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.
2023 Small Employer plans
Copay-Coinsurance Plans
| SBC by Network | ||||||||
|---|---|---|---|---|---|---|---|---|
| $25-90% Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
Deductible-Copay Plans
| SBC by Network | ||||||||
|---|---|---|---|---|---|---|---|---|
| $500-$25 Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $600-$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $1,000-$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $2,000-$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $3,000-$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $4,000-$40 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $6,100-$70 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
Three for Free Plans
| SBC by Network | ||||||||
|---|---|---|---|---|---|---|---|---|
| $1,000-70% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $2,000-70% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $4,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $5,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
HSA Non-Embedded Plans
| SBC by Network | ||||||||
|---|---|---|---|---|---|---|---|---|
| $2400-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $4500-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
HSA Embedded Plans
| SBC by Network | ||||||||
|---|---|---|---|---|---|---|---|---|
| $3000-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $3,500-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $4,800-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $6,000-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $7,000-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
HSA Plus Non-Embedded Plans
| SBC by Network | ||||||||
|---|---|---|---|---|---|---|---|---|
| $2,500-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
HSA Plus Embedded Plans
| SBC by Network | ||||||||
|---|---|---|---|---|---|---|---|---|
| $3,000-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $3,700-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $5,200-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $6,500-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $3,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $4,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $5,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
HRA Embedded Plans
| SBC by Network | ||||||||
|---|---|---|---|---|---|---|---|---|
| $5,000-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $7,000-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $8,700-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
Tiered Deductible-Copay Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $500-$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
| $1,000-$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
| $1,500-$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
| $3,000-$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
| $6,000-$90 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
Tiered HSA Plus Non-Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $3,000-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
| $3,500-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
Tiered HSA Plus Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $6,000-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
| $7,000-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
Copay-Coinsurance Plans
| SBC by Network | ||||||
|---|---|---|---|---|---|---|
| $25-90% Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
Deductible-Copay Plans
| SBC by Network | ||||||
|---|---|---|---|---|---|---|
| $500-$25 Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $600-$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $1,000-$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $2,000-$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $3,000-$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $4,000-$40 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $6,100-$70 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
Three for Free Plans
| SBC by Network | ||||||
|---|---|---|---|---|---|---|
| $1,000-70% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $2,000-70% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $4,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $5,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
HSA Non-Embedded Plans
| SBC by Network | ||||||
|---|---|---|---|---|---|---|
| $2,400-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $4,500-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
HSA Embedded Plans
<| SBC by Network | ||||||
|---|---|---|---|---|---|---|
| $3,000-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $3,500-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $4,800-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $6,000-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $7,000-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
HSA Plus Non-Embedded Plans
| SBC by Network | ||||||
|---|---|---|---|---|---|---|
| $2,500-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
HSA Plus Embedded Plans
| SBC by Network | ||||||
|---|---|---|---|---|---|---|
| $3,000-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $3,700-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $5,200-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $6,500-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $3,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $4,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $5,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
HRA Embedded Plans
| SBC by Network | ||||||
|---|---|---|---|---|---|---|
| $5,000-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $7,000-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
| $8,700-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | Cornerstone |
All-Copay Plans
| SBC by Network | ||||||
|---|---|---|---|---|---|---|
| $30/$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
Deductible-Copay Primary-Specialty Plans
| SBC by Network | ||||||
|---|---|---|---|---|---|---|
| $500-$30/$50 Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $1,000-$30/$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $2,000-$30/$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $3,000-$30/$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $4,000-$30/$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
Three for Free Plans
| SBC by Network | ||||||
|---|---|---|---|---|---|---|
| $500-70% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $1,000-70% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $2,000-70% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $4,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $5,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $6,500-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
HSA-Copay Non-Embedded Plans
| SBC by Network | ||||||
|---|---|---|---|---|---|---|
| $2,000-100% 30/$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
HSA-Copay Embedded Plans
| SBC by Network | ||||||
|---|---|---|---|---|---|---|
| $3,500-100% 30/$60 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $5,000-100% $30/$60 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $6,250-100% $30/$60 Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
HSA Non-Embedded Plans
| SBC by Network | ||||||
|---|---|---|---|---|---|---|
| $2,300-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $2,500-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
HSA Embedded Plans
| SBC by Network | ||||||
|---|---|---|---|---|---|---|
| $3,000-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $3,500-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $4,600-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $5,000-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $6,000-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $6,850-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $3,500-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
| $6,500-70% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
HSA Plus Non-Embedded Plans
| SBC by Network | ||||||
|---|---|---|---|---|---|---|
| $2,500-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused | Select |
Copay-Coinsurance Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $25-90 Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
Deductible-Copay Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $500-25 Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $600-$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $1,000-$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $2,000-$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,000-$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4,000-$40 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,100-$70 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
Three for Free Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $1,000-70% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $2,000-70% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Non-Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $2,500-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4,500-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $3,000-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,500-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4,800-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,750-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,850-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Plus Non-Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $2,500-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Plus Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $3,000-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,000-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,500-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,500-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HRA Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $5,000-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,850-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $8,400-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
For more information, visit HealthPartners UnityPoint Health.
Deductible-Copay Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $300-$25 Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $500-$25 Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $1,000-$45 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $2,000-$25 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,000-$45 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,600-$70 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
Deductible-Copay Primary-Specialty Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $1,500-$30/$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,000-$30/$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4,000-$30/$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,000-$45/$90 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
Three for Free Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $1,000-70% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $2,000-70% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $6,850-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Plus Non-Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $2,500-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Plus Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $3,000-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,500-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,000-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,500-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,500-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HRA Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $6,850-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
Deductible-Copay Primary-Specialty
| SBC by Network | ||||
|---|---|---|---|---|
| $1,500-$30/$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,500-$35/$70 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,000-$50/$100 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,250-$70/50% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
Three for Free Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $2,000-70% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,600-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4,500-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $7,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA-Copay Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $3,500-100% $0/$60 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4,500-100% $0/$60 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,250-100% $30/$60 Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Non-Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $2,500-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4,500-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $6,850-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Plus Non-Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $3,000-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Plus Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $3,000-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,000-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,000-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HRA Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $5,000-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,850-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $8,500-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
2022 Small Employer plans
Copay and Deductible-Copay Plans
| SBC by Network | ||||||||
|---|---|---|---|---|---|---|---|---|
| $25-90% Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $500-$25 Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $500-$45 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $1,000-$45 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $2,000-$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $3,500-$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $5,000-$65 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
Three for Free Plans
| SBC by Network | ||||||||
|---|---|---|---|---|---|---|---|---|
| $1,000-70% Three for Free Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $2,000-70% Three for Free Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $3,500-70% Three for Free Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $5,000-70% Three for Free Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
HSA Non-Embedded Plans
| SBC by Network | ||||||||
|---|---|---|---|---|---|---|---|---|
| $2400-100% HSA Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $4100-100% HSA Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
HSA Embedded Plans
| SBC by Network | ||||||||
|---|---|---|---|---|---|---|---|---|
| $3000-100% HSA Embedded Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $4,300-100% HSA Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $5,750-100% HSA Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $7,000-100% HSA Embedded Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
HSA Plus Non-Embedded Plans
| SBC by Network | ||||||||
|---|---|---|---|---|---|---|---|---|
| $2,500-100% HSA Plus Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
HSA Plus Embedded Plans
| SBC by Network | ||||||||
|---|---|---|---|---|---|---|---|---|
| $3,000-100% HSA Plus Embedded Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $4,600-100% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $6,500-100% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $3,000-70% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $5,500-70% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
HRA Embedded Plans
| SBC by Network | ||||||||
|---|---|---|---|---|---|---|---|---|
| $7,000-100% HRA Embedded Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
| $8,700-100% HRA Embedded Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform | CentraChoice | Achieve | Select |
Tiered Deductible-Copay Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $500-$60 Tiered Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
| $1,000-$50 Tiered Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
| $1,500-$50 Tiered Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
| $3,000-$60 Tiered Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
| $5,800-$70 Tiered Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
Tiered HSA Plus Non-Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $3,500-100% Tiered HSA Plus Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
| $3,750-100% Tiered HSA Plus Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
Tiered HSA Plus Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $5,500-100% Tiered HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
| $7,000-100% Tiered HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | TieredChoice |
Copay and Deductible-Copay Plans
| SBC by Network | |||||
|---|---|---|---|---|---|
| $25-90% Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $500-$25 Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $500-$45 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $1,000-$45 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $2,000-$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $3,500-$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $5,000-$65 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
Three for Free Plans
| SBC by Network | |||||
|---|---|---|---|---|---|
| $1,000-70% Three for Free Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $2,000-70% Three for Free Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $3,500-70% Three for Free Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $5,000-70% Three for Free Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
HSA Non-Embedded Plans
| SBC by Network | |||||
|---|---|---|---|---|---|
| $2400-100% HSA Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $4100-100% HSA Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
HSA Embedded Plans
| SBC by Network | |||||
|---|---|---|---|---|---|
| $3000-100% HSA Embedded Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $4,300-100% HSA Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $5,750-100% HSA Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $7,000-100% HSA Embedded Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
HSA Plus Non-Embedded Plans
| SBC by Network | |||||
|---|---|---|---|---|---|
| $2,500-100% HSA Plus Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
HSA Plus Embedded Plans
| SBC by Network | |||||
|---|---|---|---|---|---|
| $3,000-100% HSA Plus Embedded Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $4,600-100% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $6,500-100% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $3,000-70% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $5,500-70% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
HRA Embedded Plans
| SBC by Network | |||||
|---|---|---|---|---|---|
| $7,000-100% HRA Embedded Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
| $8,700-100% HRA Embedded Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access | Perform |
Copay and Deductible-Copay Plans
| SBC by Network | |||||
|---|---|---|---|---|---|
| $30/$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $500-$30/$50 Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $1,000-$30/$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $2,000-$30/$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $3,000-$30/$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $4,000-$30/$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $5,000-$45/$90 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
Three for Free Plans
| SBC by Network | |||||
|---|---|---|---|---|---|
| $500-70% Three for Free Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $1,000-70% Three for Free Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $2,000-70% Three for Free Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $3,500-70% Three for Free Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $4,000-70% Three for Free Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $4,000-70% Three for Free Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
HSA-Copay Non-Embedded Plans
| SBC by Network | |||||
|---|---|---|---|---|---|
| $2,000-100% 30/$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
HSA-Copay Embedded Plans
| SBC by Network | |||||
|---|---|---|---|---|---|
| $3,000-100% 30/$60 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $5,000-100% $30/$60 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $6,250-100% $30/$60 Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
HSA Non-Embedded Plans
| SBC by Network | |||||
|---|---|---|---|---|---|
| $2,300-100% HSA Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $2,500-100% HSA Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
HSA Embedded Plans
| SBC by Network | |||||
|---|---|---|---|---|---|
| $3000-100% HSA Embedded Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $4,200-100% HSA Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $5,000-100% HSA Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $6,000-100% HSA Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $6,850-100% HSA Embedded Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $3,000-70% HSA Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $6,500-70% HSA Embedded Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
HSA Plus Non-Embedded Plans
| SBC by Network | |||||
|---|---|---|---|---|---|
| $2,500-100% HSA Plus Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
HSA Plus Embedded Plans
| SBC by Network | |||||
|---|---|---|---|---|---|
| $3,000-100% HSA Plus Embedded Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $4,550-100% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
| $5,500-100% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
HRA Embedded Plans
| SBC by Network | |||||
|---|---|---|---|---|---|
| $6,900-100% HRA Embedded Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Broad | Focused |
Copay and Deductible-Copay Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $25-90% Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $500-$25 Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $500-$45 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $1,000-$45 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $2,000-$50 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,500-$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,000-$65 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
Three for Free Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $1,000-70% Three for Free Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $1,000-70% Three for Free Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,500-70% Three for Free Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,000-70% Three for Free Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Non-Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $2500-100% HSA Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4100-100% HSA Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $3000-100% HSA Embedded Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4,300-100% HSA Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,750-100% HSA Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,850-100% HSA Embedded Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Plus Non-Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $2,500-100% HSA Plus Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Plus Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $3,000-100% HSA Plus Embedded Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4,550-100% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,500-100% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,000-70% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,500-70% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HRA Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $6,850-100% HRA Embedded Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $8,400-100% HRA Embedded Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
For more information, visit HealthPartners UnityPoint Health.
Copay and Deductible-Copay Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $300-$25 Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $500-$25 Platinum | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $1,000-$45 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $2,000-$25 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,000-$45 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $1,500-$30/$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,000-$30/$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4,500-$30/$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,500-$30/$60 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
Three for Free Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $1,000-70% Three for Free Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $2,000-70% Three for Free Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,500-70% Three for Free Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $6,850-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Plus Non-Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $2,500-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Plus Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $3,000-100% HSA Plus Embedded Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,700-100% HSA Plus Embedded Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4,500-100% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,500-100% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,000-70% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,500-70% HSA Plus Embedded Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
Copay and Deductible-Copay Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $1,500-$30/$60 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,500-$35/$70 Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,000-$50/$100 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,250-$70/50% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
Three for Free Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $2,000-70% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,500-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4,500-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA-Copay Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $3,500-100% $0/$60 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4,500-100% $0/$60 Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,250-100% $30/$60 Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Non-Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $2,500-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4,100-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $6,850-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Plus Non-Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $3,000-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HSA Plus Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $3,000-100% Gold | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $4,500-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,000-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $3,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,000-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $5,500-70% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
HRA Embedded Plans
| SBC by Network | ||||
|---|---|---|---|---|
| $5,000-100% Silver | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,850-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |
| $6,850-100% Bronze | Contract | Benefit Chart | Amendments / Pediatric Dental | Open Access |