Below is a list of actual policy documents for QHP small group coverage. These policies describe how the plans generally work and include eligible expenses, claim filing and appeals procedures, and coverage limitations and exceptions, among other things.
If you have questions, contact a customer service representative at 1-888-697-0683 for more information.
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Platinum Plans
Blue Choice Advantage Platinum PPO Plans
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Policy Books
P620CHC Blue Choice Platinum PPO 810
PV20CHC Blue Choice Platinum PPO 810-in vitro
P621CHC Blue Choice Platinum PPO 811
PV21CHC Blue Choice Platinum PPO 811-in vitro
Blue Advantage Platinum HMO Plans
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Policy Books
P610ADT Blue Advantage Platinum HMO 807
PV10ADT Blue Advantage Platinum HMO 807-in vitro
P611ADT Blue Advantage Platinum HMO 808
PV11ADT Blue Advantage Platinum HMO 808-in vitro
Plan Descriptions
P610ADT Blue Advantage Platinum HMO 807
PV10ADT Blue Advantage Platinum HMO 807-in vitro
P611ADT Blue Advantage Platinum HMO 808
PV11ADT Blue Advantage Platinum HMO 808-in vitro
Gold Plans
Blue Choice Gold PPO Plans
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Policy Books
G9K4CHC Blue Choice Gold PPO 103
G9K5CHC Blue Choice Gold PPO 103-in-vitro
G9K6CHC Blue Choice Gold PPO 112
G9K7CHC Blue Choice Gold PPO 112-in-vitro
G9K8CHC Blue Choice Gold PPO 114
G9K9CHC Blue Choice Gold PPO 114-in-vitro
G9L1CHC Blue Choice Gold PPO 117
G9L2CHC Blue Choice Gold PPO 117-in-vitro
G650CHC Blue Choice Gold PPO 801
GV50CHC Blue Choice Gold PPO 801-in vitro
G651CHC Blue Choice Gold PPO 819
GV51CHC Blue Choice Gold PPO 819-in vitro
G652CHC Blue Choice Gold PPO 820
GV52CHC Blue Choice Gold PPO 820-in vitro
G653CHC Blue Choice Gold PPO 822
GV53CHC Blue Choice Gold PPO 822-in vitro
G654CHC Blue Choice Gold PPO 823
GV54CHC Blue Choice Gold PPO 823-in vitro
G656CHC Blue Choice Gold PPO 830
GV56CHC Blue Choice Gold PPO 830-in vitro
Blue Advantage Gold HMO Plans
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Policy Books
G9J1ADT Blue Advantage Gold HMO 103
G9J2ADT Blue Advantage Gold HMO 103-in vitro
G660ADT Blue Advantage Gold HMO 801
GV60ADT Blue Advantage Gold HMO 801-in vitro
G661ADT Blue Advantage Gold HMO 812
GV61ADT Blue Advantage Gold HMO 812-in vitro
G662ADT Blue Advantage Gold HMO 814
GV62ADT Blue Advantage Gold HMO 814-in vitro
G663ADT Blue Advantage Gold HMO 816
GV63ADT Blue Advantage Gold HMO 816-in vitro
G664ADT Blue Advantage Gold HMO 817
GV64ADT Blue Advantage Gold HMO 817-in vitro
G665ADT Blue Advantage Gold HMO 822
GV65ADT Blue Advantage Gold HMO 822-in vitro
G666ADT Blue Advantage Gold HMO 830
GV66ADT Blue Advantage Gold HMO 830-in vitro
G9E1ADT Blue Advantage Gold HMO 919
G9E2ADT Blue Advantage Gold HMO 919-in vitro
G9E3ADT Blue Advantage Gold HMO 922
G9E4ADT Blue Advantage Gold HMO 922-in vitro
G9E5ADT Blue Advantage Gold HMO 923
G9E6ADT Blue Advantage Gold HMO 923-in vitro
Plan Descriptions
G660ADT Blue Advantage Gold HMO 801
GV60ADT Blue Advantage Gold HMO 801-in vitro
G661ADT Blue Advantage Gold HMO 812
GV61ADT Blue Advantage Gold HMO 812-in vitro
G662ADT Blue Advantage Gold HMO 814
GV62ADT Blue Advantage Gold HMO 814-in vitro
G663ADT Blue Advantage Gold HMO 816
GV63ADT Blue Advantage Gold HMO 816-in vitro
G664ADT Blue Advantage Gold HMO 817
GV64ADT Blue Advantage Gold HMO 817-in vitro
G665ADT Blue Advantage Gold HMO 822
GV65ADT Blue Advantage Gold HMO 822-in vitro
G666ADT Blue Advantage Gold HMO 830
GV66ADT Blue Advantage Gold HMO 830-in vitro
G9E1ADT Blue Advantage Gold HMO 919
G9E2ADT Blue Advantage Gold HMO 919-in vitro
G9E3ADT Blue Advantage Gold HMO 922
G9E4ADT Blue Advantage Gold HMO 922-in vitro
G9E5ADT Blue Advantage Gold HMO 923
G9E6ADT Blue Advantage Gold HMO 923-in vitro
Silver Plans
Blue Choice Silver PPO Plans
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Policy Books
S9L3CHC Blue Choice Silver PPO 101
S9L4CHC Blue Choice Silver PPO 101-in-vitro
S9L5CHC Blue Choice Silver PPO 102
S9L6CHC Blue Choice Silver PPO 102-in-vitro
S9L7CHC Blue Choice Silver PPO 146
S9L8CHC Blue Choice Silver PPO 146-in-vitro
S9L9CHC Blue Choice Silver PPO 118
S9M1CHC Blue Choice Silver PPO 118-in-vitro
S9M2CHC Blue Choice Silver PPO 135
S9M3CHC Blue Choice Silver PPO 135-in-vitro
S660CHC Blue Choice Silver PPO 803
SV60CHC Blue Choice Silver PPO 803-in vitro
S661CHC Blue Choice Silver PPO 824
SV61CHC Blue Choice Silver PPO 824-in vitro
S662CHC Blue Choice Silver PPO 825
SV62CHC Blue Choice Silver PPO 825-in vitro
S663CHC Blue Choice Silver PPO 827
SV63CHC Blue Choice Silver PPO 827-in vitro
S665CHC Blue Choice Silver PPO 834
SV65CHC Blue Choice Silver PPO 834-in vitro
S9M4CHC Blue Choice Silver PPO 120
S9M5CHC Blue Choice Silver PPO 120-in vitro
S666CHC Blue Choice Silver PPO 844
SV66CHC Blue Choice Silver PPO 844-in vitro
S667CHC Blue Choice Silver PPO 845
SV67CHC Blue Choice Silver PPO 845-in vitro
Blue Advantage Silver HMO Plans
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Policy Books
S9J3ADT Blue Advantage Silver HMO 101
S9J4ADT Blue Advantage Silver HMO 101-in-vitro
S9J5ADT Blue Advantage Silver HMO 102
S9J6ADT Blue Advantage Silver HMO 102-in-vitro
S9J7ADT Blue Advantage Silver HMO 127
S9J8ADT Blue Advantage Silver HMO 127-in-vitro
S9J9ADT Blue Advantage Silver HMO 134
S9K1ADT Blue Advantage Silver HMO 134-in-vitro
S640ADT Blue Advantage Silver HMO 803
SV40ADT Blue Advantage Silver HMO 803-in vitro
S641ADT Blue Advantage Silver HMO 804
SV41ADT Blue Advantage Silver HMO 804-in vitro
S642ADT Blue Advantage Silver HMO 818
SV42ADT Blue Advantage Silver HMO 818-in vitro
S643ADT Blue Advantage Silver HMO 820
SV43ADT Blue Advantage Silver HMO 820-in vitro
S644ADT Blue Advantage Silver HMO 846
SV44ADT Blue Advantage Silver HMO 846-in vitro
S9E1ADT Blue Advantage Silver HMO 925
S9E2ADT Blue Advantage Silver HMO 925-in vitro
S9E3ADT Blue Advantage Silver HMO 935
S9E4ADT Blue Advantage Silver HMO 935-in vitro
S9E5ADT Blue Advantage Silver HMO 945
S9E6ADT Blue Advantage Silver HMO 945-in vitro
Plan Descriptions
S640ADT Blue Advantage Silver HMO 803
SV40ADT Blue Advantage Silver HMO 803-in vitro
S641ADT Blue Advantage Silver HMO 804
SV41ADT Blue Advantage Silver HMO 804-in vitro
S642ADT Blue Advantage Silver HMO 818
SV42ADT Blue Advantage Silver HMO 818-in vitro
S643ADT Blue Advantage Silver HMO 820
SV43ADT Blue Advantage Silver HMO 820-in vitro
S644ADT Blue Advantage Silver HMO 846
SV44ADT Blue Advantage Silver HMO 846-in vitro
S9E1ADT Blue Advantage Silver HMO 925
S9E2ADT Blue Advantage Silver HMO 925-in vitro
S9E3ADT Blue Advantage Silver HMO 935
S9E4ADT Blue Advantage Silver HMO 935-in vitro
S9E5ADT Blue Advantage Silver HMO 945
S9E6ADT Blue Advantage Silver HMO 945-in vitro
S9K2ADT Blue Advantage Silver HMO 120
S9K3ADT Blue Advantage Silver HMO 120-in vitro
Bronze Plans
Blue Choice Bronze PPO Plans
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Policy Books
B662CHC Blue Choice Bronze PPO 833
BV62CHC Blue Choice Bronze PPO 833-in vitro
B660CHC Blue Choice Bronze PPO 805
BV60CHC Blue Choice Bronze PPO 805-in vitro
B661CHC Blue Choice Bronze PPO 806
BV61CHC Blue Choice Bronze PPO 806-in vitro
Blue Advantage Bronze HMO Plans
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Policy Books
B661ADT Blue Advantage Bronze HMO 833
BV61ADT Blue Advantage Bronze HMO 833-in vitro
B660ADT Blue Advantage Bronze HMO 806
BV60ADT Blue Advantage Bronze HMO 806-in vitro
B9E1ADT Blue Advantage Bronze HMO 905
B9E2ADT Blue Advantage Bronze HMO 905-in vitro
Plan Descriptions
B661ADT Blue Advantage Bronze HMO 833
BV61ADT Blue Advantage Bronze HMO 833-in vitro
B660ADT Blue Advantage Bronze HMO 806
BV60ADT Blue Advantage Bronze HMO 806-in vitro
B9E1ADT Blue Advantage Bronze HMO 905
B9E2ADT Blue Advantage Bronze HMO 905-in vitro