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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 2024 plan year

On-Exchange

Silver 2024

Plan Individual Policy Schedule of benefits Effective date
Octave Silver Standardized Individual Policy Schedule of Benefits 1/1/2024
Octave Silver Standardized 73% CSR Individual Policy Schedule of Benefits 1/1/2024
Octave Silver Standardized 87% CSR Individual Policy Schedule of Benefits 1/1/2024
Octave Silver Standardized 94% CSR Individual Policy Schedule of Benefits 1/1/2024
Octave Silver AH Individual Policy Schedule of Benefits 1/1/2024
Octave Silver AH 73% CSR Individual Policy Schedule of Benefits 1/1/2024
Octave Silver AH 87% CSR Individual Policy Schedule of Benefits 1/1/2024
Octave Silver AH 94% CSR Individual Policy Schedule of Benefits 1/1/2024
Octave Silver AH (0% - 20% FPL) Individual Policy Schedule of Benefits 1/1/2024
Octave Silver AH (21% - 40% FPL) Individual Policy Schedule of Benefits 1/1/2024
Octave Silver AH (41% - 60% FPL) Individual Policy Schedule of Benefits 1/1/2024
Octave Silver AH (61% - 80% FPL) Individual Policy Schedule of Benefits 1/1/2024
Octave Silver AH (81% - 100% FPL) Individual Policy Schedule of Benefits 1/1/2024
Octave Silver AH (101% - 120% FPL) Individual Policy Schedule of Benefits 1/1/2024
Octave Silver AH (121% - 138% FPL) Individual Policy Schedule of Benefits 1/1/2024

Bronze  2024

Plan Individual Policy Schedule of benefits Effective date
Octave Bronze Exp Standardized Individual Policy Schedule of Benefits 1/1/2024
Octave Bronze Value Individual Policy Schedule of Benefits 1/1/2024

Gold  2024

Plan Individual Policy Schedule of benefits Effective date
Octave Gold Standardized Individual Policy Schedule of Benefits 1/1/2024

American Indian / Alaskan Native

Silver 2024

Plan Individual Policy Schedule of benefits Effective date
Octave Silver Standardized AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Octave Silver Standardized AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Octave Silver AH AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Octave Silver AH AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024

Bronze 2024

Plan Individual Policy Schedule of benefits Effective date
Octave Bronze Exp Standardized AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Octave Bronze Exp Standardized AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Octave Bronze Value AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Octave Bronze Value AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024

Gold 2024

Plan Individual Policy Schedule of benefits Effective date
Octave Gold Standardized AI/AN < 300% FPL Individual Policy Schedule of Benefits 1/1/2024
Octave Gold Standardized AI/AN > 300% FPL Individual Policy Schedule of Benefits 1/1/2024

Off-Exchange

Silver 2024

Plan Individual Policy Schedule of benefits Effective date
Octave Silver Standardized Individual Policy Schedule of Benefits 1/1/2024
Octave Silver AH Individual Policy Schedule of Benefits 1/1/2024

Bronze 2024

Plan Individual Policy Schedule of benefits Effective date
Octave Bronze Exp Standardized Individual Policy Schedule of Benefits 1/1/2024
Octave Bronze Value Individual Policy Schedule of Benefits 1/1/2024

Gold 2024

Plan Individual Policy Schedule of benefits Effective date
Octave Gold Standardized Individual Policy Schedule of Benefits 1/1/2024

*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.