2023 Summary of Benefits & Coverage
(SBC)
On-Exchange Base Plan SBCs
Click the links below to access the Summary of Benefits & Coverage (SBC) for the On-Exchange 2023 base plans:
Gold Plans
Silver Plans
- Silver $4000 Deductible
- Silver $5000 Deductible
- Silver $5650 Deductible
- HSA Silver $3000 Deductible
- Silver Standard
Bronze Plans
- Bronze $6000 Deductible
- HSA Bronze $7500 Deductible
- Bronze $8150 Deductible
- Bronze $9100 Deductible $35 PCP
- Bronze Standard
$0 Deductible Plans
- Copay Gold $0 Deductible
- Copay Silver $0 Deductible / $1000 Rx Deductible
- Copay Bronze $0 Deductible / $2250 Rx Deductible
All On-Exchange plans offer variants with Adult Vision/Allergy Testing and Preventive Dental add-on options. Click here to learn more.
Prescription Drug List | Certificate of Coverage
On-Exchange Cost-Sharing Reduction Plan SBCs
Click the links below to access the Summary of Benefits and Coverage (SBC) for these 2023 CSR plans:
73% CSR Plans
- Copay Silver $0 Deductible 73% CSR
- Silver $2625 Deductible 73% CSR
- Silver $3400 Deductible 73% CSR
- Silver $3450 Deductible 73% CSR
- Silver $3600 Deductible 73% CSR
- Silver Standard 73% CSR
87% CSR Plans
- Copay Silver $0 Deductible 87% CSR
- Silver $600 Deductible 87% CSR
- Silver $600 Deductible $30 PCP 87% CSR
- Silver $700 Deductible 87% CSR
- Silver $800 Deductible 87% CSR
- Silver Standard 87% CSR
94% CSR Plans
- Copay Silver $0 Deductible 94% CSR
- Silver $0 Deductible 94% CSR
- Silver $0 Deductible $5 PCP 94% CSR
- Silver $150 Deductible 94% CSR
- Silver $250 Deductible 94% CSR
- Silver Standard 94% CSR
$0 Deductible CSR Plans
- Copay Silver $0 Deductible / $500 Rx Deductible 73% CSR
- Copay Silver $0 Deductible 87% CSR
- Copay Silver $0 Deductible 94% CSR
- Silver $0 Deductible 94% CSR
- Silver $0 Deductible $5 PCP 94% CSR
All On-Exchange plans offer variants with Adult Vision Exam and Preventive Dental add-on options. Click here to learn more.
Prescription Drug List | Certificate of Coverage
Off-Exchange Base Plan SBCs
Click the links below to access the Summary of Benefits and Coverage (SBC) for these Off-Exchange 2023 base plans:
Gold/Platinum Plans
- Platinum $500 Deductible Vision Exam + Allergy Testing
- Platinum $1000 Deductible Vision Exam + Allergy Testing
- Gold $1800 Deductible Vision Exam + Allergy Testing
- Gold $2000 Deductible Vision Exam + Allergy Testing
- CGHC HSA Gold $3000 Deductible Vision Exam + Allergy Testing
- Gold $3000 Deductible Vision Exam + Allergy Testing
Silver Plans
- Silver $4000 Deductible Vision Exam + Allergy Testing
- Silver $5000 Deductible Vision Exam + Allergy Testing
- Silver $5650 Deductible Vision Exam + Allergy Testing
- CGHC HSA Silver $3000 Deductible Vision Exam + Allergy Testing
- Silver $5000 Deductible Dental + Vision Exam + Allergy Testing
- Silver $5650 Deductible Dental + Vision Exam+ Allergy Testing
Bronze/Catastrophic Plans
- Bronze $6000 Deductible Vision Exam + Allergy Testing
- CGHC HSA Bronze $7500 Deductible Vision Exam + Allergy Testing
- Bronze $8150 Deductible Vision Exam + Allergy Testing
- Catastrophic $9100 Deductible Vision Exam + Allergy Testing
- Bronze $9100 Deductible Vision Exam + Allergy Testing
- Bronze $9100 Deductible $35 PCP Vision Exam + Allergy Testing
$0 Deductible Plans
- Copay Gold $0 Deductible Vision Exam + Allergy Testing
- Copay Silver $0 Deductible / $1000 Rx Deductible Vision Exam + Allergy Testing
- Copay Bronze $0 Deductible / $2250 Rx Deductible Vision Exam + Allergy Testing
- Copay Bronze 0$ Deductible / $2250 Rx Deductible Dental + Vision Exam + Allergy Testing
All Off-Exchange plans offer variants with a Preventive Dental add-on option. Click here to learn more.
Prescription Drug List | Certificate of Coverage
2023 Plans from your Employer
Small Group EPO Plan SBCs
Click the links below to access the Summary of Benefits and Coverage (SBC) for these Small Group EPO plans:
Bronze Plans
Silver Plans
- EPO Silver $4000 Deductible/20%
- EPO Silver HSA $4800 Deductible/0%
- EPO Silver HSA $3000 Deductible/20%
- EPO Silver $5000 Deductible /20%
- EPO Silver $5500 Deductible/20%
- EPO Silver $6000 Deductible/20%
Gold Plans
- EPO Gold $800 Deductible/20%
- EPO Gold $1500 Deductible/20%
- EPO Gold $2000 Deductible/20%
- EPO Gold $2200 Deductible/20%
- EPO Gold $2750 Deductible/15%
- EPO Gold $2750 Deductible/15% ER Copay
- EPO HSA Gold $3000 Deductible/0%
Platinum Plans
Small Group EPO Plus Plan SBCs
Click the links below to access the Summary of Benefits and Coverage (SBC) for these Out-of-Area EPO Plus plans:
Bronze OOA Plans
- EPO Plus Bronze $8550 Deductible/0%
- EPO Plus HSA Bronze $7000 Deductible/0%
- EPO Plus Bronze $5500 Deductible/30%
Silver OOA Plans
- EPO Plus Silver $4000 Deductible/20%
- EPO Plus HSA Silver $4800 Deductible/0%
- EPO Plus Silver $5000 Deductible /20%
Gold Plans