Apex plan summary of benefits & coverage

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.

Questions about your plan? We’re here to help. Call Member Services at 800-883-2177.

View the statement of nondiscrimination for health plan members.

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

Plan name	Contract	Benefit charts	Amendments/pediatric dental	Summary of Benefits and Coverage
Apex $1,000 w/Copay Gold	CON-103.7-IND-OMKTA-1-21	BCH-103.7-GHI-IND-IE155-1-21	PMD-103.7-GHI-IND-PED80-1-21	Apex $1,000 w/Copay gold
Apex $3,000 Plus Silver	CON-103.7-IND-OMKTA-1-21	BCH-103.7-GHI-IND-IE156-1-21	PMD-103.7-GHI-IND-PED80-1-21	Apex $3,000 Plus Silver
Apex $6,250 Plus Bronze	CON-103.7-IND-OMKTA-1-21	BCH-103.7-GHI-IND-IE158-1-21	PMD-103.7-GHI-IND-PED70-1-21	Apex $6,250 Plus Bronze
Apex $8,550 Catastrophic	CON-103.7-IND-OMKTA-1-21	BCH-103.7-GHI-IND-IE159-1-21	PMD-103.7-GHI-IND-PED100-1-21	Apex $8,550 Catastrophic
Apex $3,000 w/Copay P-S Silver	CON-103.7-IND-OMKTA-1-21	BCH-103.7-GHI-IND-IE157-1-21	PMD-103.7-GHI-IND-PED75-1-21	Apex $3,000 w/Copay P-S Silver
Apex $3,000 HSA Silver	CON-103.7-IND-OMKTHSAA-1-21	BCH-103.7-GHI-IND-IE160-1-21	PMD-103.7-GHI-IND-PED80-1-21	Apex $3,000 HSA Silver
Apex $6,900 HSA Bronze	CON-103.7-IND-OMKTHSAA-1-21	BCH-103.7-GHI-IND-IE161-1-21	PMD-103.7-GHI-IND-PED100-1-21	Apex $6,900 HSA Bronze

Plan name	Contract	Benefit charts	Summary of Benefits and Coverage
Apex $1000 w/Copay Gold	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE718-1-21	Apex $1,000 w/Copay Gold
Apex Zero Cost Share Gold (IE719)	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE719-1-21	Apex Zero Cost Share Gold
Apex $1,000 w/Copay Limited Cost Share Gold	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE720-1-21	Apex $1,000 w/Copay Limited Cost Share Gold
Apex $3,000 Plus Silver	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE721-1-21	Apex $3,000 Plus Silver
Apex Zero Cost Share Silver (IE722)	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE722-1-21	Apex Zero Cost Share Silver
Apex $3,000 Plus Limited Cost Share Silver	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE723-1-21	Apex $3,000 Plus Limited Cost Share Silver
Apex $100 Plus Cost Share Reduction Silver	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE724-1-21	Apex $100 Plus Cost Share Reduction Silver
Apex $850 Plus Cost Share Reduction Silver	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE725-1-21	Apex $850 Plus Cost Share Reduction Silver
Apex $2,750 Plus Cost Share Reduction Silver	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE726-1-21	Apex $2,750 Plus Cost Share Reduction Silver
Apex $3,000 w/Copay P-S Silver	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE727-1-21	Apex $3,000 w/Copay P-S Silver
Apex Zero Cost Share Silver (IE728)	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE728-1-21	Apex Zero Cost Share Silver
Apex $3,000 w/Copay P-S Limited Cost Share Silver	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE729-1-21	Apex $3,000 w/Copay P-S Limited Cost Share Silver
Apex $50 w/Copay P-S Silver	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE730-1-21	Apex $50 w/Copay P-S Silver
Apex $1,000 w/Copay P-S Silver	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE731-1-21	Apex $1,000 w/Copay P-S Silver
Apex $2,800 w/Copay P-S Silver	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE732-1-21	Apex $2,800 w/Copay P-S Silver
Apex $6,250 Plus Bronze	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE733-1-21	Apex $6,250 Plus Bronze
Apex Zero Cost Share Bronze (IE734)	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE734-1-21	Apex Zero Cost Share Bronze
Apex $6,250 Plus Limited Cost Share Bronze	CON-103.7-IND-MKTA-1-21	BCH-103.7-GHI-IND-IE735-1-21	Apex $6,250 Plus Limited Cost Share Bronze
Apex $3,000 HSA Silver	CON-103.7-IND-MKTHSAA-1-21	BCH-103.7-GHI-IND-IE736-1-21	Apex $3,000 HSA Silver
Apex Zero Cost Share Silver (IE737)	CON-103.7-IND-MKTHSAA-1-21	BCH-103.7-GHI-IND-IE737-1-21	Apex Zero Cost Share Silver
Apex $3000 Limited Cost Share Silver	CON-103.7-IND-MKTHSAA-1-21	BCH-103.7-GHI-IND-IE738-1-21	Apex $3,000 Limited Cost Share Silver
Apex $200 Cost Share Reduction Silver	CON-103.7-IND-MKTHSAA-1-21	BCH-103.7-GHI-IND-IE739-1-21	Apex $200 Cost Share Reduction Silver
Apex $1,050 Cost Share Reduction Silver	CON-103.7-IND-MKTHSAA-1-21	BCH-103.7-GHI-IND-IE740-1-21	Apex $1,050 Cost Share Reduction Silver
Apex $2,300 Cost Share Reduction Silver	CON-103.7-IND-MKTHSAA-1-21	BCH-103.7-GHI-IND-IE741-1-21	Apex $2,300 Cost Share Reduction Silver
Apex $6,900 HSA Bronze	CON-103.7-IND-MKTHSAA-1-21	BCH-103.7-GHI-IND-IE742-1-21	Apex $6,900 HSA Bronze
Apex Zero Cost Share Bronze (IE743)	CON-103.7-IND-MKTHSAA-1-21	BCH-103.7-GHI-IND-IE743-1-21	Apex Zero Cost Share Bronze
Apex $6,900 Limited Cost Share Bronze	CON-103.7-IND-MKTHSAA-1-21	BCH-103.7-GHI-IND-IE744-1-21	Apex $6,900 Limited Cost Share Bronze

Plan name	Contract	Benefit charts	Summary of Benefits and Coverage
Apex $1,000 w/Copay P-S Gold	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE745-1-22	Apex $1,000 w/Copay P-S Gold
Apex Zero Cost Share Gold (IE719)	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE673-1-22	Apex Zero Cost Share Gold (IE719)
Apex $1,000 w/Copay P-S Limited Cost Share Gold	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE746-1-22	Apex $1,000 w/Copay P-S Limited Cost Share Gold
Apex $2,000 w/Copay Gold	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE747-1-22	Apex $2,000 w/Copay Gold
Apex Zero Cost Share Gold (IE770)	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE748-1-22	Apex Zero Cost Share Gold (IE770)
Apex $2,000 w/Copay Limited Cost Share Gold	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE749-1-22	Apex $2,000 w/Copay Limited Cost Share Gold
Apex $3,000 Plus Silver	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE653-1-22	Apex $3,000 Plus Silver
Apex Zero Cost Share Silver (IE722)	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE654-1-22	Apex Zero Cost Share Silver (IE722)
Apex $3,000 Plus Limited Cost Share Silver	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE655-1-22	Apex $3,000 Plus Limited Cost Share Silver
Apex $100 Cost Share Silver (IE724)	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE656-1-22	Apex $100 Cost Share Silver (IE724)
Apex $850 Cost Share Silver	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE657-1-22	Apex $850 Cost Share Silver
Apex $2,750 Cost Share Silver	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE658-1-22	Apex $2,750 Cost Share Silver
Apex $5,300 Plus Silver	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE750-1-22	Apex $5,300 Plus Silver
Apex Zero Cost Share Silver (IE773)	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE751-1-22	Apex Zero Cost Share Silver (IE773)
Apex $5,300 Plus Limited Cost Share Silver	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE752-1-22	Apex $5,300 Plus Limited Cost Share Silver
Apex $100 Cost Share Silver (IE775)	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE753-1-22	Apex $100 Cost Share Silver (IE775)
Apex $1,000 Cost Share Silver (IE776)	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE754-1-22	Apex $1,000 Cost Share Silver (IE776)
Apex $3,000 Cost Share Silver	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE755-1-22	Apex $3,000 Cost Share Silver
Apex $6,250 Plus Bronze	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE681-1-22	Apex $6,250 Plus Bronze
Apex Zero Cost Share Bronze (IE734)	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE682-1-22	Apex Zero Cost Share Bronze (IE734)
Apex $6,250 Plus Limited Cost Share Bronze	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE683-1-22	Apex $6,250 Plus Limited Cost Share Bronze
Apex $3,000 HSA Silver	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE660-1-22	Apex $3,000 HSA Silver
Apex Zero Cost Share Silver (IE737)	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE661-1-22	Apex Zero Cost Share Silver (IE737)
Apex $3,000 Limited Cost Share Silver	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE662-1-22	Apex $3,000 Limited Cost Share Silver
Apex $200 Cost Share Silver	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE663-1-22	Apex $200 Cost Share Silver
Apex $1,000 Cost Share Silver (IE740)	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE664-1-22	Apex $1,000 Cost Share Silver (IE740)
Apex $2,300 Cost Share Silver	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE665-1-22	Apex $2,300 Cost Share Silver
Apex $7,000 HSA Bronze	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE666-1-22	Apex $7,000 HSA Bronze
Apex Zero Cost Share Bronze (IE728)	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE667-1-22	Apex Zero Cost Share Bronze (IE728)
Apex $7,000 Limited Cost Share Bronze	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE668-1-22	Apex $7,000 Limited Cost Share Bronze
Apex $3,000 w/Copay P-S Silver	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE706-1-22	Apex $3,000 w/Copay P-S Silver
Apex Zero Cost Share Silver (IE773)	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE707-1-22	Apex Zero Cost Share Silver (IE773)
Apex $3,000 w/Copay P-S Limited Cost Share Silver	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE708-1-22	Apex $3,000 w/Copay P-S Limited Cost Share Silver
Apex $2,800 w/Copay P-S Cost Share Reduction Silver	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE711-1-22	Apex $2,800 w/Copay P-S Cost Share Reduction Silver
Apex $900 w/Copay P-S Cost Share Reduction Silver	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE710-1-22	Apex $900 w/Copay P-S Cost Share Reduction Silver
Apex $50 w/Copay P-S Cost Share Reduction Silver	CON-103.8-GHI-IND-MKTA-1-22	BCH-103.8-GHI-IND-IE709-1-22	Apex $50 w/Copay P-S Cost Share Reduction Silver

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