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About Small Group Products Off Exchange
Small Group Products Off Exchange
2021 Small Group Products Off Exchange
HMO - Large Group, Small Group, and High Deductible Member Handbook
Service Area by Zip Code
Small Group Enrollment Change Form
2021 Rewards Plans –
click to expand
Platinum Rewards–
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Rewards COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Platinum Rewards 1250–
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Rewards COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Gold Rewards-
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of
Copays and Deductible
s
Rewards COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Silver Rewards-
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Rewards COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
2021 Standard Plans –
click to expand
Platinum 750 –
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
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Gold 1250–
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Gold 2000 -
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Silver 3000 -
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Silver 5000-1 -
Benefits
Summary of Benefits & Coverage (SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Silver 5000-2 -
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Bronze 6500-1 -
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Bronze 6500-2 -
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
2021 HSA Plans –
click to expand
Platinum HSA 1400–
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
HSA COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Gold HSA 1750–
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
HSA COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Silver HSA 3000-
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
HSA COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Bronze HSA 6900-
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
HSA COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
2021 HRA Plans
– click to expand
Gold HRA 4500-
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
HRA COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
2021 Select Plans
– click to expand
Gold 2000 Select -
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Silver 5000-1 Select -
Benefits
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
2020 Small Group Products Off Exchange
HMO - Large Group, Small Group, and High Deductible Member Handbook
Service Area by Zip Code
2020 Rewards Plans –
click to expand
Platinum Rewards–
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Rewards COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Gold Rewards-
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of
Copays and Deductible
s
Rewards COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Silver Rewards-
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Rewards COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
2020 Standard Plans –
click to expand
Platinum 750 –
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Gold 1250–
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Gold 2000 -
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Silver 2500 -
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Silver 5000-1 -
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Silver 5000-2 -
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Bronze 6500-1 -
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Bronze 6500-2 -
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
2020 HSA Plans –
click to expand
Platinum HSA 1400–
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
HSA COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Gold HSA 1750–
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
HSA COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Silver HSA 3000-
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
HSA COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Bronze HSA 6900-
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
HSA COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
2020 HRA Plans
– click to expand
Gold HRA 4500-
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
HRA COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
2020 Select Plans
– click to expand
Gold 2000 Select -
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Silver 5000 Select -
Benefits
2020 –
Summary of Benefits & Coverage
(SBC)
Schedule of Copays and Deductibles
Standard COC
Quarter 1 Rates
Quarter 2 Rates
Quarter 3 Rates
Quarter 4 Rates
Documents
Individual and Small Group Community Service Area Zip Codes
MHP Community Small Group Bronze Standard
MHP Community Small Group Gold Rewards
MHP Community Small Group Gold Standard
MHP Community Small Group Platinum Rewards
MHP Community Small Group Platinum Standard
MHP Community Small Group Silver Rewards
MHP Community Small Group Silver Standard
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