2023 年场外交易计划文件

計劃年份：

處方集

DODO /訪問
AdvanceHealth、Cultivate、EverydayHealth、Individual PPO和 TrueHealth Plans
標準健康計劃
投資組合和PPO HSA 計劃

福利書籍

DODO
HMO Base Off Exchange
PPO Base Off Exchange
HMO AdvanceHealth Gold 4375
HMO AdvanceHealth Silver 6900
HMO AdvanceHealth Bronze 8700
HMO EverydayHealth Gold 2000
HMO EverydayHealth Silver 4750
HMO EverydayHealth Bronze 7500
HMO Portfolio HSA Bronze 7000
HMO TrueHealth Silver 6750
HMO Standardized Bronze 7500
HMO Standardized Gold 2000
HMO Standardized Silver 5800
PPO Gold 1250
PPO Silver 4100
PPO Portfolio HSA Gold 1500
PPO Standardized Gold 2000
PPO Standardized Silver 5800

福利及承保范围摘要 (SBC)

福利和承保范围摘要 (SBC) 简要描述了您的计划涵盖的服务以及您将为承保福利支付的费用。