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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.

2022 Small Employer plans


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

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 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

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

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

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

Three for Free Plans

        SBC by Network
$3,500-70% Silver Contract Benefit Chart Amendments / Pediatric Dental Open Access Bridges
$5,000-70% Silver Contract Benefit Chart Amendments / Pediatric Dental Open Access Bridges

HSA-Copay Embedded Plans

        SBC by Network
$3,000-100% $40/$80 Silver Contract Benefit Chart Amendments / Pediatric Dental Open Access Bridges
$6,250-100% $30/$60 Bronze Contract Benefit Chart Amendments / Pediatric Dental Open Access Bridges

HSA Non-Embedded Plans

        SBC by Network
$2,500-100% Gold Contract Benefit Chart Amendments / Pediatric Dental Open Access Bridges
$4,100-100% Silver Contract Benefit Chart Amendments / Pediatric Dental Open Access Bridges

HSA Plus Non-Embedded Plans

        SBC by Network
$3,000-100% Gold Contract Benefit Chart Amendments / Pediatric Dental Open Access Bridges

HRA Embedded Plans

        SBC by Network
$6,850-100% Bronze Contract Benefit Chart Amendments / Pediatric Dental Open Access Bridges

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

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

2021 Small group plans

HSA Plus Embedded
Plan name Contract Benefit charts Amendments/ pediatric dental Open Access Perform Achieve CentraChoice SmartCare
HSA Plus Embedded Gold 3000-100 CON-700.56-HSA-HPSE-1-21
CON-700.56-HSA-HPSE-SC-1-21
BCH-700.56-SE-SL089C-21 PMD-700.56-SE-PED100C-1-21 HSA Plus Embedded Gold 3000-100 Open Access HSA Plus Embedded Gold 3000-100 Perform HSA Plus Embedded Gold 3000-100 Achieve HSA Plus Embedded Gold 3000-100 CentraChoice HSA Plus Embedded Gold 3000-100 SmartCare
HSA Plus Embedded Silver 4600-100 CON-700.56-HSA-HPSE-1-21
CON-700.56-HSA-HPSE-SC-1-21
BCH-700.56-SE-SL094C-21 PMD-700.56-SE-PED100C-1-21 HSA Plus Embedded Silver 4600-100 Open Access HSA Plus Embedded Silver 4600-100 Perform HSA Plus Embedded Silver 4600-100 Achieve HSA Plus Embedded Silver 4600-100 CentraChoice HSA Plus Embedded Silver 4600-100 SmartCare
HSA Plus Embedded Silver 6500-100 CON-700.56-HSA-HPSE-1-21
CON-700.56-HSA-HPSE-SC-1-21
BCH-700.56-SE-SL099C-21 PMD-700.56-SE-PED100C-1-21 HSA Plus Embedded Silver 6500-100 Open Access HSA Plus Embedded Silver 6500-100 Perform HSA Plus Embedded Silver 6500-100 Achieve HSA Plus Embedded Silver 6500-100 CentraChoice HSA Plus Embedded Silver 6500-100 SmartCare
HSA Plus Embedded Silver 3000-70 CON-700.56-HSA-HPSE-1-21
CON-700.56-HSA-HPSE-SC-1-21
BCH-700.56-SE-SL104C-21 PMD-700.56-SE-PED70C-1-21 HSA Plus Embedded Silver 3000-70 Open Access HSA Plus Embedded Silver 3000-70 Perform HSA Plus Embedded Silver 3000-70 Achieve HSA Plus Embedded Silver 3000-70 CentraChoice HSA Plus Embedded Silver 3000-70 SmartCare
HSA Plus Embedded Silver 5500-70 CON-700.56-HSA-HPSE-1-21
CON-700.56-HSA-HPSE-SC-1-21
BCH-700.56-SE-SL109C-21 PMD-700.56-SE-PED70C-1-21 HSA Plus Embedded Silver 5500-70 Open Access HSA Plus Embedded Silver 5500-70 Perform HSA Plus Embedded Silver 5500-70 Achieve HSA Plus Embedded Silver 5500-70 CentraChoice HSA Plus Embedded Silver 5500-70 SmartCare
HSA w/Copay
Plan name Contract Benefit charts Amendments/ pediatric dental Open Access Perform
HSA Embedded w/Copay Silver 3000-100 MGC-900.39-MN-SE-HSA-21 BCH-900.39-MNSE-CE556C-21 PMD-900.39-MN-SE-PED-70C-1-21 HSA Embedded w/Copay Silver 3000-100 Open Access HSA Embedded w/Copay Silver 3000-100 Perform
HSA Plus
Plan name Contract Benefit charts Amendments/ pediatric dental Open Access Perform
HSA Plus Gold 2500-100 MGC-900.39-MN-SE-HSA-21 BCH-900.39-MNSE-CE570C-21 PMD-900.39-MN-SE-PED-100CC-1-21 HSA Plus Gold 2500-100 Open Access HSA Plus Gold 2500-100 Perform
HRA Embedded
Plan name Contract Benefit charts Amendments/ pediatric dental Open Access Perform
HRA Embedded Bronze 8550-100 MGC-900.39-MN-SE-MEB-21 BCH-900.39-MNSE-CE582C-21 PMD-900.39-MN-SE-PED-100C-1-21 HRA Embedded Bronze 8550-100 Open Access HRA Embedded Bronze 8550-100 Perform
Copay and Deductible Copay
Plan name Contract Benefit charts HPIC Amendments/ Pediatric dental Focused Broad
P-S Gold 30/60 MGC-900.20-WI-SE-ROBIN-COB-20 BCH-900.21-WI-SE-WL129C-21 PMD-900.21-WISEPED-100NC-1-21 P-S Gold 30/60 Focused P-S Gold 30/60 Broad
HSA Plus
Plan name Contract Benefit charts HPIC Amendments/ Pediatric dental Focused Broad
HSA Plus Gold 2500-100 MGC-900.20-WI-SE-ROBIN-HSA-20 BCH-900.21-WI-SE-WK842-WL183C-21 PMD-900.21-WISEPED-100CC-1-21 HSA Plus Gold 2500-100 Focused HSA Plus Gold 2500-100 Broad
HRA Embedded
Plan name Contract Benefit charts HPIC Amendments/ Pediatric dental Focused Broad
HRA Embedded Bronze 6900-100 MGC-900.20-WI-SE-ROBIN-HSA-20 BCH-900.21-WI-SE-WL195C-21 PMD-900.21-WISEPED-100C-1-21 HRA Embedded Bronze 6900-100 Focused HRA Embedded Bronze 6900-100 Broad

Deductible Copay P-S
Plan name Contract Benefit charts HPIC Amendments/ Pediatric dental Open Access
P-S Gold 1500-30/60 MGC-900.21-WI-SE-COB-21 BCH-900.21-WI-SE-WK829C-21 PMD-900.21-WISEPED-70C-1-21 P-S Gold 1500-30/60 Open Access
P-S Gold 3000-30/60 MGC-900.21-WI-SE-COB-21 BCH-900.21-WI-SE-WK830C-21 PMD-900.21-WISEPED-70C-1-21 P-S Gold 3000-30/60 Open Access
HSA w/Copay P-S
Plan name Contract Benefit charts HPIC Amendments/ Pediatric dental Open Access
HSA Embedded w/Copay Silver 3000-100 MGC-900.21-WI-SE-HSA-21 BCH-900.21-WI-SE-WK835C-21 PMD-900.21-WISEPED-100C-1-21 HSA Embedded w/Copay Silver 3000-100 Open Access
HSA Plus
Plan name Contract Benefit charts HPIC Amendments/ Pediatric dental Open Access
HSA Plus Gold 2500-100 MGC-900.21-WI-SE-HSA-21 BCH-900.21-WI-SE-WK842-WL183C-21 PMD-900.21-WISEPED-100CC-1-21 HSA Plus Gold 2500-100 Open Access
HRA Embedded
Plan name Contract Benefit charts HPIC Amendments/ Pediatric dental Open Access
HRA Embedded Bronze 8400-100 MGC-900.21-WI-SE-COB-21 BCH-900.21-WI-SE-WK848C-21 PMD-900.21-WISEPED-100C-1-21 HRA Embedded Bronze 8400-100 Open Access
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