Summary of Benefits and Coverage (SBCs)

Platinum

Gold

• Activate Gold
• Choice Plus Gold
• iDirect Gold Coinsurance HSAQ
• iDirect Gold Copay HSAQ
• iDirect Gold Copay
• Max Gold
• Passport Plan Local Gold HSAQ
• Passport Plan National Gold HSAQ
• Standard Healthy NY Gold
• thRed Gold

Silver

• Activate Silver
• CP Silver HSAQ
• iDirect Silver Coinsurance HSAQ
• iDirect Silver Copay HSAQ
• iDirect Silver Copay
• Max Silver
• Passport Plan Local Silver HSAQ
• Passport Plan National Silver HSAQ
• Standard Silver 200 SNF
• Standard Silver 365 SNF
• thRed Silver HSAQ
• thRed Silver

Bronze

• iDirect Bronze Blended HSAQ
• iDirect Bronze Coinsurance HSAQ
• iDirect Bronze MV HSAQ
• Passport Plan Local Bronze HSAQ
• Passport Plan National Bronze HSAQ
• thRed Bronze