Home Insurance Buying my own insurance Wisconsin Atlas plan sbc

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.
Plan name Contract Benefit charts Amendments/ pediatric dental Summary of Benefits and Coverage
Atlas $1000 w/Copay Gold CON-103.5-GHI-IND-OMKT-1-19
BCH-103.5-GHI-IND-IE135-1-19

PMD-103.5-GHI-IND-PED-80C-1-19
Peak $1000 w/Copay Gold
Atlas $3000 Plus Silver CON-103.5-GHI-IND-OMKT-1-19 BCH-103.5-GHI-IND-IE139-1-19 PMD-103.5-GHI-IND-PED-80C-1-19 Peak $3000 Plus Silver
Atlas $6000 Plus Bronze CON-103.5-GHI-IND-OMKT-1-19 BCH-103.5-GHI-IND-IE143-1-19 PMD-103.5-GHI-IND-PED-80C-1-19 Peak $6000 Plus Bronze
Atlas $7900 Catastrophic CON-103.5-GHI-IND-OMKT-1-19 BCH-103.5-GHI-IND-IE144-1-19 PMD-103.5-GHI-IND-PED-100C-1-19 Peak $7900 Catastrophic
Atlas $3000 HSA Silver CON-103.5-GHI-IND-OMKT-1-19 BCH-103.5-GHI-IND-IE145-1-19 PMD-103.5-GHI-IND-PED-85C-1-19 Peak $3000 HSA Silver
Atlas $6650 HSA Bronze CON-103.5-GHI-IND-OMKT-1-19 BCH-103.5-GHI-IND-IE146-1-19 PMD-103.5-GHI-IND-PED-100C-1-19 Peak $6650 HSA Bronze
Plan name Contract Benefit charts Amendments/ pediatric dental Summary of Benefits and Coverage
Atlas $1000 w/Copay Gold CON-103.5-GHI-IND-MKT-1-19
BCH-103.5-GHI-IND-IE672-1-19
  Peak $1000 w/Copay Gold
Atlas Gold Zero Cost Share Plan CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE673-1-19   Peak Gold Zero Cost Share Plan
Atlas $1000 w/Copay Gold Limited Cost Share Plan CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE674-1-19   Peak $1000 w/Copay Gold Limited Cost Share Plan
Atlas $3000 Plus Silver CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE653-1-19   Peak $3000 Plus Silver
Atlas Silver Zero Cost Share Plan CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE654-1-19   Peak Silver Zero Cost Share Plan
Atlas $3000 Plus Silver Limited Cost Share Plan CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE655-1-19   Peak $3000 Plus Silver Limited Cost Share Plan
Atlas $100 Silver Cost Share Reduction Plan CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE656-1-19   Peak $100 Silver Cost Share Reduction Plan
Atlas $750 Silver Cost Share Reduction Plan CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE657-1-19   Peak $750 Silver Cost Share Reduction Plan
Peak $2900 Silver Cost Share Reduction Plan CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE658-1-19   Peak $2900 Silver Cost Share Reduction Plan
Atlas $6000 Plus Bronze CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE681-1-19   Peak $6000 Plus Bronze
Atlas Bronze Zero Cost Share Plan CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE682-1-19   Peak Bronze Zero Cost Share Plan
Atlas $6000 Plus Bronze Limited Cost Share Plan CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE683-1-19   Peak $6000 Plus Bronze Limited Cost Share Plan
Atlas $3000 HSA Silver CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE660-1-19   Peak $3000 HSA Silver
Atlas Silver Zero Cost Share Plan CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE661-1-19   Peak Silver Zero Cost Share Plan
Atlas $3000 Silver Limited Cost Share Plan CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE662-1-19   Peak $3000 Silver Limited Cost Share Plan
Atlas $200 Silver Cost Share Reduction Plan CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE663-1-19   Peak $200 Silver Cost Share Reduction Plan
Atlas $800 Silver Cost Share Reduction Plan CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE664-1-19   Peak $800 Silver Cost Share Reduction Plan
Atlas $2200 Silver Cost Share Reduction Plan CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE665-1-19   Peak $2200 Silver Cost Share Reduction Plan(
Atlas $6650 HSA Bronze CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE666-1-19   Peak $6650 HSA Bronze
Atlas Bronze Zero Cost Share Plan CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE667-1-19   Peak Bronze Zero Cost Share Plan
Atlas $6650 Bronze Limited Cost Share Plan CON-103.5-GHI-IND-MKT-1-19 BCH-103.5-GHI-IND-IE668-1-19   Peak $6650 Bronze Limited Cost Share Plan