Individual Plans (2018)

Summary of Benefits and Coverage (SBCs)

In compliance with new requirements of the Affordable Care Act, Health First Health Plans has made available a Summary of Benefits and Coverage (SBC) for your plan. The SBC summarizes important information about your health coverage in a standardized format. Each SBC will display as a PDF, and you will need Adobe Reader to view it. You can download Acrobat Reader for free using the link at the bottom of this page. If you aren't clear about any of the underlined terms used in these forms, see the Glossary.

HMO

Health First Bronze HMO 100 1774
Health First Bronze HMO 100 HSA 1794
Health First Bronze HMO 60 1750
Health First Gold HMO 80 1770
Health First GYM ACCESS Bronze HMO 100 HSA 1658
Health First GYM ACCESS Bronze HMO 50 1796
Health First GYM ACCESS Bronze HMO 70 1656
Health First GYM ACCESS Bronze HMO 70 HSA 1662
Health First GYM ACCESS Catastrophic HMO 1746
Health First GYM ACCESS Gold HMO 100 1736
Health First GYM ACCESS Gold HMO 70 1742
Health First GYM ACCESS Gold HMO 80 1740
Health First GYM ACCESS Gold HMO 90 HSA 1744
Health First GYM ACCESS Silver AV73 HMO 100 1665
Health First GYM ACCESS Silver AV73 HMO 100 1673
Health First GYM ACCESS Silver AV73 HMO 70 1705
Health First GYM ACCESS Silver AV73 HMO 70 1721
Health First GYM ACCESS Silver AV73 HMO 80 1689
Health First GYM ACCESS Silver AV73 HMO 80 HSA 1729
Health First GYM ACCESS Silver AV73 HMO 90 1681
Health First GYM ACCESS Silver AV87 HMO 100 1666
Health First GYM ACCESS Silver AV87 HMO 100 1674
Health First GYM ACCESS Silver AV87 HMO 70 1706
Health First GYM ACCESS Silver AV87 HMO 70 1722
Health First GYM ACCESS Silver AV87 HMO 80 1690
Health First GYM ACCESS Silver AV87 HMO 80 1730
Health First GYM ACCESS Silver AV87 HMO 90 1682
Health First GYM ACCESS Silver AV94 HMO 100 1667
Health First GYM ACCESS Silver AV94 HMO 100 1675
Health First GYM ACCESS Silver AV94 HMO 70 1707
Health First GYM ACCESS Silver AV94 HMO 70 1723
Health First GYM ACCESS Silver AV94 HMO 80 1691
Health First GYM ACCESS Silver AV94 HMO 80 1731
Health First GYM ACCESS Silver AV94 HMO 90 1683
Health First GYM ACCESS Silver HMO 100 1664
Health First GYM ACCESS Silver HMO 100 1672
Health First GYM ACCESS Silver HMO 70 1704
Health First GYM ACCESS Silver HMO 70 1720
Health First GYM ACCESS Silver HMO 80 1688
Health First GYM ACCESS Silver HMO 80 HSA 1728
Health First GYM ACCESS Silver HMO 90 1680
Health First Silver AV73 HMO 65 1807
Health First Silver AV73 HMO 80 1755
Health First Silver AV73 HMO 80 1779
Health First Silver AV73 HMO 90 1799
Health First Silver AV87 HMO 65 1808
Health First Silver AV87 HMO 80 1756
Health First Silver AV87 HMO 80 1780
Health First Silver AV87 HMO 90 1800
Health First Silver AV94 HMO 65 1809
Health First Silver AV94 HMO 80 1781
Health First Silver AV94 HMO 90 1801
Health First Silver AV94 HMO 95 1757
Health First Silver HMO 65 1806
Health First Silver HMO 80 1754
Health First Silver HMO 80 1778
Health First Silver HMO 90 1798

HMO Plans - 3000 Series

Health First GYM ACCESS Silver HMO 100 3664
Health First GYM ACCESS Silver HMO 100 3672
Health First GYM ACCESS Silver HMO 70 3704
Health First GYM ACCESS Silver HMO 70 3720
Health First GYM ACCESS Silver HMO 80 3688
Health First GYM ACCESS Silver HMO 80 HSA 3728
Health First GYM ACCESS Silver HMO 90 3680
Health First Silver HMO 65 3806
Health First Silver HMO 80 3754
Health First Silver HMO 80 3778
Health First Silver HMO 90 3798

POS Plans

Health First Bronze POS 100 1775
Health First Bronze POS 60 1751
Health First Gold POS 80 1771
Health First GYM ACCESS Bronze POS 100 HSA 1659
Health First GYM ACCESS Catastrophic POS 1747
Health First GYM ACCESS Gold POS 100 1737
Health First GYM ACCESS Silver AV73 POS 70 1709
Health First GYM ACCESS Silver AV73 POS 80 1693
Health First GYM ACCESS Silver AV87 POS 70 1710
Health First GYM ACCESS Silver AV87 POS 80 1694
Health First GYM ACCESS Silver AV94 POS 70 1711
Health First GYM ACCESS Silver AV94 POS 80 1695
Health First GYM ACCESS Silver POS 70 1708
Health First GYM ACCESS Silver POS 80 1692
Health First Silver AV73 POS 80 1759
Health First Silver AV73 POS 80 1783
Health First Silver AV87 POS 80 1760
Health First Silver AV87 POS 80 1784
Health First Silver AV94 POS 80 1785
Health First Silver AV94 POS 95 1761
Health First Silver POS 80 1758
Health First Silver POS 80 1782

POS Plans - 3000 Series

Health First GYM ACCESS Silver POS 70 3708
Health First GYM ACCESS Silver POS 80 3692
Health First Silver POS 80 3758
Health First Silver POS 80 3782

A paper copy of your SBC is also available, free of charge, by calling Customer Service toll-free at 1.855.443.4735 (TTY/TDD relay: 1.800.955.8771) weekdays from 8 a.m. to 6 p.m.

In compliance with requirements of the Affordable Care Act, Health First Health Plans has made available a Summary of Benefits and Coverage (SBC) for Limited Cost Share and Zero Cost Share Plans.

Health First Health Plans has entered into an agreement with CMS to provide health insurance coverage through Qualified Health Plans on the Federally Facilitated Marketplace. Health First Health Plans does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. For more information, contact your agent or your local Health First Health Plans office.

Last updated: 9/21/2017