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Documents Off Exchange 2023

Off Exchange Plan Documents 2023

Plan Year:

Formulary

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

Benefit Books

DOCUMENTS	DOWNLOAD
HMO Base Off Exchange	Base Benefit Book
PPO Base Off Exchange	Base Benefit Book
HMO AdvanceHealth Gold 4375	Plan Attachment
HMO AdvanceHealth Silver 6900	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
HMO Standardized Bronze 7500	Plan Attachment
HMO Standardized Gold 2000	Plan Attachment
HMO Standardized Silver 5800	Plan Attachment
PPO Gold 1250	Plan Attachment
PPO Silver 4100	Plan Attachment
PPO Portfolio HSA Gold 1500	Plan Attachment
PPO Standardized Gold 2000	Plan Attachment
PPO Standardized Silver 5800	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
EverydayHealth Gold	SBC - Neighborhood Network
EverydayHealth Silver	SBC - Neighborhood Network SBC - PimaFocus Network SBC - MaricopaFocus Network
EverydayHealth Bronze	SBC - Neighborhood Network SBC - PimaFocus Network SBC - MaricopaFocus Network
EverydayHealth Silver 4	SBC - Neighborhood Network SBC - PimaFocus Network SBC - MaricopaFocus Network
EverydayHealth Silver 5	SBC - Neighborhood Network SBC - PimaFocus Network SBC - MaricopaFocus Network
EverydayHealth Silver 6	SBC - Neighborhood Network SBC - PimaFocus Network SBC - MaricopaFocus Network
EverydayHealth Gold	SBC - PimaFocus Network SBC - MaricopaFocus Network

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

Plans DOWNLOAD
PPO Portfolio HSA Gold
SBC - Statewide Network
Portfolio Bronze
SBC - Neighborhood Network
SBC - PimaFocus Network
SBC - MaricopaFocus Network

Plans	DOWNLOAD
AdvanceHealth Gold	SBC - Neighborhood Network SBC - PimaFocus Network SBC - MaricopaFocus Network
AdvanceHealth Silver	SBC - Neighborhood Network SBC - PimaFocus Network SBC - MaricopaFocus Network
AdvanceHealth Silver 4	SBC - Neighborhood Network SBC - PimaFocus Network SBC - MaricopaFocus Network
AdvanceHealth Silver 5	SBC - Neighborhood Network SBC - PimaFocus Network SBC - MaricopaFocus Network
AdvanceHealth Silver 6	SBC - Neighborhood Network SBC - PimaFocus Network SBC - MaricopaFocus Network
AdvanceHealth Bronze	SBC - Neighborhood Network SBC - PimaFocus Network SBC - MaricopaFocus Network

Plans	DOWNLOAD
PPO Gold - Statewide Network	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
Standardized Gold	SBC - Neighborhood Network
Standardized Silver	SBC - Neighborhood Network SBC - PimaFocus Network SBC - MaricopaFocus Network
Standardized Silver 4	SBC - Neighborhood Network SBC - PimaFocus Network SBC - MaricopaFocus Network
Standardized Silver 5	SBC - Neighborhood Network SBC - PimaFocus Network SBC - MaricopaFocus Network
Standardized Silver 6	SBC - Neighborhood Network SBC - PimaFocus Network SBC - MaricopaFocus Network
Standardized Bronze	SBC - Neighborhood Network SBC - PimaFocus Network SBC - MaricopaFocus Network
Standardized Gold	SBC - PimaFocus Network SBC - MaricopaFocus Network

Plans	DOWNLOAD
PPO Standardized Gold	SBC - Statewide PPO Network
PPO Standardized Silver	SBC - Statewide PPO Network
PPO Standardized Silver 4	SBC - Statewide PPO Network
PPO Standardized Silver 5	SBC - Statewide PPO Network
PPO Standardized Silver 6	SBC - Statewide PPO Network