2025 QHP Small Group Actual Policy Documents

Platinum Plans

Blue PPO Platinum Plans

Off Exchange

• P503PPO Blue PPO Platinum 119
• P5E1PPO Blue PPO Platinum 136
• P5M1PPO PPO Platinum 501

Blue Choice Preferred PPO Platinum Plans

Off Exchange

• P5E2BCE Blue Choice Preferred Platinum PPO 119
• P5E1BCE Blue Choice Preferred Platinum PPO 136
• P5M1BCE Blue Choice Preferred Platinum PPO 501

Blue Precision Platinum Plans

Off Exchange

• P506PSN Blue Precision Platinum HMO 107
• P5E1PSN Blue Precision Platinum HMO 110
• P5J1PSN Blue Precision Platinum HMO 200

Blue Options Platinum Plans

• P5N1OPT Blue Options Platinum PPO 403

Gold Plans

Blue PPO Gold Plans

Off Exchange

• G530PPO Blue PPO Gold 101
• G531PPO Blue PPO Gold 102
• G532PPO Blue PPO Gold 107
• G533PPO Blue PPO Gold 113
• G534PPO Blue PPO Gold 114
• G535PPO Blue PPO Gold 115
• G536PPO Blue PPO Gold 116
• G537PPO Blue PPO Gold 123
• P5M2PPO Blue PPO Gold 502

Blue Precision Gold HMO Plans

Off Exchange

• G532PSN Blue Precision Gold HMO 101
• G5J2PSN Blue Precision Gold HMO 201
• G5N1PSN Blue Precision Gold HMO 402

Blue Options Gold Plans

Off Exchange

• G506OPT Blue Options Gold PPO 101
• G507OPT Blue Options Gold PPO 102
• G508OPT Blue Options Gold PPO 106
• G5K1OPT Blue Options Gold PPO 200
• G5M3OPT Blue Options Gold PPO 503

BlueChoice Preferred Gold PPO Plans

Off Exchange

• G530BCE Blue Choice Preferred Gold PPO 101
• G531BCE Blue Choice Preferred Gold PPO 102
• G532BCE Blue Choice Preferred Gold PPO 107
• G533BCE Blue Choice Preferred Gold PPO 113
• G534BCE Blue Choice Preferred Gold PPO 114
• G535BCE Blue Choice Preferred Gold PPO 115
• Blue Choice Preferred Gold PPO 116
• Blue Choice Preferred Gold PPO 123
• Blue Choice Preferred Gold PPO 502

Silver Plans

Blue PPO Silver Plans

Off Exchange

• S531PPO Blue PPO Silver 104
• S535PPO Blue PPO Silver 105
• S532PPO Blue PPO Silver 120
• S534PPO Blue PPO Silver 133
• S5J1PPO Blue PPO Silver 200

Blue Precision Silver HMO Plans

Off Exchange

• S530PSN Blue Precision Silver HMO 102
• S531PSN Blue Precision Silver HMO 106

BlueChoice Preferred Silver PPO Plans

Off Exchange

• S531BCE Blue Choice Preferred Silver PPO 104
• S535BCE Blue Choice Preferred Silver PPO 105
• S532BCE Blue Choice Preferred Silver PPO 120
• S534BCE Blue Choice Preferred Silver PPO 133
• S5J1BCE Blue Choice Preferred Silver PPO 200

Blue Options Silver PPO Plans

Off Exchange

• S506OPT Blue Options Silver PPO 104
• S507OPT Blue Options Silver PPO 107
• S5N1OPT Blue Options Silver PPO 404

Bronze Plans

Blue PPO Bronze Plans

Off Exchange

• B535PPO Blue PPO Bronze 106
• B536PPO Blue PPO Bronze 132
• B5N1PPO Blue PPO Bronze 401

BlueChoice Preferred Bronze PPO Plans

Off Exchange

• B535BCE Blue Choice Preferred Bronze PPO 106
• B536BCE Blue Choice Preferred Bronze PPO 132
• B5N1BCE Blue Choice Preferred Bronze PPO 401

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