Summary of Benefits and Coverage Forms
Get information on what your plan covers and what it costs.
Individual
BlueConnect
BlueMax
BlueSaver
BlueSelect
Blue Value
Community Blue
HMO POS
Group
BlueConnect HMO
BlueConnect POS
BlueSaver
$1,200 80% Option 25 Maternity
$1,200 80% Option 25
$1,200 100% Option 20 Maternity
$1,200 100% Option 20
$1,300 80% Option 25 Maternity
$1,300 80% Option 25
$1,300 100% Option 20 Maternity
$1,300 100% Option 20
$1,700 80% Option 9 Maternity
$1,700 80% Option 9
$1,700 100% Option 4 Maternity
$1,700 100% Option 4
$1,900 80% Option 21 Maternity
$1,900 80% Option 21
$1,900 100% Option 21 Maternity
$1,900 100% Option 21
$2,500 80% Option 10 Maternity
$2,500 80% Option 10
$2,500 100% Option 5 Maternity
$2,500 100% Option 5
$2,800 80% Option 27 Maternity
$2,800 80% Option 27
$2,800 100% Option 22 Maternity
$2,800 100% Option 22
$3,000 80% Option 11 Maternity
$3,000 80% Option 11
$3,000 100% Option 6 Maternity
$3,000 100% Option 6
$3,300 80% Option 28 Maternity
$3,300 80% Option 28
$3,300 100% Option 23
$3,300 100% Option 23 Maternity
$5,000 100% Option 7
$5,000 100% Option 7 Maternity
$5,500 100% Option 24
$5,500 100% Option 24 Maternity
Community Blue
HMO
POS
Premier Blue
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