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Insurance documents

Read about the details of your insurance plan. This is all the “fine print” for the insurance plans we offer.

Information that's easy to read

If you’re looking for information that’s easy to read, the column labeled “Summary of Benefits and Coverage" is your best bet. These are also called SBCs. Use this document if you’re looking for detailed information about your plan. Plus, all SBCs are legally required to include the same information, so it’s easy to compare plans.

Questions about your plan? We’re here to help. Call Member Services at 952-883-5000.

2018 Small group plans


Embedded HSA
Plan name Contract Benefit charts Amendments/ pediatric dental Open Access Perform Achieve CentraChoice
HSA Embedded Gold 2800-100 CON-700.53-HSA-HPSE-1-18 BCH-700.53-SE-SE372-CT-18 PMD-700.53-SE-PED-100C-1-18 HSA Embedded Gold 2800-100 Open Access HSA Embedded Gold 2800-100 Perform HSA Embedded Gold 2800-100 Achieve HSA Embedded Gold 2800-100 CentraChoice
HSA Embedded Silver 3600-100 CON-700.53-HSA-HPSE-1-18 BCH-700.53-SE-SE376-CT-18 PMD-700.53-SE-PED-100C-1-18 HSA Embedded Silver 3600-100 Open Access HSA Embedded Silver 3600-100 Perform HSA Embedded Silver 3600-100 Achieve HSA Embedded Silver 3600-100 CentraChoice
HSA Embedded Silver 4000-100 CON-700.53-HSA-HPSE-1-18 BCH-700.53-SE-SE380-CT-18 PMD-700.53-SE-PED-100C-1-18 HSA Embedded Silver 4000-100 Open Access HSA Embedded Silver 4000-100 Perform HSA Embedded Silver 4000-100 Achieve HSA Embedded Silver 4000-100 CentraChoice
HSA Embedded Silver 3000-80 CON-700.53-HSA-HPSE-1-18 BCH-700.53-SE-SE388-CT-18 PMD-700.53-SE-PED-80C-1-18 HSA Embedded Silver 3000-80 Open Access HSA Embedded Silver 3000-80 Perform HSA Embedded Silver 3000-80 Achieve HSA Embedded Silver 3000-80 CentraChoice
HSA Embedded Bronze 6500-100 CON-700.53-HSA-HPSE-1-18 BCH-700.53-SE-SE384-CT-18 PMD-700.53-SE-PED-100C-1-18 HSA Embedded Bronze 6500-100 Open Access HSA Embedded Bronze 6500-100 Perform HSA Embedded Bronze 6500-100 Achieve HSA Embedded Bronze 6500-100 CentraChoice
HSA Embedded Bronze 5200-70 CON-700.53-HSA-HPSE-1-18 BCH-700.53-SE-SE392-CT-18 PMD-700.53-SE-PED-70C-1-18 HSA Embedded Bronze 5200-70 Open Access HSA Embedded Bronze 5200-70 Perform HSA Embedded Bronze 5200-70 Achieve HSA Embedded Bronze 5200-70 CentraChoice
HSA Embedded Bronze 6000-70 CON-700.53-HSA-HPSE-1-18 BCH-700.53-SE-SE396-CT-18 PMD-700.53-SE-PED-70C-1-18 HSA Embedded Bronze 6000-70 Open Access HSA Embedded Bronze 6000-70 Perform HSA Embedded Bronze 6000-70 Achieve HSA Embedded Bronze 6000-70 CentraChoice
HSA Rx Plus Embedded
Plan name Contract Benefit charts HPIC Amendments/ Pediatric dental Open Access
HSA Embedded Silver 4000-100 Rx Plus MGC-900.18-WI-SE-HSA-18 BCH-900.18-WI-SE-WE434CT-18 PMD-900.18-WISEPED100C-1-18R HSA Embedded Silver 4000-100 Rx Plus Open Access
HSA Embedded Silver 3000-80 Rx Plus MGC-900.18-WI-SE-HSA-18 BCH-900.18-WI-SE-WE435CT-18 PMD-900.18-WISEPED80C-1-18R HSA Embedded Silver 3000-80 Rx Plus Open Access

2017 Small group plans

HSA
Plan name Contract Benefit charts HPIC Amendments/ Pediatric dental Open Access
HSA Gold 2000-100 MGC-900.17-WISE-N1-E-17R2 BCH-900.17-WISE-WE386C-17 PMD-900.17-WISEPED100CC-1-17 HSA Gold 2000-100 Open Access
HSA Rx Plus Embedded
Plan name Contract Benefit charts HPIC Amendments/ Pediatric dental Open Access
HSA Embedded Silver 4000-100 Rx Plus MGC-900.17-WISE-N1-E-17R2 BCH-900.17-WISE-WE421CT-17 PMD-900.17-WISEPED100TC-1-17 HSA Embedded Silver 4000-100 Rx Plus Open Access
HSA Embedded Silver 3000-80 Rx Plus MGC-900.17-WISE-N1-E-17R2 BCH-900.17-WISE-WE422CT-17 PMD-900.17-WISEPED80TC-1-17 HSA Embedded Silver 3000-80 Rx Plus Open Access
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