Resources and Forms

Everything you need for your Maine coverage.

Individual & Family Plans

Summary of Benefits and Coverage (SBC)
Bronze Specialist Saver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health) - OffEx
Download PDF
Bronze Specialist Saver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health) - OnEx
Download PDF
Bronze Specialist Saver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health) - OnEx ZCS
Download PDF
Bronze Specialist Saver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health) - OnEx LCS
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OffEx
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx ZCS
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx LCS
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx CSR 73%
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx CSR 87%
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx CSR 94%
Download PDF
Gold 0000 $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs & X-Rays) 50% Coinsurance - OffEx
Download PDF
Gold 0000 $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs & X-Rays) 50% Coinsurance - OnEx
Download PDF
Gold 0000 $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs & X-Rays) 50% Coinsurance - OnEx ZCS
Download PDF
Gold 0000 $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs & X-Rays) 50% Coinsurance - OnEx LCS
Download PDF
Clear Choice Enhanced Bronze 9100 - OffEx
Download PDF
Clear Choice Enhanced Bronze 9100 - OnEx
Download PDF
Clear Choice Enhanced Bronze 9100 - OnEx ZCS
Download PDF
Clear Choice Enhanced Bronze 9100 - OnEx LCS
Download PDF
Clear Choice Silver 3000 - OffEx
Download PDF
Clear Choice Silver 3000 - OnEx
Download PDF
Clear Choice Silver 3000 - OnEx ZCS
Download PDF
Clear Choice Silver 3000 - OnEx LCS
Download PDF
Clear Choice Silver 3000 - OnEx CSR 73%
Download PDF
Clear Choice Silver 3000 - OnEx CSR 87%
Download PDF
Clear Choice Silver 3000 - OnEx CSR 94%
Download PDF
Clear Choice Gold 1500 - OffEx
Download PDF
Clear Choice Gold 1500 - OnEx
Download PDF
Clear Choice Gold 1500 - OnEx ZCS
Download PDF
Clear Choice Gold 1500 - OnEx LCS
Download PDF
Schedule of Benefits (SOB)
Bronze Specialist Saver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health) - OffEx
Download PDF
Bronze Specialist Saver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health) - OnEx
Download PDF
Bronze Specialist Saver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health) - OnEx ZCS
Download PDF
Bronze Specialist Saver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health) - OnEx LCS
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OffEx
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx ZCS
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx LCS
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx CSR 73%
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx CSR 87%
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx CSR 94%
Download PDF
Gold 0000 $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs & X-Rays) 50% Coinsurance - OffEx
Download PDF
Gold 0000 $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs & X-Rays) 50% Coinsurance - OnEx
Download PDF
Gold 0000 $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs & X-Rays) 50% Coinsurance - OnEx ZCS
Download PDF
Gold 0000 $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs & X-Rays) 50% Coinsurance - OnEx LCS
Download PDF
Clear Choice Enhanced Bronze 9100 - OffEx
Download PDF
Clear Choice Enhanced Bronze 9100 - OnEx
Download PDF
Clear Choice Enhanced Bronze 9100 - OnEx ZCS
Download PDF
Clear Choice Enhanced Bronze 9100 - OnEx LCS
Download PDF
Clear Choice Silver 3000 - OffEx
Download PDF
Clear Choice Silver 3000 - OnEx
Download PDF
Clear Choice Silver 3000 - OnEx ZCS
Download PDF
Clear Choice Silver 3000 - OnEx LCS
Download PDF
Clear Choice Silver 3000 - OnEx CSR 73%
Download PDF
Clear Choice Silver 3000 - OnEx CSR 87%
Download PDF
Clear Choice Silver 3000 - OnEx CSR 94%
Download PDF
Clear Choice Gold 1500 - OffEx
Download PDF
Clear Choice Gold 1500 - OnEx
Download PDF
Clear Choice Gold 1500 - OnEx ZCS
Download PDF
Clear Choice Gold 1500 - OnEx LCS
Download PDF
Evidence of Coverage (EOC)
Bronze Specialist Saver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health) - OffEx
Download PDF
Bronze Specialist Saver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health) - OnEx
Download PDF
Bronze Specialist Saver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health) - OnEx ZCS
Download PDF
Bronze Specialist Saver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health) - OnEx LCS
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OffEx
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx ZCS
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx LCS
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx CSR 73%
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx CSR 87%
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OnEx CSR 94%
Download PDF
Gold 0000 $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs & X-Rays) 50% Coinsurance - OffEx
Download PDF
Gold 0000 $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs & X-Rays) 50% Coinsurance - OnEx
Download PDF
Gold 0000 $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs & X-Rays) 50% Coinsurance - OnEx ZCS
Download PDF
Gold 0000 $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs & X-Rays) 50% Coinsurance - OnEx LCS
Download PDF
Clear Choice Enhanced Bronze 9100 - OffEx
Download PDF
Clear Choice Enhanced Bronze 9100 - OnEx
Download PDF
Clear Choice Enhanced Bronze 9100 - OnEx ZCS
Download PDF
Clear Choice Enhanced Bronze 9100 - OnEx LCS
Download PDF
Clear Choice Silver 3000 - OffEx
Download PDF
Clear Choice Silver 3000 - OnEx
Download PDF
Clear Choice Silver 3000 - OnEx ZCS
Download PDF
Clear Choice Silver 3000 - OnEx LCS
Download PDF
Clear Choice Silver 3000 - OnEx CSR 73%
Download PDF
Clear Choice Silver 3000 - OnEx CSR 87%
Download PDF
Clear Choice Silver 3000 - OnEx CSR 94%
Download PDF
Clear Choice Gold 1500 - OffEx
Download PDF
Clear Choice Gold 1500 - OnEx
Download PDF
Clear Choice Gold 1500 - OnEx ZCS
Download PDF
Clear Choice Gold 1500 - OnEx LCS
Download PDF

Small Group Plans

Summary of Benefits and Coverage (SBC)
Bronze Specialist Saver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health) - OffEx
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OffEx
Download PDF
Gold 0000 $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs & X-Rays) 50% Coinsurance - OffEx
Download PDF
Clear Choice Enhanced Bronze 9100 - OffEx
Download PDF
Clear Choice Silver 3000 - OffEx
Download PDF
Clear Choice Gold 1500 - OffEx
Download PDF
Schedule of Benefits (SOB)
Bronze Specialist Saver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health) - OffEx
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OffEx
Download PDF
Gold 0000 $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs & X-Rays) 50% Coinsurance - OffEx
Download PDF
Clear Choice Enhanced Bronze 9100 - OffEx
Download PDF
Clear Choice Silver 3000 - OffEx
Download PDF
Clear Choice Gold 1500 - OffEx
Download PDF
Evidence of Coverage (EOC)
Bronze Specialist Saver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health) - OffEx
Download PDF
Silver $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs) - OffEx
Download PDF
Gold 0000 $0 Direct Primary Care + $0 Copays (Telehealth + Mental Health + Generic Drugs + Labs & X-Rays) 50% Coinsurance - OffEx
Download PDF
Clear Choice Enhanced Bronze 9100 - OffEx
Download PDF
Clear Choice Silver 3000 - OffEx
Download PDF
Clear Choice Gold 1500 - OffEx
Download PDF
A loading animation