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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.

You are now viewing 2024 plan year

View Plan year: 2023

On-Exchange

Silver 2024

Plan Individual Policy Schedule of benefits Effective date
HA Silver AH Individual Policy Schedule of Benefits 1/1/2024
HA Silver AH 73% CSR Individual Policy Schedule of Benefits 1/1/2024
HA Silver AH 87% CSR Individual Policy Schedule of Benefits 1/1/2024
HA Silver AH 94% CSR Individual Policy Schedule of Benefits 1/1/2024
HA Silver AH (0% - 20% FPL) Individual Policy Schedule of Benefits 1/1/2024
HA Silver AH (21% - 40% FPL) Individual Policy Schedule of Benefits 1/1/2024
HA Silver AH (41% - 60% FPL) Individual Policy Schedule of Benefits 1/1/2024
HA Silver AH (61% - 80% FPL) Individual Policy Schedule of Benefits 1/1/2024
HA Silver AH (81% - 100% FPL) Individual Policy Schedule of Benefits 1/1/2024
HA Silver AH (101% - 120% FPL) Individual Policy Schedule of Benefits 1/1/2024
HA Silver AH (121% - 138% FPL) Individual Policy Schedule of Benefits 1/1/2024
HA Silver Standardized Individual Policy Schedule of Benefits 1/1/2024
HA Silver Standardized 73% CSR Individual Policy Schedule of Benefits 1/1/2024
HA Silver Standardized 87% CSR Individual Policy Schedule of Benefits 1/1/2024
HA Silver Standardized 94% CSR Individual Policy Schedule of Benefits 1/1/2024

Bronze 2024

Plan Individual Policy Schedule of benefits Effective date
HA Bronze Suitcase Individual Policy Schedule of Benefits 1/1/2024
HA Bronze Exp Standardized Individual Policy Schedule of Benefits 1/1/2024

Gold 2024

Plan Individual Policy Schedule of benefits Effective date
HA Gold Standardized Individual Policy Schedule of Benefits 1/1/2024

American Indian / Alaskan Native

Silver 2024

Plan Individual Policy Schedule of benefits Effective date
HA Silver AH AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
HA Silver AH AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024
HA Silver Standardized AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
HA Silver Standardized AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024

Bronze 2024

Plan Individual Policy Schedule of benefits Effective date
HA Bronze Suitcase AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
HA Bronze Suitcase AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024
HA Bronze Exp Standardized AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
HA Bronze Exp Standardized AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024

Gold 2024

Plan Individual Policy Schedule of benefits Effective date
HA Gold Standardized AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
HA Gold Standardized AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024

Off-Exchange

Silver 2024

Plan Individual Policy Schedule of benefits Effective date
HA Silver AH Individual Policy Schedule of Benefits 1/1/2024
HA Silver Standardized Individual Policy Schedule of Benefits 1/1/2024

Bronze 2024

Plan Individual Policy Schedule of benefits Effective date
HA Bronze Suitcase Individual Policy Schedule of Benefits 1/1/2024
HA Bronze Exp Standardized Individual Policy Schedule of Benefits 1/1/2024

Gold 2024

Plan Individual Policy Schedule of benefits Effective date
HA Gold Standardized Individual Policy Schedule of Benefits 1/1/2024

*CSR-Cost sharing reduction: A discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance, and copayments. You can get this reduction if you get health insurance through the Marketplace, your income is below a certain level and you choose a health plan from the Silver plan category. If you are a member of a federally recognized tribe, you may qualify for additional cost-sharing benefits.

Note: Policy ID may also be referenced as Certificate ID in other correspondence.