New York Public Exchange SBCs 2023
2023 Individual Marketplace: New York
Summary of Benefits and Coverage (SBC) Documents
Learn more about the variety of Compass plans offered by UnitedHealthcare of New York, Inc. through the NY State of Health Marketplace, by reviewing the SBCs below.
It is important to understand some plans are designed for specific groups, such as American Indians and Alaska Native Americans. Other plans, such as Silver plans, may only be available for individuals or families based on income levels. You can find out what options you qualify for when you sign up on the NY State of Health Marketplace.
View the NY Brochure and explore other resources in the sections below for an overview of our plan options.
Look closely at your options to see which plan is right for you.
Compass SBC Documents
To find the SBC for the plan option you are interested in learning more about, select the metal level category by using the down arrow. Then, find the full name of the plan you want to learn more about and review the SBC to learn more about coverage and cost details.
Note: All plans include “Standard” in the name (Standard = ST)
Adut and Child:
- UHC Compass Platinum ST INN Pediatric Dental Dep 25
- UHC Compass Platinum ST INN Pediatric Dental Dep 29
Variations of Adult and Child for American Indians:
- UHC Compass Platinum ST INN Pediatric Dental Dep 25 A (American Indian $0)
- UHC Compass Platinum ST INN Pediatric Dental Dep 29 A (American Indian $0)
- UHC Compass Platinum ST INN Pediatric Dental Dep 25 B (American Indian Ltd)
- UHC Compass Platinum ST INN Pediatric Dental Dep 29 B (American Indian Ltd)
Child Only:
Variations of Child-Only for American Indians:
Note: All plans include “Standard” in the name (Standard = ST)
Adult and Child:
Variations of Adult and Child for American Indians:
- UHC Compass Gold ST INN Pediatric Dental Dep 25 A (American Indian $0)
- UHC Compass Gold ST INN Pediatric Dental Dep 29 A (American Indian $0)
- UHC Compass Gold ST INN Pediatric Dental Dep 25 B (American Indian Ltd)
- UHC Compass Gold ST INN Pediatric Dental Dep 29 B (American Indian Ltd)
Child-Only:
Variations of Child-Only for American Indians:
Note: Silver plans fall in to two categories “Standard” and “Non-Standard” (Standard = ST; Non-Standard = NS)
Silver (Standard = ST)
Adult and Child:
Variations of Adult and Child for American Indians:
- UHC Compass Silver ST INN Pediatric Dental Dep 25 A (American Indian $0)
- UHC Compass Silver ST INN Pediatric Dental Dep 29 A (American Indian $0)
- UHC Compass Silver ST INN Pediatric Dental Dep 25 B (American Indian Ltd)
- UHC Compass Silver ST INN Pediatric Dental Dep 29 B (American Indian Ltd)
Other Variations of Adult and Child (Cost Share Reduction = CSR):
- UHC Compass Silver ST INN Pediatric Dental Dep 25 C (CSR 94)
- UHC Compass Silver ST INN Pediatric Dental Dep 29 C (CSR 94)
- UHC Compass Silver ST INN Pediatric Dental Dep 25 D (CSR 87)
- UHC Compass Silver ST INN Pediatric Dental Dep 29 D (CSR 87)
- UHC Compass Silver ST INN Pediatric Dental Dep 25 E (CSR 73)
- UHC Compass Silver ST INN Pediatric Dental Dep 29 E (CSR 73)
Child-Only Plan:
Other Variations of Child-Only Plan:
- UHC Compass Silver ST INN Pediatric Dental Child Only A (American Indian $0)
- UHC Compass Silver ST INN Pediatric Dental Child Only B (American Indian Ltd)
Other Variations of Adult and Child (Cost Share Reduction = CSR):
- UHC Compass Silver ST INN Pediatric Dental Child Only C (CSR 94)
- UHC Compass Silver ST INN Pediatric Dental Child Only D (CSR 87)
- UHC Compass Silver ST INN Pediatric Dental Child Only E (CSR 73)
Silver (Non-Standard = NS)
Adult and Child:
Variations of Adult and Child Plans for American Indians:
- UHC Compass Silver NS INN Pediatric Dental Dep 25 A (American Indian $0)
- UHC Compass Silver NS INN Pediatric Dental Dep 29 A (American Indian $0)
- UHC Compass Silver NS INN Pediatric Dental Dep 25 B (American Indian Ltd)
- UHC Compass Silver NS INN Pediatric Dental Dep 29 B (American Indian Ltd)
Other Variations of Adult and Child (Cost Share Reduction = CSR):
- UHC Compass Silver NS INN Pediatric Dental Dep 25 C (CSR 94)
- UHC Compass Silver NS INN Pediatric Dental Dep 29 C (CSR 94)
- UHC Compass Silver NS INN Pediatric Dental Dep 25 D (CSR 87)
- UHC Compass Silver NS INN Pediatric Dental Dep 29 D (CSR 87)
- UHC Compass Silver NS INN Pediatric Dental Dep 25 E (CSR 73)
- UHC Compass Silver NS INN Pediatric Dental Dep 29 E (CSR 73)
Child-Only:
Other Variations of Child-Only for American Indians:
- UHC Compass Silver NS INN Pediatric Dental Child Only A (American Indian $0)
- UHC Compass Silver NS INN Pediatric Dental Child Only B (American Indian Ltd)
Other Variations of Adult and Child (Cost Share Reduction = CSR):
Note: Bronze plans fall in to two categories “Standard” and “Non-Standard” (Standard = ST; Non-Standard = NS)
Bronze (Standard = ST)
Adult and Child:
- UHC Compass Bronze ST3PCP INN Pediatric Dental Dep 25
- UHC Compass Bronze ST3PCP INN Pediatric Dental Dep 29
Variations of Adult and Child for American Indians:
- UHC Compass Bronze ST3PCP INN Pediatric Dental Dep 25 A (American Indian $0)
- UHC Compass Bronze ST3PCP INN Pediatric Dental Dep 29 A (American Indian $0)
- UHC Compass Bronze ST3PCP INN Pediatric Dental Dep 25 B (American Indian Ltd)
- UHC Compass Bronze ST3PCP INN Pediatric Dental Dep 29 B (American Indian Ltd)
Child-Only:
Variations of Child-Only for American Indians:
- UHC Compass Bronze ST3PCP INN Pediatric Dental Child Only A (American Indian $0)
- UHC Compass Bronze ST3PCP INN Pediatric Dental Child Only B (American Indian Ltd)
Bronze (Non-Standard = NS)
Adult and Child:
- UHC Compass HSA Bronze NS INN Pediatric Dental Dep 25
- UHC Compass HSA Bronze NS INN Pediatric Dental Dep 29
Variations of Adult and Child for American Indians:
- UHC Compass Bronze NS INN Pediatric Dental Dep 25 A (American Indian $0)
- UHC Compass Bronze NS INN Pediatric Dental Dep 29 A (American Indian $0)
- UHC Compass HSA Bronze NS INN Pediatric Dental Dep 25 B (American Indian Ltd)
- UHC Compass HSA Bronze NS INN Pediatric Dental Dep 29 B (American Indian Ltd)
Child-Only:
Variations of Child-Only for American Indians:
Adult and Child Plan
Questions?
- Call the NY State of Health Marketplace at 1-855-355-5777
- Visit nystateofhealth.ny.gov
- Or, work with us at 1-800-980-5213, TTY 711
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