Summary of Benefits and Coverage (SBCs) for Individual and Family Plans
In compliance with 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
- Bronze 1826, English | Spanish
- Bronze 1826 + Adult Dental + Adult Vision, English | Spanish
- Bronze Savings 1820, English | Spanish
- Bronze Savings 1820 + Adult Dental + Adult Vision, English | Spanish
- Bronze Standard 1828, English | Spanish
- Bronze Value 1814, English | Spanish
- Bronze Value 1814 + Adult Dental + Adult Vision, English | Spanish
- Catastrophic 1746, English | Spanish
- Gold 1742, English | Spanish
- Gold 1742 + Adult Dental + Adult Vision, English | Spanish
- Gold Savings 1825, English | Spanish
- Gold Savings 1825 + Adult Dental + Adult Vision, English | Spanish
- Gold Standard 1833, English | Spanish
- Gold Value 1819, English | Spanish
- Gold Value 1819 + Adult Dental + Adult Vision, English | Spanish
- Silver 1664, English | Spanish
- Silver 1664 + Adult Dental + Adult Vision, English | Spanish
- Silver AV73 1665, English | Spanish
- Silver AV73 1665 + Adult Dental + Adult Vision, English | Spanish
- Silver AV87 1666, English | Spanish
- Silver AV87 1666 + Adult Dental + Adult Vision, English | Spanish
- Silver AV94 1667, English | Spanish
- Silver AV94 1667 + Adult Dental + Adult Vision, English | Spanish
- Silver Savings 1821, English | Spanish
- Silver Savings 1821 + Adult Dental + Adult Vision, English | Spanish
- Silver Savings AV73 1822, English | Spanish
- Silver Savings AV87 1823, English | Spanish
- Silver Savings AV87 1823 + Adult Dental + Adult Vision, English | Spanish
- Silver Savings AV94 1824, English | Spanish
- Silver Savings AV94 1824 + Adult Dental + Adult Vision, English | Spanish
- Silver Standard 1829, English | Spanish
- Silver Standard AV73 1830, English | Spanish
- Silver Standard AV87 1831, English | Spanish
- Silver Standard AV94 1832, English | Spanish
- Silver Value 1815, English | Spanish
- Silver Value 1815 + Adult Dental + Adult Vision, English | Spanish
- Silver Value AV73 1816, English | Spanish
- Silver Value AV73 1816 + Adult Dental + Adult Vision, English | Spanish
- Silver Value AV87 1817, English | Spanish
- Silver Value AV87 1817 + Adult Dental + Adult Vision, English | Spanish
- Silver Value AV94 1818, English | Spanish
- Silver Value AV94 1818 + Adult Dental + Adult Vision, English | Spanish
- Non QHP Silver 3704, English | Spanish
- Non QHP Silver 5554, English | Spanish
- Non QHP Gold 5574, English | Spanish
- Non QHP Gold 5582, English | Spanish
- Non QHP Gold HSA 5586, English | Spanish
- Bronze 1826, English | Spanish
- Bronze 1826 + Adult Dental + Adult Vision, English | Spanish
- Bronze Savings 1820, English | Spanish
- Bronze Savings 1820 + Adult Dental + Adult Vision, English | Spanish
- Bronze Standard 1828, English | Spanish
- Bronze Value 1814, English | Spanish
- Bronze Value 1814 + Adult Dental + Adult Vision, English | Spanish
- Catastrophic 1746, English | Spanish
- Gold 1742, English | Spanish
- Gold 1742 + Adult Dental + Adult Vision, English | Spanish
- Gold Savings 1825, English | Spanish
- Gold Savings 1825 + Adult Dental + Adult Vision, English | Spanish
- Gold Standard 1833, English | Spanish
- Gold Value 1819, English | Spanish
- Gold Value 1819 + Adult Dental + Adult Vision, English | Spanish
- Silver 1664, English | Spanish
- Silver 1664 + Adult Dental + Adult Vision, English | Spanish
- Silver AV73 1665, English | Spanish
- Silver AV73 1665 + Adult Dental + Adult Vision, English | Spanish
- Silver AV87 1666, English | Spanish
- Silver AV87 1666 + Adult Dental + Adult Vision, English | Spanish
- Silver AV94 1667, English | Spanish
- Silver AV94 1667 + Adult Dental + Adult Vision, English | Spanish
- Silver Savings 1821, English | Spanish
- Silver Savings 1821 + Adult Dental + Adult Vision, English | Spanish
- Silver Savings AV73 1822, English | Spanish
- Silver Savings AV87 1823, English | Spanish
- Silver Savings AV87 1823 + Adult Dental + Adult Vision, English | Spanish
- Silver Savings AV94 1824, English | Spanish
- Silver Savings AV94 1824 + Adult Dental + Adult Vision, English | Spanish
- Silver Standard 1829, English | Spanish
- Silver Standard AV73 1830, English | Spanish
- Silver Standard AV87 1831, English | Spanish
- Silver Standard AV94 1832, English | Spanish
- Silver Value 1815, English | Spanish
- Silver Value 1815 + Adult Dental + Adult Vision, English | Spanish
- Silver Value AV73 1816, English | Spanish
- Silver Value AV73 1816 + Adult Dental + Adult Vision, English | Spanish
- Silver Value AV87 1817, English | Spanish
- Silver Value AV87 1817 + Adult Dental + Adult Vision, English | Spanish
- Silver Value AV94 1818, English | Spanish
- Silver Value AV94 1818 + Adult Dental + Adult Vision, English | Spanish
- Non QHP Silver 3704, English | Spanish
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 is underwritten by Health First Commercial Plans, Inc. Health First Commercial Plans, Inc. 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.