SimpleCare Small Group (2 – 50) SBC and Rates

Notice

SimpleCare small group fully insured product will close on 12/31/22 at 11:59:59. Please contact your insurance broker or employer for more information. For questions about your current benefits, please call Client Services at (866) 403-2785

2022 Off Marketplace Only

50000 Series - Single Network Options
PlatinumGoldSilverBronze
PPO 50080PPO 50086PPO 50056PPO 50072
PPO 50082 PPO 50088PPO 50058PPO 50074
PPO 50084 PPO 50090PPO 50060-
Copay 50096PPO 50092PPO 50062-
PPO 50094PPO 50064
Copay 50098PPO 50066-
-PPO 50068-
PPO 50070
PPO 50100
100000 Series – High Deductible Health Plans - Single Network Options
GoldSilverBronze
HDHP 100012HDHP 100014HDHP 100016
HDHP 100013HDHP 100015HDHP 100017

2021 Off Marketplace Only

50000 Series - Single Network Options
PlatinumGoldSilverBronze
PPO 50080PPO 50086PPO 50056PPO 50072
PPO 50082 PPO 50088PPO 50058PPO 50074
PPO 50084 PPO 50090PPO 50060-
Copay 50096PPO 50092PPO 50062-
PPO 50094PPO 50064
Copay 50098PPO 50066-
-PPO 50068-
PPO 50070
PPO 50100
80000 Series – Dual Network Option
PlatinumGoldSilverBronze
PPO 80040PPO 80046PPO 80096PPO 80112
PPO 80042PPO 80048PPO 80098PPO 80114
PPO 80044PPO 80050PPO 80100
Copay 80116PPO 80052PPO 80102
PPO 80054PPO 80104
Copay 80118PPO 80106
PPO 80108
PPO 80110
Copay 80120
90000 Series – High Deductible Health Plans – Dual Network Option
GoldSilverBronze
HDHP 90076HDHP 90088HDHP 90090
HDHP 90077HDHP 90089HDHP 90091
100000 Series – High Deductible Health Plans - Single Network Options
GoldSilverBronze
HDHP 100012HDHP 100014HDHP 100016
HDHP 100013HDHP 100015HDHP 100017

Network Options

Alliant Health Plans Network OR PHCS Primary Network

 

Subscribers (and all dependents) are assigned a network based upon their residential address.

  • Subscribers who reside within the Alliant Network Area are assigned the Alliant Only network.

  • Subscribers who reside outside the Alliant Network Area are assigned the PHCS Primary network; this assignment does not provide access to the Alliant network.

 

The Alliant Network Area is defined by the Georgia and Tennessee counties shown below.

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Formulary Tools
2022 PY Magellan Formulary List

2022 Magellan Formulary Look-Up Tool 

2021 PY Magellan Formulary List
2021 Magellan Formulary Look-Up Tool

Transitional Plans

10CYPP

Alliant Health Plans Network & PHCS Wrap Network

501
02 – 07 – 09
18 – 19 – 32
1002
02 – 07 – 09
18 – 19 – 32

2002
02 – 07 – 09
18 – 19 – 32

2505
02 – 07 – 09
18 – 19 – 32
5001
02 – 07 – 09
18 – 19 – 32
7501
02 – 07 – 09
18 – 19 – 32
502
02 – 07 – 09
19 – Rx19
1500
02 – 07 – 09
18 – 19 – 32
2501
02 – 07 – 09
18 – 19 – 32
3001
02 – 07 – 09
18 – 19 – 32
5003
02 – 07 – 09
18 – 19 – 32
7502
02 – 07 – 09
18 – 19 – 32
1000
02 – 07 – 09
18 – 19 – 32
1501
02 – 07 – 09
18 – 19 – 32
2502
02 – 07 – 09
18 – 19 – 32
3002
02 – 07 – 09
18 – 19 – 32
5004
02 – 07 – 09
18 – 19 – 32
1001
02 – 07 – 09
18 – 19 – 32
2001
02 – 07 – 09
18 – 19 – 32
2504
02 – 07 – 09
18 – 19 – 32
3003
02 – 07 – 09
18 – 19 – 32
5005
02 – 07 – 09
18 – 19 – 32

10HDHP

Alliant Health Plans Network & PHCS Wrap Network

1500
14
–

5000
14
2501
14
–
2502
14
–
3000
14
–

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