2024 Non-Marketplace Health Insurance Plans

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*RX Coverage: Generic/Preferred Brand/Non-Preferred Brand Copay.

When you click one of the View buttons below, your Summary of Benefits and Coverage or Policy will pull up in PDF Format.
Al hacer clic en uno de los botones de Ver que están a continuación, su Resumen de Beneficios y Cobertura o póliza saldrá a la ver en formato PDF.

SBC Policy Plan Number Network Maternity In-Network
Deductible Amount		 Primary Care
Practitioner/Specialist
Copay		 Teladoc Coinsurance
Percent		 Out-of-Pocket
Maximum		 RX Coverage*
View View Bronze B07E E Yes $5,950 Individual/  $11,900 Family ded/coins $0 0.5 $7,100 Individual/  $14,200 Family ded/coins
View View Bronze B07L L Yes $5,950 Individual/  $11,900 Family ded/coins $0 0.5 $7,100 Individual/  $14,200 Family ded/coins
View View Bronze B07S S Yes $5,950 Individual/  $11,900 Family ded/coins $0 0.5 $7,100 Individual/  $14,200 Family ded/coins
View View Bronze B08S S Yes $8,700 Individual/  $17,400 Family ded/coins $0 0.0 $8,700 Individual/  $17,400 Family ded/coins
View View Bronze B10E E Yes $7,100 Individual/  $14,200 Family ded/coins $0 0.5 $8,600 Individual/  $17,200 Family ded/coins $20/$50/$100 PRx
View View Bronze B10L L Yes $7,100 Individual/  $14,200 Family ded/coins $0 0.5 $8,600 Individual/  $17,200 Family ded/coins $20/$50/$100 PRx
View View Bronze B10S S Yes $7,100 Individual/  $14,200 Family ded/coins $0 0.5 $8,600 Individual/  $17,200 Family ded/coins $20/$50/$100 PRx
View View Bronze B11E E Yes $6,900 Individual/  $13,800 Family Sanitas PCP: $25 All Others: ded/coins $0 0.5 $9,100 Individual/  $18,200 Family ded/coins $20/$50/$100 PRx
View View Bronze B15E E Yes $9,450 Individual/  $18,900 Family ded/coins $0 0.0 $9,450 Individual/  $18,900 Family ded/coins
View View Bronze B15L L Yes $9,450 Individual/  $18,900 Family ded/coins $0 0.0 $9,450 Individual/  $18,900 Family ded/coins
View View Bronze B15S S Yes $9,450 Individual/  $18,900 Family ded/coins $0 0.0 $9,450 Individual/  $18,900 Family ded/coins
View View Bronze B16E E Yes $7,500 Individual/  $15,000 Family PCP: $50 Spec: $100 $0 0.5 $9,400 Individual/  $18,800 Family 25/ [50/100 sub to ded]
View View Bronze B16L L Yes $7,500 Individual/  $15,000 Family PCP: $50 Spec: $100 $0 0.5 $9,400 Individual/  $18,800 Family 25/ [50/100 sub to ded]
View View Bronze B16S S Yes $7,500 Individual/  $15,000 Family PCP: $50 Spec: $100 $0 0.5 $9,400 Individual/  $18,800 Family 25/ [50/100 sub to ded]
View View Gold G06E E Yes $3,000 Individual/  $6,000 Family PCP: $35 Spec: $50 $0 0.2 $6,600 Individual/  $13,200 Family $8/$35/$60
View View Gold G06L L Yes $3,000 Individual/  $6,000 Family PCP: $35 Spec: $50 $0 0.2 $6,600 Individual/  $13,200 Family $8/$35/$60
View View Gold G06S S Yes $3,000 Individual/  $6,000 Family PCP: $35 Spec: $50 $0 0.2 $6,600 Individual/  $13,200 Family $8/$35/$60
View View Gold G07E E Yes $1,550 Individual/  $3,100 Family Sanitas PCP: $10 Copay Other PCP: ded/coins Spec: ded/coins $0 0.3 $6,200 Individual/  $12,400 Family ded/coins $20/$50/$100 PRx
View View Gold G07S S Yes $1,000 Individual/  $2,000 Family Sanitas PCP: $10 Copay Other PCP: ded/coins Spec: ded/coins $0 0.3 $4,800 Individual/  $9,600 Family ded/coins $20/$50/$100 PRx
View View Gold G08E E Yes $1,500 Individual/  $3,000 Family PCP: $30 Copay Spec: $60 Copay $0 0.25 $8,700 Individual/  $17,400 Family $15/$30/$60
View View Gold G08L L Yes $1,500 Individual/  $3,000 Family PCP: $30 Copay Spec: $60 Copay $0 0.25 $8,700 Individual/  $17,400 Family $15/$30/$60
View View Gold G08S S Yes $1,500 Individual/  $3,000 Family PCP: $30 Copay Spec: $60 Copay $0 0.25 $8,700 Individual/  $17,400 Family $15/$30/$60
View View Silver S04E E Yes $3,300 Individual/  $6,600 Family ded/coins $0 0.5 $6,450 Individual/  $12,900 Family ded/coins $20/$50/$100 PRx
View View Silver S04L L Yes $3,300 Individual/  $6,600 Family ded/coins $0 0.5 $6,450 Individual/  $12,900 Family ded/coins $20/$50/$100 PRx
View View Silver S04S S Yes $3,300 Individual/  $6,600 Family ded/coins $0 0.5 $6,450 Individual/  $12,900 Family ded/coins $20/$50/$100 PRx
View View Silver S20E E Yes $3,200 Individual/  $6,400 Family ded/coins $0 0.5 $7,300 Individual/  $14,600 Family ded/coins $20/$50/$100 PRx
View View Silver S20L L Yes $3,200 Individual/  $6,400 Family ded/coins $0 0.5 $7,300 Individual/  $14,600 Family ded/coins $20/$50/$100 PRx
View View Silver S20S S Yes $3,200 Individual/  $6,400 Family ded/coins $0 0.5 $7,300 Individual/  $14,600 Family ded/coins $20/$50/$100 PRx
View View Silver S22E E Yes $4,050 Individual/  $8,100 Family Sanitas PCP: $25 All Others: ded/coins $0 0.5 $7,650 Individual/  $15,300 Family ded/coins $20/$50/$100 PRx
View View Silver S22S S Yes $3,900 Individual/  $7,800 Family Sanitas PCP: $25 All Others: ded/coins $0 0.5 $7,450 Individual/  $14,900 Family ded/coins $20/$50/$100 PRx
View View Silver S24E E Yes $5,450 Individual/  $10,900 Family PCP: $35 Copay Spec: $75 Copay $0 0.5 $8,900 Individual/  $17,800 Family $60/$100/$250
View View Silver S24L L Yes $5,450 Individual/  $10,900 Family PCP: $35 Copay Spec: $75 Copay $0 0.5 $8,900 Individual/  $17,800 Family $60/$100/$250
View View Silver S24S S Yes $5,450 Individual/  $10,900 Family PCP: $35 Copay Spec: $75 Copay $0 0.5 $8,900 Individual/  $17,800 Family $60/$100/$250
View View Silver S25E E Yes $0 Individual/  $0 Family PCP: $55 Copay Spec: $100 Copay $0 0.5 $9,450 Individual/  $18,900 Family $4500 ded/coins
View View Silver S25L L Yes $0 Individual/  $0 Family PCP: $55 Copay Spec: $100 Copay $0 0.5 $9,450 Individual/  $18,900 Family $4500 ded/coins
View View Silver S25S S Yes $0 Individual/  $0 Family PCP: $55 Copay Spec: $100 Copay $0 0.5 $9,450 Individual/  $18,900 Family $4500 ded/coins
View View Silver S26E E Yes $5,900 Individual/  $11,800 Family PCP: $40 Copay Spec: $80 Copay $0 0.4 $9,100 Individual/  $18,200 Family 20/40[80 sub to ded]
View View Silver S26L L Yes $5,900 Individual/  $11,800 Family PCP: $40 Copay Spec: $80 Copay $0 0.4 $9,100 Individual/  $18,200 Family 20/40[80 sub to ded]
View View Silver S26S S Yes $5,900 Individual/  $11,800 Family PCP: $40 Copay Spec: $80 Copay $0 0.4 $9,100 Individual/  $18,200 Family 20/40[80 sub to ded]
View View Silver S27E E Yes $5,700 Individual/  $11,400 Family PCP: $60 Copay Spec: $120 Copay $0 0.5 $6,700 Individual/  $13,400 Family ded/coins
View View Silver S27L L Yes $5,700 Individual/  $11,400 Family PCP: $60 Copay Spec: $120 Copay $0 0.5 $6,700 Individual/  $13,400 Family ded/coins
View View Silver S27S S Yes $5,700 Individual/  $11,400 Family PCP: $60 Copay Spec: $120 Copay $0 0.5 $6,700 Individual/  $13,400 Family ded/coins
View View Silver S28E E Yes $5,850 Individual/  $11,700 Family Sanitas: $30 Copay All Other PCP: $60 Copay Spec: $120 Copay $0 0.5 $6,800 Individual/  $13,600 Family ded/coins