On Exchange Zero Cost Plan Documents 2022

Plans available through the Health Insurance Marketplace or Healthcare.gov. to American Indians/Native Alaskans who earn less than 300% of the Federal Poverty Level (FPL).

Formulary

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

Benefit Books

DOCUMENTS	DOWNLOAD
HMO Base On Exchange	Base Benefit Book
PPO Base On Exchange	Base Benefit Book
HMO January Rider	Rider
PPO January Rider	Rider
HMO AdvanceHealth ZCS	Plan Attachment
HMO EverydayHealth ZCS	Plan Attachment
HMO Portfolio ZCS	Plan Attachment
HMO TrueHealth ZCS	Plan Attachment
PPO ZCS	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
AdvanceHealth 2
SBC- MaricopaFocus Network
SBC- Neighborhood Network
SBC- PimaFocus Network
PLANS DOWNLOAD
EverydayHealth 2
SBC- MaricopaFocus Network
SBC- Neighborhood Network
SBC- PimaFocus Network
Plans Download
Portfolio 2
SBC- MaricopaFocus Network
SBC- Neighborhood Network
SBC- PimaFocus Network
PLANS Download
PPO 2
SBC- Statewide Network
PLANS DOWNLOAD
TrueHealth 2
SBC- MaricopasFocus Network
SBC- Neighborhood Network
SBC- PimaFocus Network