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Peak plan information

Find all the documents and details for your Peak plan.

Information about your plan

This is all the “fine print” about the insurance plans we offer.

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.

Here’s what you’ll find in the other documents:

  • Contract: This is the legal contract between you and HealthPartners. It includes all the details about your insurance plan.
  • Benefit charts: Use these charts to find the exact, legal terms of everything your plan covers.
  • Amendments and pediatric dental: Some insurance plans have dental benefits that only apply to people younger than 19. Those benefits are explained here. This also shows you if things have changed with your plans.
  • View the statement of nondiscrimination for health plan members

Questions about your plan? We’re here to help. Call Member Services at 952-967-7540.

2022 Off Exchange

Plan name Contract Benefit charts Amendments/ pediatric dental Summary of Benefits and Coverage
Peak $1,000 w/Copay P-S Gold CON-103.8-GHI-IND-OMKT-1-22 BCH-103.8-GHI-IND-IE162-1-22 PMD-103.8-GHI-IND-PED80-1-22 Peak $1,000 w/Copay P-S Gold
Peak $2,000 w/Copay Gold CON-103.8-GHI-IND-OMKT-1-22 BCH-103.8-GHI-IND-IE163-1-22 PMD-103.8-GHI-IND-PED80-1-22 Peak $2,000 w/Copay Gold
Peak $3,000 Plus Silver CON-103.8-GHI-IND-OMKT-1-22 BCH-103.8-GHI-IND-IE139-1-22 PMD-103.8-GHI-IND-PED80-1-22 Peak $3,000 Plus Silver
Peak $5,300 Plus Silver CON-103.8-GHI-IND-OMKT-1-22 BCH-103.8-GHI-IND-IE164-1-22 PMD-103.8-GHI-IND-PED80-1-22 Peak $5,300 Plus Silver
Peak $6,250 Plus Bronze CON-103.8-GHI-IND-OMKT-1-22 BCH-103.8-GHI-IND-IE143-1-22 PMD-103.8-GHI-IND-PED70-1-22 Peak $6,250 Plus Bronze
Peak $8,700 Catastrophic CON-103.8-GHI-IND-OMKT-1-22 BCH-103.8-GHI-IND-IE144-1-22 PMD-103.8-GHI-IND-PED100-1-22 Peak $8,700 Catastrophic
Peak $3,000 w/Copay P-S Silver CON-103.8-GHI-IND-OMKT-1-22 BCH-103.8-GHI-IND-IE153-1-22 PMD-103.8-GHI-IND-PED75-1-22 Peak $3,000 w/Copay P-S Silver
Peak $3,000 HSA Silver CON-103.8-GHI-IND-OMKTHSA-1-22 BCH-103.8-GHI-IND-IE145-1-22 PMD-103.8-GHI-IND-PED80-1-22 Peak $3,000 HSA Silver
Peak $7,000 HSA Bronze CON-103.8-GHI-IND-OMKTHSA-1-22 BCH-103.8-GHI-IND-IE146-1-22 PMD-103.8-GHI-IND-PED100-1-22 Peak $7,000 HSA Bronze

2022 On Exchange

Plan name Contract Benefit charts Amendments/ pediatric dental Summary of Benefits and Coverage
Peak $1,000 w/Copay P-S Gold CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE745-1-22   Peak $1,000 w/Copay P-S Gold
Peak Zero Cost Share Gold (IE673) CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE673-1-22   Peak Zero Cost Share Gold (IE673)
Peak $1,000 w/Copay P-S Limited Cost Share Gold CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE746-1-22   Peak $1,000 w/Copay P-S Limited Cost Share Gold
Peak $2,000 w/Copay Gold CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE747-1-22   Peak $2,000 w/Copay Gold
Peak Zero Cost Share Gold (IE748) CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE748-1-22   Peak Zero Cost Share Gold (IE748)
Peak $2,000 w/Copay Limited Cost Share Gold CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE749-1-22   Peak $2,000 w/Copay Limited Cost Share Gold
Peak $3,000 Plus Silver CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE653-1-22   Peak $3,000 Plus Silver
Peak Zero Cost Share Silver (IE654) CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE654-1-22   Peak Zero Cost Share Silver (IE654)
Peak $3,000 Plus Limited Cost Share Silver CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE655-1-22   Peak $3,000 Plus Limited Cost Share Silver
Peak $100 Cost Share Silver (IE656) CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE656-1-22   Peak $100 Cost Share Silver (IE656)
Peak $850 Cost Share Silver CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE657-1-22   Peak $850 Cost Share Silver
Peak $2,750 Cost Share Silver CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE658-1-22   Peak $2,750 Cost Share Silver
Peak $5,300 Plus Silver CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE750-1-22   Peak $5,300 Plus Silver
Peak Zero Cost Share Silver (IE751) CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE751-1-22   Peak Zero Cost Share Silver (IE751)
Peak $5,300 Plus Limited Cost Share Silver CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE752-1-22   Peak $5,300 Plus Limited Cost Share Silver
Peak $100 Cost Share Silver (IE753) CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE753-1-22   Peak $100 Cost Share Silver (IE753)
Peak $1,000 Cost Share Silver (IE754) CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE754-1-22   Peak $1,000 Cost Share Silver (IE754)
Peak $3,000 Cost Share Silver CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE755-1-22   Peak $3,000 Cost Share Silver
Peak $6,250 Plus Bronze CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE681-1-22   Peak $6,250 Plus Bronze
Peak Zero Cost Share Bronze (IE682) CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE682-1-22   Peak Zero Cost Share Bronze (IE682)
Peak $6,250 Plus Limited Cost Share Bronze CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE683-1-22   Peak $6,250 Plus Limited Cost Share Bronze
Peak $3,000 w/Copay P-S Silver CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE706-1-22   Peak $3,000 w/Copay P-S Silver
Peak Zero Cost Share Silver (IE707) CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE707-1-22   Peak Zero Cost Share Silver (IE707)
Peak $3,000 w/Copay P-S Limited Cost Share Silver CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE708-1-22   Peak $3,000 w/Copay P-S Limited Cost Share Silver
Peak $50 Cost Share Reduction Silver CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE709-1-22   Peak $50 Cost Share Reduction Silver
Peak $900 Cost Share Reduction Silver CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE710-1-22   Peak $900 Cost Share Reduction Silver
Peak $2,800 Cost Share Reduction Silver CON-103.8-GHI-IND-MKT-1-22 BCH-103.8-GHI-IND-IE711-1-22   Peak $2,800 Cost Share Reduction Silver
Peak $3,000 HSA Silver CON-103.8-GHI-IND-MKTHSA-1-22 BCH-103.8-GHI-IND-IE660-1-22   Peak $3,000 HSA Silver
Peak Zero Cost Share Silver (IE661) CON-103.8-GHI-IND-MKTHSA-1-22 BCH-103.8-GHI-IND-IE661-1-22   Peak Zero Cost Share Silver (IE661)
Peak $3,000 Limited Cost Share Silver CON-103.8-GHI-IND-MKTHSA-1-22 BCH-103.8-GHI-IND-IE662-1-22   Peak $3,000 Limited Cost Share Silver
Peak $200 Cost Share Silver CON-103.8-GHI-IND-MKTHSA-1-22 BCH-103.8-GHI-IND-IE663-1-22   Peak $200 Cost Share Silver
Peak $1000 Cost Share Silver (IE664) CON-103.8-GHI-IND-MKTHSA-1-22 BCH-103.8-GHI-IND-IE664-1-22   Peak $1000 Cost Share Silver (IE664)
Peak $2,300 Cost Share Silver CON-103.8-GHI-IND-MKTHSA-1-22 BCH-103.8-GHI-IND-IE665-1-22   Peak $2,300 Cost Share Silver
Peak $7,000 HSA Bronze CON-103.8-GHI-IND-MKTHSA-1-22 BCH-103.8-GHI-IND-IE666-1-22   Peak $7,000 HSA Bronze
Peak Zero Cost Share Bronze (IE667) CON-103.8-GHI-IND-MKTHSA-1-22 BCH-103.8-GHI-IND-IE667-1-22   Peak Zero Cost Share Bronze (IE667)
Peak $7,000 Limited Cost Share Bronze CON-103.8-GHI-IND-MKTHSA-1-22 BCH-103.8-GHI-IND-IE668-1-22   Peak $7,000 Limited Cost Share Bronze

2021 Off Exchange

Plan name Contract Benefit charts Amendments/ pediatric dental Summary of Benefits and Coverage
Peak $1,000 w/Copay Gold CON-103.7-IND-OMKT-1-21 BCH-103.7-GHI-IND-IE135-1-21 PMD-103.7-GHI-IND-PED80-1-21 Peak $1,000 w/Copay Gold
Peak $3,000 Plus Silver CON-103.7-IND-OMKT-1-21 BCH-103.7-GHI-IND-IE139-1-21 PMD-103.7-GHI-IND-PED80-1-21 Peak $3,000 Plus Silver
Peak $6,250 Plus Bronze CON-103.7-IND-OMKT-1-21 BCH-103.7-GHI-IND-IE143-1-21 PMD-103.7-GHI-IND-PED70-1-21 Peak $6,250 Plus Bronze
Peak $8,550 Catastrophic CON-103.7-IND-OMKT-1-21 BCH-103.7-GHI-IND-IE144-1-21 PMD-103.7-GHI-IND-PED100-1-21 Peak $8,550 Catastrophic
Peak $3,000 w/Copay P-S Silver CON-103.7-IND-OMKT-1-21 BCH-103.7-GHI-IND-IE153-1-21 PMD-103.7-GHI-IND-PED75-1-21 Peak $3,000 w/Copay P-S Silver
Peak $3,000 HSA Silver CON-103.7-IND-OMKTHSA-1-21 BCH-103.7-GHI-IND-IE145-1-21 PMD-103.7-GHI-IND-PED80-1-21 Peak $3,000 HSA Silver
Peak $6,900 HSA Bronze CON-103.7-IND-OMKTHSA-1-21 BCH-103.7-GHI-IND-IE146-1-21 PMD-103.7-GHI-IND-PED100-1-21 Peak $6,900 HSA Bronze

2021 On Exchange

Plan name Contract Benefit charts Amendments/ pediatric dental Summary of Benefits and Coverage
Peak $1,000 w/Copay Gold CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE672-1-21   Peak $1,000 w/Copay Gold
Peak Gold Zero Cost Share Plan CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE673-1-21   Peak Gold Zero Cost Share Plan
Peak $1,000 w/Copay Gold Limited Cost Share Plan CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE674-1-21   Peak $1,000 w/Copay Gold Limited Cost Share Plan
Peak $3,000 Plus Silver CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE653-1-21   Peak $3,000 Plus Silver
Peak Silver Zero Cost Share Plan CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE654-1-21   Peak Silver Zero Cost Share Plan
Peak $3,000 Plus Silver Limited Cost Share Plan CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE655-1-21   Peak $3,000 Plus Silver Limited Cost Share Plan
Peak $100 Cost Share Silver CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE656-1-21   Peak $100 Cost Share Silver
Peak $850 Cost Share Silver CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE657-1-21   Peak $850 Cost Share Silver
Peak $2,750 Cost Share Silver CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE658-1-21   Peak $2,750 Cost Share Silver
Peak $6,250 Plus Bronze CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE681-1-21   Peak $6,250 Plus Bronze
Peak Bronze Zero Cost Share Plan CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE682-1-21   Peak Bronze Zero Cost Share Plan
Peak $6,250 Plus Limited Cost Share Bronze CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE683-1-21   Peak $6,250 Plus Limited Cost Share Bronze
Peak Silver Zero Cost Share Plan CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE707-1-21   Peak Silver Zero Cost Share Plan
Peak $3,000 w/Copay P-S Silver CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE706-1-21   Peak $3,000 w/Copay P-S Silver
Peak $3,000 w/Copay P-S Limited Cost Share Silver CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE708-1-21   Peak $3,000 w/Copay P-S Limited Cost Share Silver
Peak $50 Cost Share Reduction Silver CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE709-1-21   Peak $50 Cost Share Reduction Silver
Peak $1,000 Cost Share Reduction Silver CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE710-1-21   Peak $1,000 Cost Share Reduction Silver
Peak $2,800 Cost Share Reduction Silver CON-103.7-IND-MKT-1-21 BCH-103.7-GHI-IND-IE711-1-21   Peak $2,800 Cost Share Reduction Silver
Peak $3,000 HSA Silver CON-103.7-IND-MKTHSA-1-21 BCH-103.7-GHI-IND-IE660-1-21   Peak $3,000 HSA Silver
Peak Zero Cost Share Silver CON-103.7-IND-MKTHSA-1-21 BCH-103.7-GHI-IND-IE661-1-21   Peak Zero Cost Share Silver
Peak $3,000 Silver Limited Cost Share Plan CON-103.7-IND-MKTHSA-1-21 BCH-103.7-GHI-IND-IE662-1-21   Peak $3,000 Silver Limited Cost Share Plan
Peak $200 Cost Share Silver CON-103.7-IND-MKTHSA-1-21 BCH-103.7-GHI-IND-IE663-1-21   Peak $200 Cost Share Silver
Peak $1,050 Cost Share Silver CON-103.7-IND-MKTHSA-1-21 BCH-103.7-GHI-IND-IE664-1-21   Peak $1,050 Cost Share Silver
Peak $2,300 Cost Share Silver CON-103.7-IND-MKTHSA-1-21 BCH-103.7-GHI-IND-IE665-1-21   Peak $2,300 Cost Share Silver
Peak $6,900 HSA Bronze CON-103.7-IND-MKTHSA-1-21 BCH-103.7-GHI-IND-IE666-1-21   Peak $6,900 HSA Bronze
Peak Bronze Zero Cost Share Plan CON-103.7-IND-MKTHSA-1-21 BCH-103.7-GHI-IND-IE667-1-21   Peak Bronze Zero Cost Share Plan
Peak $6,900 Limited Cost Share Bronze CON-103.7-IND-MKTHSA-1-21 BCH-103.7-GHI-IND-IE668-1-21   Peak $6,900 Limited Cost Share Bronze
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