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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)
Portfolio Plans	Search Online Download (pdf)

Benefit Books

Documents	Download
HMO Base Off Exchange	Base Benefit Book
PPO Base Off Exchange	Base Benefit Book
HMO January	Rider
PPO January	Rider
HMO AdvanceHealth Gold 4750	Plan Attachment
HMO AdvanceHealth Silver 8000	Plan Attachment
HMO AdvanceHealth Bronze 8700	Plan Attachment
HMO EverydayHealth Gold 2000	Plan Attachment
HMO EverydayHealth Silver 4750	Plan Attachment
HMO EverydayHealth Bronze 7500	Plan Attachment
HMO Portfolio HSA Bronze 7000	Plan Attachment
HMO TrueHealth Silver 6750	Plan Attachment
PPO Gold 1200	Plan Attachment
PPO Silver 3100	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 Bronze	SBC- MaricopaFocus Network SBC - Neighborhood Network SBC- PimaFocus Network
AdvanceHealth Gold	SBC- MaricopaFocus Network SBC- Neighborhood Network SBC- PimaFocus Network
AdvanceHealth Silver	SBC- MaricopaFocus Network SBC- Neighborhood Network SBC- PimaFocus Network
AdvanceHealth Silver 4	SBC- MaricopaFocus Network SBC- Neighborhood Network SBC- PimaFocus Network
AdvanceHealth Silver 5	SBC- MaricopaFocus Network SBC- Neighborhood Network SBC- PimaFocus Network
AdvanceHealth Silver 6	SBC- MaricopaFocus Network SBC- Neighborhood Network SBC- PimaFocus Network

PLANS	DOWNLOAD
EverydayHealth Bronze	SBC- MaricopaFocus Network SBC- Neighborhood Network SBC- PimaFocus Network
EverydayHealth Gold	SBC- MaricopaFocus Network SBC- Neighborhood Network SBC- PimaFocus Network
EverydayHealth Silver	SBC- MaricopaFocus Network SBC- Neighborhood Network SBC- PimaFocus Network
EverydayHealth Silver 4	SBC- MaricopaFocus Network SBC- Neighborhood Network SBC- PimaFocus Network
EverydayHealth Silver 5	SBC- MaricopaFocus Network SBC- Neighborhood Network SBC- PimaFocus Network
EverydayHealth Silver 6	SBC- MaricopaFocus Network SBC- Neighborhood Network SBC- PimaFocus Network

PLANS DOWNLOAD
Portfolio HSA Bronze
SBC- MaricopaFocus Network
SBC- Neighborhood Network
SBC- PimaFocus Network
PLANS DOWNLOAD
PPO Gold
SBC- Statewide Network
PPO Silver
SBC- Statewide Network
PPO Silver 4
SBC- Statewide Network
PPO Silver 5
SBC- Statewide Network
PPO Silver 6
SBC- Statewide Network

PLANS	DOWNLOAD
TrueHealth Silver	SBC- MaricopaFocus Network SBC- Neighborhood Network SBC- PimaFocus Network
TrueHealth Silver 4	SBC- MaricopaFocus Network SBC- Neighborhood Network SBC- PimaFocus Network
TrueHealth Silver 5	SBC- MaricopaFocus Network SBC- Neighborhood Network SBC- PimaFocus Network
TrueHealth Silver 6	SBC- MaricopaFocus Network SBC- Neighborhood Network SBC- PimaFocus Network