Summaries of Benefits and Coverage for large group plans — 2020

AmeriHealth Advantage plans

• AmeriHealth Advantage EPO $15/$25 $1,500 $100/day
• AmeriHealth Advantage EPO $15/$30 $1,000 $100/day
• AmeriHealth Advantage EPO $20/$40 $2,000/20%
• AmeriHealth Advantage EPO $30/$45 $2,500/30%
• AmeriHealth Advantage EPO $30/$60 $2,500/30%
• AmeriHealth Advantage EPO HSA $1,500/10% $7/50%/$125 Rx
• AmeriHealth Advantage EPO HSA $2,500/30% $7/50%/$125 Rx

AmeriHealth Hospital Advantage plans

• AmeriHealth Hospital Advantage EPO $50/$75 $2,500/30%
• AmeriHealth Hospital Advantage EPO HSA $2,500/30% $7/50%/$125 Rx

EPO HSA plans

• EPO HSA $30/$50 $2,500/0% $25/$50/$75 Rx
• EPO HSA $1,500/30% $7/50%/$125 Rx
• EPO HSA $1,500/30% $10/$40/$60 Rx
• EPO HSA $1,500/50% $7/50%/125 Rx
• EPO HSA $2,500/20% $25/$50/$75 Rx
• EPO HSA $2,500/50% $25/$50/$75 Rx

EPO plans

• EPO $20/$40 $250/Day
• EPO $20/$40 $1,500/20%
• EPO $20/$40 $2,000 $250/Day
• EPO $20/$50 $2,000 30%
• EPO $30/$50 $250 $500/Day
• EPO $30/$50 $500/Day
• EPO $30/$50 $1,500/30%
• EPO $30/$50 $2,500/20%/$100 ER
• EPO $50/$75 $2,500/50%

POS plans

• POS $30/$50 $400/Day
• POS $30/$50 $1,500/20%
• POS $30/$50 $2,000/30%

POS Plus plans

• POS Plus $10/$20 $0 Day
• POS Plus $20/$40 $0/Day
• POS Plus $20//$40 $250/Day
• POS Plus $20/$40 $1,000/10%
• POS Plus $30/$40 $300/Day
• POS Plus $30/$50 $1,500/20%
• POS Plus $30/$50 $2,000/30%

PPO HSA plans

• PPO HSA $1,500/0% $10/$40/$60 Rx
• PPO HSA $2,000/10% $7/$35/$50 Rx
• PPO HSA $2,500/30% $7/$35/$50 Rx