Skip to Content (Press Enter)

Individual policy & schedule of benefits

To view the Individual Policy and Schedule of Benefits you are interested in, select the applicable plan name below.

You are now viewing 2025 plan year

View Plan year: 2024 2025

On-Exchange

Silver 2025

Plan Individual Policy Schedule of benefits Effective date
Octave Silver AH Individual Policy Schedule of Benefits 1/1/2025
Octave Silver AH 73% CSR Individual Policy Schedule of Benefits 1/1/2025
Octave Silver AH 87% CSR Individual Policy Schedule of Benefits 1/1/2025
Octave Silver AH 94% CSR Individual Policy Schedule of Benefits 1/1/2025
Octave Silver Standardized Individual Policy Schedule of Benefits 1/1/2025
Octave Silver Standardized 73% CSR Individual Policy Schedule of Benefits 1/1/2025
Octave Silver Standardized 87% CSR Individual Policy Schedule of Benefits 1/1/2025
Octave Silver Standardized 94% CSR Individual Policy Schedule of Benefits 1/1/2025
Octave Silver Classic Suitcase Individual Policy Schedule of Benefits 1/1/2025
Octave Silver Classic Suitcase 73% CSR Individual Policy Schedule of Benefits 1/1/2025
Octave Silver Classic Suitcase 87% CSR Individual Policy Schedule of Benefits 1/1/2025
Octave Silver Classic Suitcase 94% CSR Individual Policy Schedule of Benefits 1/1/2025
Octave Silver AH (0% - 20% FPL) Individual Policy Schedule of Benefits 1/1/2025
Octave Silver AH (21% - 40% FPL) Individual Policy Schedule of Benefits 1/1/2025
Octave Silver AH (41% - 60% FPL) Individual Policy Schedule of Benefits 1/1/2025
Octave Silver AH (61% - 80% FPL) Individual Policy Schedule of Benefits 1/1/2025
Octave Silver AH (81% - 100% FPL) Individual Policy Schedule of Benefits 1/1/2025
Octave Silver AH (101% - 120% FPL) Individual Policy Schedule of Benefits 1/1/2025
Octave Silver AH (121% - 138% FPL) Individual Policy Schedule of Benefits 1/1/2025

Bronze  2025

Plan Individual Policy Schedule of benefits Effective date
Octave Bronze Exp Standardized Individual Policy Schedule of Benefits 1/1/2025
Octave Bronze Value Individual Policy Schedule of Benefits 1/1/2025

Gold  2025

Plan Individual Policy Schedule of benefits Effective date
Octave Gold Standardized Individual Policy Schedule of Benefits 1/1/2025

American Indian / Alaskan Native

Silver 2025

Plan Individual Policy Schedule of benefits Effective date
Octave Silver AH AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Octave Silver AH AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Octave Silver Standardized AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Octave Silver Standardized AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Octave Silver Classic Suitcase AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Octave Silver Classic Suitcase AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2025

Bronze 2025

Plan Individual Policy Schedule of benefits Effective date
Octave Bronze Exp Standardized AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Octave Bronze Exp Standardized AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Octave Bronze Value AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Octave Bronze Value AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2025

Gold 2025

Plan Individual Policy Schedule of benefits Effective date
Octave Gold Standardized AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2025
Octave Gold Standardized AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2025

Off-Exchange

Silver 2025

Plan Individual Policy Schedule of benefits Effective date
Octave Silver AH Individual Policy Schedule of Benefits 1/1/2025
Octave Silver Standardized Individual Policy Schedule of Benefits 1/1/2025
Octave Silver Classic Suitcase Individual Policy Schedule of Benefits 1/1/2025

Bronze 2025

Plan Individual Policy Schedule of benefits Effective date
Octave Bronze Exp Standardized Individual Policy Schedule of Benefits 1/1/2025
Octave Bronze Value Individual Policy Schedule of Benefits 1/1/2025

Gold 2025

Plan Individual Policy Schedule of benefits Effective date
Octave Gold Standardized Individual Policy Schedule of Benefits 1/1/2025

*CSR-Cost sharing reduction: A discount that lowers the amount you have to pay out-of-pocket for deductibles, coinsurance, and copayments. You can get this reduction if you get health insurance through the Marketplace, your income is below a certain level and you choose a health plan from the Silver plan category. If you are a member of a federally recognized tribe, you may qualify for additional cost-sharing benefits.

Note: Policy ID may also be referenced as Certificate ID in other correspondence.