Attachment (Opens in a new tab)
HMO AdvanceHealth Bronze 8700	Plan Attachment (Opens in a new tab)
HMO EverydayHealth Gold 2000	Plan Attachment (Opens in a new tab)
HMO EverydayHealth Silver 4750	Plan Attachment (Opens in a new tab)
HMO EverydayHealth Bronze 7500	Plan Attachment (Opens in a new tab)
HMO Portfolio HSA Bronze 7000	Plan Attachment (Opens in a new tab)
HMO TrueHealth Silver 6750	Plan Attachment (Opens in a new tab)
PPO Gold 1200	Plan Attachment (Opens in a new tab)
PPO Silver 3100	Plan Attachment (Opens in a new tab)

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
AdvanceHealth Bronze	SBC- MaricopaFocus Network (Opens in a new tab) SBC - Neighborhood Network (Opens in a new tab) SBC- PimaFocus Network (Opens in a new tab)
AdvanceHealth Gold	SBC- MaricopaFocus Network (Opens in a new tab) SBC- Neighborhood Network (Opens in a new tab) SBC- PimaFocus Network (Opens in a new tab)
AdvanceHealth Silver	SBC- MaricopaFocus Network (Opens in a new tab) SBC- Neighborhood Network (Opens in a new tab) SBC- PimaFocus Network (Opens in a new tab)
AdvanceHealth Silver 4	SBC- MaricopaFocus Network (Opens in a new tab) SBC- Neighborhood Network (Opens in a new tab) SBC- PimaFocus Network (Opens in a new tab)
AdvanceHealth Silver 5	SBC- MaricopaFocus Network (Opens in a new tab) SBC- Neighborhood Network (Opens in a new tab) SBC- PimaFocus Network (Opens in a new tab)
AdvanceHealth Silver 6	SBC- MaricopaFocus Network (Opens in a new tab) SBC- Neighborhood Network (Opens in a new tab) SBC- PimaFocus Network (Opens in a new tab)

PLANS	DOWNLOAD
EverydayHealth Bronze	SBC- MaricopaFocus Network (Opens in a new tab) SBC- Neighborhood Network (Opens in a new tab) SBC- PimaFocus Network (Opens in a new tab)
EverydayHealth Gold	SBC- MaricopaFocus Network (Opens in a new tab) SBC- Neighborhood Network (Opens in a new tab) SBC- PimaFocus Network (Opens in a new tab)
EverydayHealth Silver	SBC- MaricopaFocus Network (Opens in a new tab) SBC- Neighborhood Network (Opens in a new tab) SBC- PimaFocus Network (Opens in a new tab)
EverydayHealth Silver 4	SBC- MaricopaFocus Network (Opens in a new tab) SBC- Neighborhood Network (Opens in a new tab) SBC- PimaFocus Network (Opens in a new tab)
EverydayHealth Silver 5	SBC- MaricopaFocus Network (Opens in a new tab) SBC- Neighborhood Network (Opens in a new tab) SBC- PimaFocus Network (Opens in a new tab)
EverydayHealth Silver 6	SBC- MaricopaFocus Network (Opens in a new tab) SBC- Neighborhood Network (Opens in a new tab) SBC- PimaFocus Network (Opens in a new tab)

PLANS DOWNLOAD
Portfolio HSA Bronze
SBC- MaricopaFocus Network (Opens in a new tab)
SBC- Neighborhood Network (Opens in a new tab)
SBC- PimaFocus Network (Opens in a new tab)

PLANS	DOWNLOAD
PPO Gold	SBC- Statewide Network (Opens in a new tab)
PPO Silver	SBC- Statewide Network (Opens in a new tab)
PPO Silver 4	SBC- Statewide Network (Opens in a new tab)
PPO Silver 5	SBC- Statewide Network (Opens in a new tab)
PPO Silver 6	SBC- Statewide Network (Opens in a new tab)

PLANS	DOWNLOAD
TrueHealth Silver	SBC- MaricopaFocus Network (Opens in a new tab) SBC- Neighborhood Network (Opens in a new tab) SBC- PimaFocus Network (Opens in a new tab)
TrueHealth Silver 4	SBC- MaricopaFocus Network (Opens in a new tab) SBC- Neighborhood Network (Opens in a new tab) SBC- PimaFocus Network (Opens in a new tab)
TrueHealth Silver 5	SBC- MaricopaFocus Network (Opens in a new tab) SBC- Neighborhood Network (Opens in a new tab) SBC- PimaFocus Network (Opens in a new tab)
TrueHealth Silver 6	SBC- MaricopaFocus Network (Opens in a new tab) SBC- Neighborhood Network (Opens in a new tab) SBC- PimaFocus Network (Opens in a new tab)