MHBE Certified SHOP Medical and Dental Plans (by Carrier) Medical Plans Care First Plan ID Plan Marketing Name 28137MD0520002 BlueChoice HMO Referral HSA/HRA $4000 28137MD0410001 BlueChoice HMO HSA/HRA $2000 28137MD0420001 BlueChoice HMO $1000 28137MD0430001 BlueChoice Advantage 90%/70% 45532MD0270001 BluePreferred PPO HSA/HRA $4000 45532MD0280002 BluePreferred PPO100% / 80% 45532MD0240001 BlueCross BlueShield Preferred 1000, A Multi-State Plan 45532MD0300001 BlueCross BlueShield Preferred 2000, A Multi-State Plan 94084MD0150001 BluePreferred PPO HSA/HRA $4000 94084MD0160002 BluePreferred PPO 100% / 80% 94084MD0180001 BlueCross BlueShield Preferred 1000, A Multi-State Plan 94084MD0200001 BlueCross BlueShield Preferred 2000, A Multi-State Plan Coventry Plan ID Plan Marketing Name 14468MD0530001 Gold $0 Copay HMO 14468MD0530002 Silver $10 Copay HMO 14468MD0530003 Bronze $10 Copay HMO 68541MD1100001 Gold $0 Copay PPO 68541MD1100002 Silver $10 Copay PPO 68541MD1100003 Bronze Deductible-Only PPO HSA-Eligible Evergreen Plan ID Plan Marketing Name 72564MD0020001 Evergreen Health Care - Small Group Gold Plus Plan 72564MD0020002 Evergreen Health Care - Small Group Gold Plan 72564MD0020003 Evergreen Health Care - Small Group Silver Plus Plan 72564MD0020004 Evergreen Health Care - Small Group Silver Plan 72564MD0040001 Evergreen Health Insurance - Small Group Gold Plus Plan 72564MD0040002 Evergreen Health Insurance - Small Group Gold Plan 72564MD0040003 Evergreen Health Insurance - Silver Plus Plan 72564MD0040004 Evergreen Health Insurance - Small Group Silver Plan 72564MD0040005 Evergreen Health Insurance - Small Group Bronze Plan Kaiser Permanente Plan ID Plan Marketing Name 90296MD0570001 KP MD Platinum 0/20/Dental 90296MD0570004 KP MD Gold 0/30/Dental 90296MD0570002 KP MD Platinum 500/20/Dental 90296MD0570005 KP MD Gold 1000/30/Dental 90296MD0570008 KP MD Silver 1250/35/Dental 90296MD0570009 KP MD Silver 2500/35/Dental 90296MD0570012 KP MD Bronze 3550/50/Dental 90296MD0570003 KP MD Platinum 1250/10/HSA/Dental 90296MD0570006 KP MD Gold 1250/0%/HSA/Dental 90296MD0570007 KP MD Gold 1500/30/HSA/HRA/Dental 90296MD0570010 KP MD Silver 1500/30/HSA/Dental 90296MD0570011 KP MD Silver 2000/30/HSA/HRA/Dental 90296MD0570013 KP MD Bronze 3150/20%/HSA/Dental 90296MD0570014 KP MD Bronze 2900/20/HSA/Dental 90296MD0580001 KP MD Bronze 3550/50/POS/Dental United Healthcare Plan ID Plan Marketing Name 65635MD0050001 HSA KV-Z EPO with Rx YM 65635MD0050002 HSA KV-4 EPO with Rx YM 65635MD0050004 HSA KW-Y EPO with Rx YM 65635MD0050005 HSA KW-8 EPO with Rx YM 65635MD0050006 HSA KX-M EPO with Rx YM 65635MD0050007 HSA KX-S EPO with Rx YM 65635MD0050010 Choice Direct OCI EDGE POST LD-5 EPO with Rx ZS 65635MD0020001 Choice Plus Direct OCI EDGE POST LG-6 POS with Rx ZR 65635MD0050008 Choice Direct OCI EDGE POST LC-6 EPO with Rx ZV 65635MD0050015 Choice Direct OCI EDGE POST LG-8 EPO with Rx ZU 65635MD0050009 Choice Direct OCI EDGE POST LD-S EPO with Rx YM 65635MD0050013 Choice Direct OCI EDGE POST LG-2 EPO with Rx YM 65635MD0050011 Choice Direct OCI EDGE POST LF-G EPO with Rx ZT 65635MD0050012 Choice Direct OCI EDGE POST LF-3 EPO with Rx ZT 72375MD0010001 HSA KV-1 HMO with Rx YM 72375MD0010002 HSA KV-2 HMO with Rx ZX 72375MD0010004 HSA KV-6 HMO with Rx YM 72375MD0010005 HSA KW-6 HMO with Rx YM 72375MD0010006 HSA KX-Q HMO with Rx YM 72375MD0010007 HSA KX-U HMO with Rx YM 72375MD0010008 OCI Direct OCI EDGE POST LG-7 HMO with Rx ZR 72375MD0010009 OCI Direct OCI EDGE POST LD-R HMO with Rx ZU 72375MD0010010 OCI Direct OCI EDGE POST LH-P HMO with Rx Z 72375MD0010011 OCI Direct OCI EDGE POST LE-J HMO with Rx ZS 72375MD0010014 OCI Direct OCI EDGE POST LD-3 HMO with Rx YM 72375MD0010015 OCI Direct OCI EDGE POST LE-7 HMO with Rx YM 72375MD0010016 OCI Direct OCI EDGE POST LG-4 HMO with Rx YM 72375MD0010012 OCI Direct OCI EDGE POST LF-1 HMO with Rx D0 72375MD0010013 OCI Direct OCI EDGE POST LF-7 HMO with Rx ZT 23620MD0020002 HSA KV-V POS with Rx YM 23620MD0020003 HSA KW-2 POS with Rx YM 23620MD0020004 HSA KX-K POS with Rx YM 23620MD0020005 HSA KX-O POS with Rx YM 23620MD0020006 HSA KX-W POS with Rx YM 23620MD0020013 HSA KU-6 POS with Rx YM 23620MD0020001 Traditional with Deductible MT-M POS with Rx ZV 23620MD0020009 Choice Plus Direct EDGE POST LD-7 POS with Rx ZS 23620MD0020007 Choice Plus Direct EDGE POST LC-7 POS with Rx ZV 23620MD0020012 Choice Plus Direct EDGE POST LG-9 POS with Rx ZU 23620MD0020008 Choice Plus Direct EDGE POST LD-U POS with Rx YM 23620MD0020011 Choice Plus Direct EDGE POST LG-3 POS with Rx YM 23620MD0020010 Choice Plus Direct EDGE POST LF-5 POS with Rx ZT 31112MD0010002 HSA KX-Y HMO with Rx YM 31112MD0010003 HSA KV-3 HMO with Rx ZX 31112MD0010004 HSA KV-5 HMO with Rx ZX 31112MD0010001 Traditional with Deductible MT-K HMO with Rx ZV 31112MD0010009 Choice Direct EDGE POST LF-9 HMO with Rx ZT 31112MD0010010 Choice Direct EDGE POST LG-5 HMO with Rx ZR 31112MD0010005 Choice Direct EDGE POST LC-9 HMO with Rx ZU 31112MD0020001 Choice Plus Direct EDGE POST LD-A POS with Rx ZU 31112MD0010006 Choice Direct EDGE POST LE-3 HMO with Rx YM 31112MD0020002 Choice Plus Direct EDGE POST LE-5 POS with Rx YM 31112MD0010007 Choice Direct EDGE POST LE-9 HMO with Rx YM 31112MD0020003 Choice Plus Direct EDGE POST LF-C POS with Rx YM Dental Plans BestLife Plan ID Plan Marketing Name 34137MD0010001 BEST Life Child Dental Plus 34137MD0010002 BEST Life Child Dental 34137MD0010003 BEST Dental Advantage - Gold 34137MD0010004 BEST Dental Basic - Gold 34137MD0010005 BEST Dental Advantage - Silver 34137MD0010006 BEST Dental Basic – Silver Coventry Plan ID Plan Marketing Name 68541MD108003 Bronze Comprehensive PPO 68541MD108001 Gold Pediatric PPO 68541MD108002 Bronze Pediatric Pediatric PPO DentaQuest Plan ID Plan Marketing Name 49014MD0010001 Pediatric High 49014MD0010002 Pediatric Low 49014MD0010003 Family High 49014MD0010004 Family Low Dominion Plan ID Plan Marketing Name 88078MD0030001 Select Plan Kids 88078MD0040001 Access PPO Kids 88078MD0030002 Select Plan 88078MD0040002 Access PPO Guardian Plan ID Plan Marketing Name 85008MD0050001 Guardian Pediatric Advantage 85008MD0070001 Guardian Family Advantage Plus United Concordia Plan ID Plan Marketing Name 98514MD0100001 Smile for Health Child C60A60 98514MD0100002 Smile for Health Family C60A60 98514MD0120002 Smile for Health Family C60A50 98514MD0150002 Smile for Health Family C80A80 62400MD0010001 Smile for Health Child DHMO 62400MD0010002 Smile for Health Family DHMO
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