SimpleCare SBC – Small Groups | Alliant Health Plans

SimpleCare Small Group (2 – 50) SBC and Rates

2021 Off Marketplace Only

50000 Series - Single Network Options

Platinum	Gold	Silver	Bronze
PPO 50080	PPO 50086	PPO 50056	PPO 50072
PPO 50082	PPO 50088	PPO 50058	PPO 50074
PPO 50084	PPO 50090	PPO 50060	-
Copay 50096	PPO 50092	PPO 50062	-
	PPO 50094	PPO 50064
	Copay 50098	PPO 50066	-
-		PPO 50068	-
		PPO 50070
		PPO 50100

80000 Series – Dual Network Option

Platinum	Gold	Silver	Bronze
PPO 80040	PPO 80046	PPO 80096	PPO 80112
PPO 80042	PPO 80048	PPO 80098	PPO 80114
PPO 80044	PPO 80050	PPO 80100
Copay 80116	PPO 80052	PPO 80102
	PPO 80054	PPO 80104
	Copay 80118	PPO 80106
		PPO 80108
		PPO 80110
		Copay 80120

90000 Series – High Deductible Health Plans – Dual Network Option

Gold	Silver	Bronze
HDHP 90076	HDHP 90088	HDHP 90090
HDHP 90077	HDHP 90089	HDHP 90091

100000 Series – High Deductible Health Plans - Single Network Options

Gold	Silver	Bronze
HDHP 100012	HDHP 100014	HDHP 100016
HDHP 100013	HDHP 100015	HDHP 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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SimpleCare Rates
2021 1st Quarter
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2020 2nd Quarter
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2020 Off Marketplace Only

50000 Series - Single Network Options

Platinum	Gold	Silver	Bronze
PPO 50080	PPO 50086	PPO 50056	PPO 50072
PPO 50082	PPO 50088	PPO 50058	PPO 50074
PPO 50084	PPO 50090	PPO 50060	-
Copay 50096	PPO 50092	PPO 50062	-
	PPO 50094	PPO 50064
	Copay 50098	PPO 50066	-
-		PPO 50068	-
		PPO 50070
		PPO 50100

80000 Series – Dual Network Option

Platinum	Gold	Silver	Bronze
PPO 80040	PPO 80046	PPO 80096	PPO 80112
PPO 80042	PPO 80048	PPO 80098	PPO 80114
PPO 80044	PPO 80050	PPO 80100
Copay 80116	PPO 80052	PPO 80102
	PPO 80054	PPO 80104
	Copay 80118	PPO 80106
		PPO 80108
		PPO 80110
		Copay 80120

90000 Series – High Deductible Health Plans – Dual Network Option

Gold	Silver	Bronze
HDHP 90076	HDHP 90088	HDHP 90090
HDHP 90077	HDHP 90089	HDHP 90091

100000 Series – High Deductible Health Plans - Single Network Options

Gold	Silver	Bronze
HDHP 100012	HDHP 100014	HDHP 100016
HDHP 100013	HDHP 100015	HDHP 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.

2022 Off Marketplace Only

50000 Series - Single Network Options

Platinum	Gold	Silver	Bronze
PPO 50080	PPO 50086	PPO 50056	PPO 50072
PPO 50082	PPO 50088	PPO 50058	PPO 50074
PPO 50084	PPO 50090	PPO 50060	-
Copay 50096	PPO 50092	PPO 50062	-
	PPO 50094	PPO 50064
	Copay 50098	PPO 50066	-
-		PPO 50068	-
		PPO 50070
		PPO 50100

100000 Series – High Deductible Health Plans - Single Network Options

Gold	Silver	Bronze
HDHP 100012	HDHP 100014	HDHP 100016
HDHP 100013	HDHP 100015	HDHP 100017

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
–

2021 Off Marketplace Only

50000 Series - Single Network Options

80000 Series – Dual Network Option

90000 Series – High Deductible Health Plans – Dual Network Option

100000 Series – High Deductible Health Plans - Single Network Options

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.

2020 Off Marketplace Only

50000 Series - Single Network Options

80000 Series – Dual Network Option

90000 Series – High Deductible Health Plans – Dual Network Option

100000 Series – High Deductible Health Plans - Single Network Options

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.

2022 Off Marketplace Only

50000 Series - Single Network Options

100000 Series – High Deductible Health Plans - Single Network Options

Transitional Plans

10CYPP

Alliant Health Plans Network & PHCS Wrap Network

10HDHP

Alliant Health Plans Network & PHCS Wrap Network