Summaries of Benefits & Coverage (SBC) and Schedules of Benefits (SOB)

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.

2027 Summaries of Benefits and Coverage (SBC)

The Spanish SBC's will be available soon.

  • Bronze 1826 + Adult Dental + Adult Vision, English | Spanish
  • Bronze Savings 1820 + Adult Dental + Adult Vision, English | Spanish
  • Bronze Value 1814 + Adult Dental + Adult Vision, English | Spanish 
  • Gold 1742 + Adult Dental + Adult Vision, English | Spanish 
  • Gold Savings 1825 + Adult Dental + Adult Vision, English | Spanish 
  • Gold Value 1819 + Adult Dental + Adult Vision, English | Spanish 
  • Silver 1664 + Adult Dental + Adult Vision, English | Spanish 
  • Silver AV73 1665 + Adult Dental + Adult Vision, English | Spanish 
  • Silver AV87 1666 + Adult Dental + Adult Vision, English | Spanish 
  • Silver AV94 1667 + Adult Dental + Adult Vision, English | Spanish 
  • Silver Savings 1821 + Adult Dental + Adult Vision, English | Spanish 
  • Silver Savings AV87 1823 + Adult Dental + Adult Vision, English | Spanish
  • Silver Savings AV94 1824 + Adult Dental + Adult Vision, English | Spanish 
  • Silver Value 1815 + Adult Dental + Adult Vision, English | Spanish 
  • Silver Value AV73 1816 + Adult Dental + Adult Vision, English | Spanish 
  • Silver Value AV87 1817 + Adult Dental + Adult Vision, English | Spanish 
  • Silver Value AV94 1818 + Adult Dental + Adult Vision, English | Spanish 

  • Gold Value 1819 + Enhanced Diabetes Benefits, English | Spanish
  • Gold Value 1819 Limited + Enhanced Diabetes Benefits, English | Spanish
  • Gold Value 1819 Zero + Enhanced Diabetes Benefits, English | Spanish
  • Silver Value 1815 + Enhanced Diabetes Benefits, English | Spanish
  • Silver Value 1815 Limited + Enhanced Diabetes Benefits, English | Spanish
  • Silver Value 1815 Zero + Enhanced Diabetes Benefits, English | Spanish
  • Silver Value AV73 1816 + Enhanced Diabetes Benefits, English | Spanish
  • Silver Value AV87 1817 + Enhanced Diabetes Benefits, English | Spanish
  • Silver Value AV94 1818 + Enhanced Diabetes Benefits, English | Spanish

  • Bronze 1826 ZERO, English | Spanish 
  • Bronze 1826 ZERO + Adult Dental + Adult Vision, English | Spanish 
  • Bronze Savings 1820 ZERO, English | Spanish 
  • Bronze Savings 1820 ZERO + Adult Dental + Adult Vision, English | Spanish 
  • Bronze Standard 1828 ZERO, English | Spanish 
  • Bronze Value 1814 ZERO, English | Spanish 
  • Bronze Value 1814 ZERO + Adult Dental + Adult Vision, English | Spanish 
  • Gold 1742 ZERO, English | Spanish 
  • Gold 1742 ZERO + Adult Dental + Adult Vision, English | Spanish 
  • Gold Savings 1825 ZERO, English | Spanish 
  • Gold Savings 1825 ZERO + Adult Dental + Adult Vision, English | Spanish 
  • Gold Standard 1833 ZERO, English | Spanish 
  • Gold Value 1819 ZERO, English | Spanish 
  • Gold Value 1819 ZERO + Adult Dental + Adult Vision, English | Spanish 
  • Silver 1664 ZERO, English | Spanish 
  • Silver 1664 ZERO + Adult Dental + Adult Vision, English | Spanish 
  • Silver Savings 1821 ZERO, English | Spanish 
  • Silver Savings 1821 ZERO + Adult Dental + Adult Vision, English | Spanish 
  • Silver Standard 1829 ZERO, English | Spanish 
  • Silver Value 1815 ZERO, English | Spanish 
  • Silver Value 1815 ZERO + Adult Dental + Adult Vision, English | Spanish

  • Bronze 1826 LIMITED, English | Spanish 
  • Bronze 1826 LIMITED + Adult Dental + Adult Vision, English | Spanish 
  • Bronze Savings 1820 LIMITED, English | Spanish 
  • Bronze Savings 1820 LIMITED + Adult Dental + Adult Vision, English | Spanish 
  • Bronze Standard 1828 LIMITED, English | Spanish 
  • Bronze Value 1814 LIMITED, English | Spanish 
  • Bronze Value 1814 LIMITED + Adult Dental + Adult Vision, English | Spanish 
  • Gold 1742 LIMITED, English | Spanish 
  • Gold 1742 LIMITED + Adult Dental + Adult Vision, English | Spanish 
  • Gold Savings 1825 LIMITED, English | Spanish 
  • Gold Savings 1825 LIMITED + Adult Dental + Adult Vision, English | Spanish 
  • Gold Standard 1833 LIMITED, English | Spanish 
  • Gold Value 1819 LIMITED, English | Spanish 
  • Gold Value 1819 LIMITED + Adult Dental + Adult Vision, English | Spanish 
  • Silver 1664 LIMITED, English | Spanish 
  • Silver 1664 LIMITED + Adult Dental + Adult Vision, English | Spanish 
  • Silver Savings 1821 LIMITED, English | Spanish 
  • Silver Savings 1821 LIMITED + Adult Dental + Adult Vision, English | Spanish 
  • Silver Standard 1829 LIMITED, English | Spanish 
  • Silver Value 1815 LIMITED, English | Spanish 
  • Silver Value 1815 LIMITED + 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

2027 Schedules of Benefits (SOB)

  • Silver 1664 + Adult Dental + Adult Vision, English | Spanish
  • Silver AV73 1665 + Adult Dental + Adult Vision, English | Spanish
  • Silver AV87 1666 + Adult Dental + Adult Vision, English | Spanish
  • Silver AV94 1667 + Adult Dental + Adult Vision, English | Spanish
  • Gold 1742 + Adult Dental + Adult Vision, English | Spanish
  • Bronze 1826 + Adult Dental + Adult Vision, English | Spanish
  • Bronze Value 1814 + Adult Dental + Adult Vision, English | Spanish
  • Silver Value 1815 + Adult Dental + Adult Vision, English | Spanish
  • Silver Value AV73 1816 + Adult Dental + Adult Vision, English | Spanish
  • Silver Value AV87 1817 + Adult Dental + Adult Vision, English | Spanish
  • Silver Value AV94 1818 + Adult Dental + Adult Vision, English | Spanish
  • Gold Value 1819 + Adult Dental + Adult Vision, English | Spanish
  • Bronze Savings 1820 + Adult Dental + Adult Vision, English | Spanish
  • Silver Savings 1821 + Adult Dental + Adult Vision, English | Spanish
  • Silver Savings AV73 1822 + Adult Dental + Adult Vision, English | Spanish
  • Silver Savings AV87 1823 + Adult Dental + Adult Vision, English | Spanish
  • Silver Savings AV94 1824 + Adult Dental + Adult Vision, English | Spanish
  • Gold Savings 1825 + Adult Dental + Adult Vision, English | Spanish

  • Gold Value 1819 + Enhanced Diabetes Benefits, English | Spanish
  • Gold Value 1819 Zero + Enhanced Diabetes Benefits, English | Spanish
  • Gold Value 1819 Limited + Enhanced Diabetes Benefits, English | Spanish
  • Silver Value 1815 + Enhanced Diabetes Benefits, English | Spanish
  • Silver Value 1815 Zero + Enhanced Diabetes Benefits, English | Spanish
  • Silver Value 1815 Limited + Enhanced Diabetes Benefits, English | Spanish
  • Silver Value AV73 1816 + Enhanced Diabetes Benefits, English | Spanish
  • Silver Value AV87 1817 + Enhanced Diabetes Benefits, English | Spanish
  • Silver Value AV94 1818 + Enhanced Diabetes Benefits, English | Spanish 

2026 Summaries of Benefits & Coverage

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.

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.

 

Schedules of Benefits


Adult Dental and Vision

  • Silver 1664 + Adult Dental + Adult Vision, English | Spanish
  • Silver AV73 1665 + Adult Dental + Adult Vision, English | Spanish
  • Silver AV87 1666 + Adult Dental + Adult Vision, English | Spanish
  • Silver AV94 1667 + Adult Dental + Adult Vision, English | Spanish
  • Gold 1742 + Adult Dental + Adult Vision, English | Spanish
  • Bronze 1826 + Adult Dental + Adult Vision, English | Spanish
  • Bronze Value 1814 + Adult Dental + Adult Vision, English | Spanish
  • Silver Value 1815 + Adult Dental + Adult Vision, English | Spanish
  • Silver Value AV73 1816 + Adult Dental + Adult Vision, English | Spanish
  • Silver Value AV87 1817 + Adult Dental + Adult Vision, English | Spanish
  • Silver Value AV94 1818 + Adult Dental + Adult Vision, English | Spanish
  • Gold Value 1819 + Adult Dental + Adult Vision, English | Spanish
  • Bronze Savings 1820 + Adult Dental + Adult Vision, English | Spanish
  • Silver Savings 1821 + Adult Dental + Adult Vision, English | Spanish
  • Silver Savings AV73 1822 + Adult Dental + Adult Vision, English | Spanish
  • Silver Savings AV87 1823 + Adult Dental + Adult Vision, English | Spanish
  • Silver Savings AV94 1824 + Adult Dental + Adult Vision, English | Spanish
  • Gold Savings 1825 + 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


Enhanced Diabetes Benefits

Gold Value 1819 + Enhanced Diabetes Benefits, English | Spanish
Gold Value 1819 Zero + Enhanced Diabetes Benefits, English | Spanish
Gold Value 1819 Limited + Enhanced Diabetes Benefits, English | Spanish
Silver Value 1815 + Enhanced Diabetes Benefits, English | Spanish
Silver Value 1815 Zero + Enhanced Diabetes Benefits, English | Spanish
Silver Value 1815 Limited + Enhanced Diabetes Benefits, English | Spanish
Silver Value AV73 1816 + Enhanced Diabetes Benefits, English | Spanish
Silver Value AV87 1817 + Enhanced Diabetes Benefits, English | Spanish
Silver Value AV94 1818 + Enhanced Diabetes Benefits, English | Spanish