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Documents On Exchange 2025

On Exchange Plan Documents 2025

Plan Year:

Formulary

DOCUMENTS	DOWNLOAD/ACCESS
AdvanceHealth, Cultivate, EverydayHealth, Individual PPO, and TrueHealth Plans	Search Online Download (Opens in a new tab)
StandardHealth Plans	Search Online Download (Opens in a new tab)
Portfolio and PPO HSA Plans	Search Online Download (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
EverydayHealth Gold	Summary of Benefits (Opens in a new tab)
EverydayHealth Gold Limited	Summary of Benefits (Opens in a new tab)
EverydayHealth Silver	Summary of Benefits (Opens in a new tab)
EverydayHealth Silver Limited	Summary of Benefits (Opens in a new tab)
EverydayHealth Silver 4	Summary of Benefits (Opens in a new tab)
EverydayHealth Silver 5	Summary of Benefits (Opens in a new tab)
EverydayHealth Silver 6	Summary of Benefits (Opens in a new tab)

Plans	Download
AdvanceHealth Gold	Summary of Benefits (Opens in a new tab)
AdvanceHealth Gold Limited	Summary of Benefits (Opens in a new tab)
AdvanceHealth Silver	Summary of Benefits (Opens in a new tab)
AdvanceHealth Silver Limited	Summary of Benefits (Opens in a new tab)
AdvanceHealth Bronze	Summary of Benefits (Opens in a new tab)
AdvanceHealth Bronze Limited	Summary of Benefits (Opens in a new tab)
AdvanceHealth Silver 4	Summary of Benefits (Opens in a new tab)
AdvanceHealth Silver 5	Summary of Benefits (Opens in a new tab)
AdvanceHealth Silver 6	Summary of Benefits (Opens in a new tab)

Plans	Download
Portfolio Bronze	Summary of Benefits (Opens in a new tab)
Portfolio Bronze Limited	Summary of Benefits (Opens in a new tab)

Plans	Download
PPO PremierHealth Gold	Summary of Benefits (Opens in a new tab)
PPO PremierHealth Gold Limited	Summary of Benefits (Opens in a new tab)
PPO PremierHealth Silver	Summary of Benefits (Opens in a new tab)
PPO PremierHealth Silver Limited	Summary of Benefits (Opens in a new tab)
PPO PremierHealth Silver 4	Summary of Benefits (Opens in a new tab)
PPO PremierHealth Silver 5	Summary of Benefits (Opens in a new tab)
PPO PremierHealth Silver 6	Summary of Benefits (Opens in a new tab)

Plans	Download
PPO Portfolio Gold Limited	Summary of Benefits (Opens in a new tab)
PPO Portfolio HSA Gold	Summary of Benefits (Opens in a new tab)

Plans	Download
StandardHealth Gold	Summary of Benefits (Opens in a new tab)
StandardHealth Gold Limited	Summary of Benefits (Opens in a new tab)
StandardHealth Silver	Summary of Benefits (Opens in a new tab)
StandardHealth Silver Limited	Summary of Benefits (Opens in a new tab)
StandardHealth Bronze	Summary of Benefits (Opens in a new tab)
StandardHealth Bronze Limited	Summary of Benefits (Opens in a new tab)
StandardHealth Silver 4	Summary of Benefits (Opens in a new tab)
StandardHealth Silver 5	Summary of Benefits (Opens in a new tab)
StandardHealth Silver 6	Summary of Benefits (Opens in a new tab)

Plans	Download
PPO StandardHealth Gold	Summary of Benefits (Opens in a new tab)
PPO StandardHealth Gold Limited	Summary of Benefits (Opens in a new tab)
PPO StandardHealth Silver	Summary of Benefits (Opens in a new tab)
PPO StandardHealth Silver Limited	Summary of Benefits (Opens in a new tab)
PPO StandardHealth Silver 4	Summary of Benefits (Opens in a new tab)
PPO StandardHealth Silver 5	Summary of Benefits (Opens in a new tab)
PPO StandardHealth Silver 6	Summary of Benefits (Opens in a new tab)

Plans	Download
ACA StandardHealth Silver with Health Choice	Summary of Benefits (Opens in a new tab)
ACA StandardHealth Silver Limited with Health Choice	Summary of Benefits (Opens in a new tab)
ACA StandardHealth Silver 2 with Health Choice	Summary of Benefits (Opens in a new tab)
ACA StandardHealth Silver 4 with Health Choice	Summary of Benefits (Opens in a new tab)
ACA StandardHealth Silver 5 with Health Choice	Summary of Benefits (Opens in a new tab)
ACA StandardHealth Silver 6 with Health Choice	Summary of Benefits (Opens in a new tab)

Benefit Books


HMO Base On Exchange Benefit Book	Base Benefit Book (Opens in a new tab)
PPO Base On Exchange Benefit Book	Base Benefit Book (Opens in a new tab)
HMO ACA StandardHealth with Health Choice Base On Exchange Benefit Book	Base Benefit Book (Opens in a new tab)

DOCUMENTS	DOWNLOAD/ACCESS
HMO AdvanceHealth Gold 4375	Plan Attachment (Opens in a new tab)
HMO AdvanceHealth Silver 6600	Plan Attachment (Opens in a new tab)
HMO AdvanceHealth Bronze 9000	Plan Attachment (Opens in a new tab)
HMO AdvanceHealth Silver 4	Plan Attachment (Opens in a new tab)
HMO AdvanceHealth Silver 5	Plan Attachment (Opens in a new tab)
HMO AdvanceHealth Silver 6	Plan Attachment (Opens in a new tab)

DOCUMENTS	DOWNLOAD/ACCESS
HMO EverydayHealth Gold 1300	Plan Attachment (Opens in a new tab)
HMO EverydayHealth Silver 5000	Plan Attachment (Opens in a new tab)
HMO EverydayHealth Silver 4	Plan Attachment (Opens in a new tab)
HMO EverydayHealth Silver 5	Plan Attachment (Opens in a new tab)
HMO EverydayHealth Silver 6	Plan Attachment (Opens in a new tab)

DOCUMENTS	DOWNLOAD/ACCESS
HMO Portfolio HSA Bronze 7050	Plan Attachment (Opens in a new tab)

DOCUMENTS	DOWNLOAD/ACCESS
HMO StandardHealth with Health Choice Silver 4	Plan Attachment (Opens in a new tab)
HMO StandardHealth with Health Choice Silver 5	Plan Attachment (Opens in a new tab)
HMO StandardHealth with Health Choice Silver 6	Plan Attachment (Opens in a new tab)
HMO StandardHealth with Health Choice Silver 5000	Plan Attachment (Opens in a new tab)

DOCUMENTS	DOWNLOAD/ACCESS
HMO StandardHealth Bronze 7500	Plan Attachment (Opens in a new tab)
HMO StandardHealth Gold 1500	Plan Attachment (Opens in a new tab)
HMO StandardHealth Silver 4	Plan Attachment (Opens in a new tab)
HMO StandardHealth Silver 5	Plan Attachment (Opens in a new tab)
HMO StandardHealth Silver 6	Plan Attachment (Opens in a new tab)
HMO StandardHealth Silver 5000	Plan Attachment (Opens in a new tab)

DOCUMENTS	DOWNLOAD/ACCESS
PPO StandardHealth Gold 1500	Plan Attachment (Opens in a new tab)
PPO StandardHealth Silver 4	Plan Attachment (Opens in a new tab)
PPO StandardHealth Silver 5	Plan Attachment (Opens in a new tab)
PPO StandardHealth Silver 6	Plan Attachment (Opens in a new tab)
PPO StandardHealth Silver 5000	Plan Attachment (Opens in a new tab)

DOCUMENTS	DOWNLOAD/ACCESS
PPO PremierHealth Gold 1250	Plan Attachment (Opens in a new tab)
PPO PremierHealth Silver 4	Plan Attachment (Opens in a new tab)
PPO PremierHealth Silver 5	Plan Attachment (Opens in a new tab)
PPO PremierHealth Silver 6	Plan Attachment (Opens in a new tab)
PPO PremierHealth Silver 3400	Plan Attachment (Opens in a new tab)

DOCUMENTS	DOWNLOAD/ACCESS
PPO Portfolio HSA Gold 2500	Plan Attachment (Opens in a new tab)