2025 Non-Group (Individual) plans: Standard Platinum – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard High Gold Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) HMO 2000 Value II – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard Silver II Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard High Bronze HSA - Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) HMO 3500 – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard ConnectorCare 1 Provider Look Up Formulary Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard ConnectorCare 2 Provider Look Up Formulary Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard ConnectorCare 3 Provider Look Up Formulary Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) 2025 Health Connector for Business plans: Standard Platinum – Flex Provider Look Up Formulary Product Grid Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard High Gold Provider Look Up Formulary Product Grid Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) HMO 2000 Value II – Flex Provider Look Up Formulary Product Grid Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard Silver Provider Look Up Formulary Product Grid Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard Low Silver HSA - Flex Provider Look Up Formulary Product Grid Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard High Bronze HSA - Flex Provider Look Up Formulary Product Grid Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) PPO Access HSA 2000 - Flex Provider Look Up Formulary Product Grid Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) HMO 3500 – Flex Provider Look Up Formulary Product Grid Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) 2024 Non-Group (Individual) plans: Standard Platinum – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard High Gold Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) HMO 2000 Low – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard Silver II Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard High Bronze HSA - Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) HMO 3500 – Flex Provider Look Up Formulary Product Guide Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard ConnectorCare 1 Provider Look Up Formulary Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard ConnectorCare 2 Provider Look Up Formulary Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard ConnectorCare 3 Provider Look Up Formulary Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) 2024 Health Connector for Business plans: Standard Platinum – Flex Provider Look Up Formulary Product Grid Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard High Gold Provider Look Up Formulary Product Grid Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) HMO 2000 Low – Flex Provider Look Up Formulary Product Grid Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard Silver Provider Look Up Formulary Product Grid Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard Low Silver HSA - Flex Provider Look Up Formulary Product Grid Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) Standard High Bronze HSA - Flex Provider Look Up Formulary Product Grid Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) PPO HSA 2000 - Flex Provider Look Up Formulary Product Grid Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB) HMO 3500 – Flex Provider Look Up Formulary Product Grid Summary of Benefits (SBC) Evidence of Coverage (EOC) Schedule of Benefits (SOB)
