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Individual policy & schedule of benefits

To view the Individual Policy and Schedule of Benefits you are interested in, select the applicable plan name below.

On-Exchange

Silver 2023

PlanIndividual PolicySchedule of benefitsEffective date
Silver Plan AH1 PPO Individual Policy Schedule of Benefits1/1/2023
Silver Plan AH1 - 73% PPO Individual Policy Schedule of Benefits 1/1/2023
Silver Plan AH1 - 87% PPO Individual Policy Schedule of Benefits 1/1/2023
Silver Plan AH1 - 94% POS Individual Policy Schedule of Benefits 1/1/2023
Silver Plan AH1 (0-20% FPL) Individual Policy Schedule of Benefits 1/1/2023
Silver Plan AH1 (21 - 40% FPL) Individual Policy Schedule of Benefits 1/1/2023
Silver Plan AH1 (41 - 60% FPL) Individual Policy Schedule of Benefits 1/1/2023
Silver Plan AH1 (61 - 80% FPL) Individual Policy Schedule of Benefits 1/1/2023
Silver Plan AH1 (81 - 100% FPL) Individual Policy Schedule of Benefits 1/1/2023
Silver Plan AH1 (101 - 120% FPL) Individual Policy Schedule of Benefits 1/1/2023
Silver Plan AH1 (121 - 138% FPL) Individual Policy Schedule of Benefits 1/1/2023

American Indian / Alaskan Native

Silver 2023

PlanIndividual PolicySchedule of benefitsEffective date
Silver Plan AH1 - Indian Under 300% FPL PPO Individual Policy Schedule of benefits 1/1/2023
Silver Plan AH1 - Indian Over 300% FPL PPO Individual Policy Schedule of benefits 1/1/2023

Off-Exchange

Silver 2023

PlanIndividual PolicySchedule of benefitsEffective date
Silver Plan AH1 (monthly) Individual Policy Schedule of Benefits 1/1/2023
Silver Plan AH1 (quarterly) Individual Policy Schedule of Benefits 1/1/2023