Archived plan information

Summaries of benefits and coverage

Gold

• Gold Option A 58326WI0090001-00 (Off Exchange) OR 01 (On Exchange) 2020
• Gold Option B Standard 58326WI0090012-00 (Off Exchange) OR 01 (On Exchange) 2020
• Gold Option C 58326WI0090013-00 (Off Exchange) OR 01 (On Exchange) 2020

Silver

• Silver Option A 58326WI0090002-00 (Off Exchange) OR 01 (On Exchange) 2020
  • Silver Option A 94% 58326WI0090002-06 (only available through the Exchange) 2020
  • Silver-Option-A-87%-58326WI0090002-05 (only available through the Exchange) 2020
  • Silver Option A 73% 58326WI0090002-04(only available through the Exchange) 2020
• Silver Option B 58326WI0090015-00(Off Exchange) OR 01 (On Exchange) 2020
  • Silver Option B 94% 58326WI0090015-06 (only available through the Exchange) 2020
  • Silver Option B 87% 58326WI0090015-05 (only available through the Exchange) 2020
  • Silver Option B 73% 58326WI0090015-04 (only available through the Exchange) 2020
• Silver Option C 58326WI0090016-00 (Off Exchange) OR 01 (On Exchange) 2020
  • Silver Option C 94% 58326WI0090016-06 (only available through the Exchange) 2020
  • Silver Option C 87% 58326WI0090016-05 (only available through the Exchange) 2020
  • Silver Option C 73% 58326WI0090016-04 (only available through the Exchange) 2020

Bronze

• Bronze Option A 58326WI0090006-00 (Off Exchange) OR 01 (On Exchange) 2020
• Bronze Option B Standard 58326WI0090018-00 (Off Exchange) OR 01 (On Exchange) 2020
• Bronze Option C 58326WI0090019-00 (Off Exchange) OR 01 (On Exchange) 2020
• Bronze Option D 58326WI0090020-00 (Off Exchange) OR 01 (On Exchange) 2020

Summaries of benefits and coverage: Only available on Exchange

Gold

• Gold Option A
  • Gold Option A Zero Cost Share 58326WI0090001-02 2020
  • Gold Option A Limited Cost Share 58326WI0090001-03 2020
• Gold Option B
  • Gold Option B Zero Cost Share 58326WI0090012-02 2020
  • Gold Option B Limited Cost Share 58326WI0090012-03 2020
• Gold Option C
  • Gold Option C Zero Cost Share 58326WI0090013-02 2020
  • Gold Option C Limited Cost Share 58326WI0090013-03 2020

Silver

• Silver Option A
  • Silver Option A Zero Cost Share 58326WI0090002-02 2020
  • Silver Option A Limited Cost Share 58326WI0090002-03 2020
• Silver Option B
  • Silver Option B Zero Cost Share 58326WI0090015-02-02 2020
  • Silver Option B Limited Cost Share 58326WI0090015-03 2020
• Silver Option C
  • Silver Option C Zero Cost Share 58326WI0090016-02 2020
  • Silver Option C Limited Cost Share 58326WI0090016-03 2020

Bronze

• Bronze Option A
  • Bronze Option A Zero Cost Share 58326WI0090006-022020
  • Bronze Option A Limited Cost Share 58326WI0090006-032020
• Bronze Option B
  • Bronze Option B Zero Cost Share 58326WI0090018-02 2020
  • Bronze Option B Limited Cost Share 58326WI0090018-03 2020
• Bronze Option C
  • Bronze Option C Zero Cost Share 58326WI0090019-02 2020
  • Bronze Option C Limited Cost Share 58326WI0090019-03 2020
• Bronze Option D
  • Bronze Option D Zero Cost Share 58326WI0090020-02 2020
  • Bronze Option D Limited Cost Share 58326WI0090020-03 2020

• 2020 individual booklet
• 2020 claims payment policies and other information
• 2020 Individual Certificate of Coverage
• 2020 Formulary

Summaries of benefits and coverage

Gold

• Gold Option A 58326WI0090001 2019
• Gold Option B- Standard – 58326WI0090012 2019
• Gold Option C 58326WI0090013 2019

Silver

• Silver Option A 58326WI009002 2019
  • Silver Option A 94% 58326WI009002-06 2019– 94% (only available through the marketplace)
  • Silver-Option-A-87-58326WI009002-05-2019– 87% (only available through the marketplace)
  • Silver Option A 73% 58326WI009002-04 2019 (only available through the marketplace)
• Silver Option B 58326WI0090015 2019
  • Silver Option B 94% 58326WI0090015-06 2019– 94% (only available through the marketplace)
  • Silver Option B 87% 58326WI0090015-05 2019– 87% (only available through the marketplace)
  • Silver Option B 73% 58326WI0090015-04 2019 – 73% (only available through the marketplace)
• Silver Option C 58326WI0090016 2019
  • Silver Option C 94% 58326WI0090016-06 2019 – 94% (only available through the marketplace)
  • Silver Option C 87% 58326WI0090016-05 2019 – 87% (only available through the marketplace)
  • Silver Option C 73% 58326WI0090016-04 2019– 73% (only available through the marketplace)

Bronze

• Bronze Option A 58326WI0090006 2019
• Bronze Option B Standard 58326WI0090018 2019
• Bronze Option C 58326WI0090019 2019
• Bronze Option D 58326WI0090020 2019

Limited and zero cost sharing plans

Uniform glossary

Health insurance plans (only available on the Marketplace)

Summaries of benefits and coverage

Gold

• Gold Option A
  • Gold Option A Limited Cost Sharing 58326WI0090001-03 2019
  • Gold Option A- Zero Cost Share 58326WI0090001-02 2019
• Gold Option B – Standard Plan
  • Gold Option B Limited Cost Sharing 58326WI0090012-03 2019
  • Gold Option B- Zero Cost Share 58326WI0090012-02 2019
• Gold Option C
  • Gold Option C Limited Cost Sharing 58326WI0090013-03 2019
  • Gold Option C- Zero Cost Share 58326WI0090013-02 2019

Silver

• Silver Option A
  • Silver Option A Limited Cost Sharing 58326WI009002-03 2019
  • Silver Option A- Zero Cost Share 58326WI0090002-02 2019
• Silver Option B – Standard Plan
  • Silver Option B Limited Cost Sharing 58326WI0090015-03 2019
  • Silver Option B – Zero Cost Share 58326WI0090015-02 2019
• Silver Option C
  • Silver Option C Limited Cost Sharing 58326WI0090016-03 2019
  • Silver Option C – Zero Cost Share 58326WI0090016-02 2019

Bronze

• Bronze Option A
  • Bronze Option A Limited Cost Sharing 58326WI0090006-03 2019
  • Bronze Option A – Zero Cost Share 58326WI0090006-02 2019
• Bronze Option B – Standard Plan
  • Bronze Option B Limited Cost Sharing 58326WI0090018-03 2019
  • Bronze Option B – Zero Cost Share 58326WI0090018-02 2019
• Bronze Option C
  • Bronze Option C Limited Cost Sharing 58326WI0090019-03 2019
  • Bronze Option C – Zero Cost Share 58326WI0090019-02 2019
• Bronze Option D
  • Bronze Option D Limited Cost Sharing 58326WI0090020-03 2019
  • Bronze Option D – Zero Cost Share 58326WI0090020-02 2019

• 2019 claims payment policies and other information