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 1-855-258-8471 for more information.
Return to Sample Policy Documents
Platinum Plans
Blue Preferred Platinum PPO Plans
Off Exchange
- P910PFR Blue Preferred Platinum PPO 101
- P911PFR Blue Preferred Platinum PPO 102
- P6K1PFR Blue Preferred Platinum PPO103
Blue Focus Platinum PPO Plans
Off Exchange
- P6E1BLC Blue Focus Platinum POS 006
- P6K4BLC Blue Focus Platinum POS 007
- P6K1BLC Blue Focus Platinum POS 008
Gold Plans
Blue Preferred Gold PPO Plans
Off Exchange
- G6J2PFR Blue Preferred Gold PPO 101
- G930PFR Blue Preferred Gold PPO 105
- G931PFR Blue Preferred Gold PPO 107
- G933PFR Blue Preferred Gold PPO 110
- G6K2PFR Blue Preferred Gold PPO 111
- G936PFR Blue Preferred Gold PPO 123
- G6E1PFR Blue Preferred Gold PPO 135
Blue Focus Gold PPO Plans
Off Exchange
- G6E1BLC Blue Focus Gold POS 005
- G6E2BLC Blue Focus Gold POS 007
- G6E3BLC Blue Focus Gold POS 008
- G6K2BlC Blue Focus Gold POS 009
- G6J2BLC Blue Focus Gold POS 101
Silver Plans
Blue Preferred Silver PPO Plans
Off Exchange
- S6J3PFR Blue Preferred Silver PPO 101
- S931PFR Blue Preferred Silver PPO 117
- S932PFR Blue Preferred Silver PPO 120
- S6K3PFR Blue Preferred Silver PPO 121
- S933PFR Blue Preferred Silver PPO 122
- S935PFR Blue Preferred Silver PPO 127
- S6E1PFR Blue Preferred Silver PPO 136
Blue Focus Silver PPO Plans
Off Exchange
- S6E3BLC Blue Focus Silver POS 001
- S6E2BLC Blue Focus Silver POS 003
- S6E1BLC Blue Focus Silver POS 010
- S6K3BLC Blue Focus Silver POS 011
- S6J3BLC Blue Focus Silver POS 101