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Limited Cost Share and Zero Cost Share Plans (2019)

Summary of Benefits And Coverage (SBCs) for Individual Zero Cost Sharing and Limited Cost Sharing 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.

The SBCs below are provided for limited cost sharing and zero cost sharing plans. Limited cost sharing plans are available to members of the federally recognized tribes and Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders, regardless of income or eligibility for premium tax credits. Zero cost sharing plans are available to members of the federally recognized tribes and ANCSA Corporation shareholders whose income is between 100% and 300% of the federal poverty level and qualify for premium tax credits. Eligibility for these plans is determined by the Marketplace.

Limited Cost Share Plans

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 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 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 HMO 65 1806
Health First Silver HMO 80 1754
Health First Silver HMO 80 1778
Health First Silver HMO 90 1798

Zero Cost Share Plans

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 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 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 HMO 65 1806
Health First Silver HMO 80 1754
Health First Silver HMO 80 1778

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.

Last updated: 12/18/2018