Home Health insurance Individual & family Wisconsin Robin Oak plan Robin Oak plan information

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.

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
Robin Oak $25-$50 P-S Silver

MGC-200.5-WI-IND-ROBIN-OMK-22

BCH-200.5-WI-IND-IR108-22

PMD-200.5-WI-IND-PED-10080P-1-22

Robin Oak $25-$50 P-S Silver
Robin Oak $1,800 w/Copay P-S Gold

MGC-200.5-WI-IND-ROBIN-OMK-22

BCH-200.5-WI-IND-IR107-22

PMD-200.5-WI-IND-PED-80P-1-22

Robin Oak $1,800 w/Copay P-S Gold
Robin Oak $7,500 w/Copay P-S Silver

MGC-200.5-WI-IND-ROBIN-OMK-22

BCH-200.5-WI-IND-IR102-22

PMD-200.5-WI-IND-PED-80P75-1-22

Robin Oak $7,500 w/Copay P-S Silver
Robin Oak $4,500 Plus Silver

MGC-200.5-WI-IND-ROBIN-OMK-22

BCH-200.5-WI-IND-IR109-22

PMD-200.5-WI-IND-PED-75-1-22

Robin Oak $4,500 Plus Silver
Robin Oak $6,250 Plus Bronze

MGC-200.5-WI-IND-ROBIN-OMK-22

BCH-200.5-WI-IND-IR105-22

PMD-200.5-WI-IND-PED-75-1-22

Robin Oak $6,250 Plus Bronze
Robin Oak $8,000 Plus Bronze

MGC-200.5-WI-IND-ROBIN-OMK-22

BCH-200.5-WI-IND-IR110-22

PMD-200.5-WI-IND-PED-100-1-22

Robin Oak $8,000 Plus Bronze
Robin Oak $8,700 Catastrophic

MGC-200.5-WI-IND-ROBIN-OMK-22

BCH-200.5-WI-IND-IR106-22

PMD-200.5-WI-IND-PED-75-1-22

Robin Oak $8,700 Catastrophic
Robin Oak $7,000 HSA Bronze

MGC-200.5-WI-IND-ROBIN-OMK-22

BCH-200.5-WI-IND-IR111-22

PMD-200.5-WI-IND-PED-10080P-1-22

Robin Oak $7,000 HSA Bronze
Plan name Contract Benefit charts Amendments/ pediatric dental Summary of Benefits and Coverage
Robin Oak $25-$50 P-S Silver

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR628-22

  Robin Oak $25-$50 P-S Silver
Robin Oak Zero Cost Share Silver (IR629)

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR629-22

  Robin Oak Zero Cost Share Silver (IR629)
Robin Oak $25-$50 P-S Limited Cost Share Silver

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR630-22

  Robin Oak $25-$50 P-S Limited Cost Share Silver
Robin Oak $5-$10 P-S Cost Share Reduction Silver

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR631-22

  Robin Oak $5-$10 P-S Cost Share Reduction Silver
Robin Oak $5-$20 P-S Cost Share Reduction Silver

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR632-22

  Robin Oak $5-$20 P-S Cost Share Reduction Silver
Robin Oak $25-$50 P-S Cost Share Reduction Silver

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR633-22

  Robin Oak $25-$50 P-S Cost Share Reduction Silver
Robin Oak $1,800 w/Copay P-S Gold

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR626-22

  Robin Oak $1,800 w/Copay P-S Gold
Robin Oak Zero Cost Share Gold (IR602)

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR602-22

  Robin Oak Zero Cost Share Gold (IR602)
Robin Oak $1,800 w/Copay P-S Limited Cost Share Gold

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR627-22

  Robin Oak $1,800 w/Copay P-S Limited Cost Share Gold
Robin Oak $7,500 w/Copay P-S Silver

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR604-22

  Robin Oak $7,500 w/Copay P-S Silver
Robin Oak Zero Cost Share Silver (IR605)

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR605-22

  Robin Oak Zero Cost Share Silver (IR605)
Robin Oak $7,500 w/Copay P-S Limited Cost Share Silver

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR606-22

  Robin Oak $7,500 w/Copay P-S Limited Cost Share Silver
Robin Oak $100 Cost Share Reduction Silver

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR607-22

  Robin Oak $100 Cost Share Reduction Silver
Robin Oak $1,000 Cost Share Reduction Silver

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR608-22

  Robin Oak $1,000 Cost Share Reduction Silver
Robin Oak $3,700 Cost Share Reduction Silver

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR609-22

  Robin Oak $3,700 Cost Share Reduction Silver
Robin Oak $4,500 Plus Silver

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR634-22

  Robin Oak $4,500 Plus Silver
Robin Oak Zero Cost Share Silver (IR617)

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR617-22

  Robin Oak Zero Cost Share Silver (IR617)
Robin Oak $4,500 Plus Limited Cost Share Silver

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR635-22

  Robin Oak $4,500 Plus Limited Cost Share Silver
Robin Oak $100 Cost Share Reduction Silver

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR619-22

  Robin Oak $100 Cost Share Reduction Silver
Robin Oak $1,000 Cost Share Reduction Silver

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR620-22

  Robin Oak $1,000 Cost Share Reduction Silver
Robin Oak $3,000 Cost Share Reduction Silver

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR621-22

  Robin Oak $3,000 Cost Share Reduction Silver
Robin Oak $6,250 Plus Bronze

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR622-22

  Robin Oak $6,250 Plus Bronze
Robin Oak Zero Cost Share Bronze (IR623)

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR623-22

  Robin Oak Zero Cost Share Bronze (IR623)
Robin Oak $6,250 Plus Limited Cost Share Bronze

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR624-22

  Robin Oak $6,250 Plus Limited Cost Share Bronze
Robin Oak $8,000 Plus Bronze

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR636-22

  Robin Oak $8,000 Plus Bronze
Robin Oak Zero Cost Share Bronze (IR637)

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR637-22

  Robin Oak Zero Cost Share Bronze (IR637)
Robin Oak $8,000 Plus Limited Cost Share Bronze

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR638-22

  Robin Oak $8,000 Plus Limited Cost Share Bronze
Robin Oak $8,700 Catastrophic

MGC-200.5-WI-IND-MK-22

BCH-200.5-WI-IND-IR625-22

  Robin Oak $8,700 Catastrophic
Robin Oak $7,000 HSA Bronze

MGC-200.5-WI-IND-ROBIN-MK-22

BCH-200.5-WI-IND-IR639-22

  Robin Oak $7,000 HSA Bronze
Robin Oak Zero Cost Share Bronze (IR640)

MGC-200.5-WI-IND-ROBIN-MK-22

BCH-200.5-WI-IND-IR640-22

  Robin Oak Zero Cost Share Bronze (IR640)
Robin Oak $7,000 HSA Limited Cost Share Bronze

MGC-200.5-WI-IND-ROBIN-MK-22

BCH-200.5-WI-IND-IR641-22

  Robin Oak $7,000 HSA Limited Cost Share Bronze
Plan name Contract Benefit charts Amendments/ pediatric dental Summary of Benefits and Coverage
Robin Oak $1,200 w/Copay Gold MGC-200.4-WI-IND-ROBIN-OMK-21 BCH-200.4-WI-IND-IR101-21 PMD-200.4-WI-IND-PED-80P-1-21 Robin Oak $1,200 w/Copay Gold
Robin Oak $3,500 w/Copay P-S Silver MGC-200.4-WI-IND-ROBIN-OMK-21 BCH-200.4-WI-IND-IR102-21 PMD-200.4-WI-IND-PED-80P75-1-21 Robin Oak $3,500 w/Copay P-S Silver
Robin Oak $4,000 Plus Silver MGC-200.4-WI-IND-ROBIN-OMK-21 BCH-200.4-WI-IND-IR103-21 PMD-200.4-WI-IND-PED-75-1-21 Robin Oak $4,000 Plus Silver
Robin Oak $5,000 Plus Silver MGC-200.4-WI-IND-ROBIN-OMK-21 BCH-200.4-WI-IND-IR104-21 PMD-200.4-WI-IND-PED-75-1-21 Robin Oak $5,000 Plus Silver
Robin Oak $6,800 Plus Bronze MGC-200.4-WI-IND-ROBIN-OMK-21 BCH-200.4-WI-IND-IR105-21 PMD-200.4-WI-IND-PED-75-1-21 Robin Oak $6,800 Plus Bronze
Robin Oak $8,550 Catastrophic MGC-200.4-WI-IND-ROBIN-OMK-21 BCH-200.4-WI-IND-IR106-21 PMD-200.4-WI-IND-PED-75-1-21 Robin Oak $8,550 Catastrophic
Plan name Contract Benefit charts Amendments/pediatric dental Summary of Benefits and Coverage
Robin Oak $1,200 w/Copay Gold MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR601-21   Robin Oak $1,200 w/Copay Gold
Robin Oak Zero Cost Share Gold MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR602-21   Robin Oak Zero Cost Share Gold
Robin Oak $1,200 w/Copay Limited Cost Share Gold MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR603-21   Robin Oak $1,200 w/Copay Limited Cost Share Gold
Robin Oak $3,500 w/Copay P-S  Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR604-21   Robin Oak $3,500 w/Copay P-S  Silver
Robin Oak Zero Cost Share Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR605-21   Robin Oak Zero Cost Share Silver
Robin Oak $3,500 w/Copay P-S Limited Cost Share Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR606-21   Robin Oak $3,500 w/Copay P-S Limited Cost Share Silver
Robin Oak $75 Cost Share Reduction Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR607-21   Robin Oak $75 Cost Share Reduction Silver
Robin Oak $1,100 Cost Share Reduction Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR608-21   Robin Oak $1,100 Cost Share Reduction Silver
Robin Oak $3,000 Cost Share Reduction Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR609-21   Robin Oak $3,000 Cost Share Reduction Silver
Robin Oak $4,000 Plus Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR610-21   Robin Oak $4,000 Plus Silver
Robin Oak Zero Cost Share Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR611-21   Robin Oak Zero Cost Share Silver
Robin Oak $4,000 Plus Limited Cost Share Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR612-21   Robin Oak $4000 Plus Limited Cost Share Silver
Robin Oak $100 Cost Share Reduction Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR613-21   Robin Oak $100 Cost Share Reduction Silver
Robin Oak $1,050 Cost Share Reduction Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR614-21   Robin Oak $1,050 Cost Share Reduction Silver
Robin Oak $2,600 Cost Share Reduction Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR615-21   Robin Oak $2,600 Cost Share Reduction Silver
Robin Oak $5,000 Plus Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR616-21   Robin Oak $5,000 Plus Silver
Robin Oak Zero Cost Share Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR617-21   Robin Oak Zero Cost Share Silver
Robin Oak $5,000 Plus Limited Cost Share Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR618-21   Robin Oak $5,000 Plus Limited Cost Share Silver
Robin Oak $100 Cost Share Reduction Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR619-21   Robin Oak $100 Cost Share Reduction Silver
Robin Oak $1,050 Cost Share Reduction Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR620-21   Robin Oak $1,050 Cost Share Reduction Silver
Robin Oak $2,600 Cost Share Reduction Silver MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR621-21   Robin Oak $2,600 Cost Share Reduction Silver
Robin Oak $6,800 Plus Bronze MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR622-21   Robin Oak $6,800 Plus Bronze
Robin Oak Zero Cost Share Bronze MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR623-21   Robin Oak Zero Cost Share Bronze
Robin Oak $6,800 Plus Limited Cost Share Bronze MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR624-21   Robin Oak $6,800 Plus Limited Cost Share Bronze
Robin Oak $8,550 Catastrophic MGC-200.4-WI-IND-ROBIN-MK-21 BCH-200.4-WI-IND-IR625-21   Robin Oak $8,550 Catastrophic