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:
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 |
---|---|---|---|---|
Select $1,000 w/Copay P-S Gold | Select $1,000 w/Copay P-S Gold | |||
Select $2,000 w/Copay Gold |
|
Select $2,000 w/Copay Gold | ||
Select $3,000 Plus Silver |
|
Select $3,000 Plus Silver | ||
Select $5,300 Plus Silver |
|
Select $5,300 Plus Silver | ||
Select $6,250 Plus Bronze | Select $6,250 Plus Bronze | |||
Select $8,700 Catastrophic | Select $8,700 Catastrophic | |||
Select $3,000 w/Copay P-S Silver | Select $3,000 w/Copay P-S Silver | |||
Select $3,000 HSA Silver | Select $3,000 HSA Silver | |||
Select $7,000 HSA Bronze |
|
Select $7,000 HSA Bronze |
Plan name | Contract | Benefit charts | Amendments/pediatric dental | Summary of Benefits and Coverage |
---|---|---|---|---|
Select $1,000 w/Copay P-S Gold | Select $1,000 w/Copay P-S Gold | |||
Select Zero Cost Share Gold (IE686) | Select Zero Cost Share Gold (IE686) | |||
Select $1,000 w/Copay P-S Limited Cost Share Gold | Select $1,000 w/Copay P-S Limited Cost Share Gold | |||
Select $2,000 w/Copay Gold | Select $2,000 w/Copay Gold | |||
Select Zero Cost Share Gold (IE759) | Select Zero Cost Share Gold (IE759) | |||
Select $2,000 w/Copay Limited Cost Share Gold | Select $2,000 w/Copay Limited Cost Share Gold | |||
Select $3,000 Plus Silver | Select $3,000 Plus Silver | |||
Select Zero Cost Share Silver (IE689) | Select Zero Cost Share Silver (IE689) | |||
Select $3,000 Plus Limited Cost Share Silver | Select $3,000 Plus Limited Cost Share Silver | |||
Select $100 Cost Share Silver (IE691) | Select $100 Cost Share Silver (IE691) | |||
Select $850 Cost Share Silver | Select $850 Cost Share Silver | |||
Select $2,750 Cost Share Silver | Select $2,750 Cost Share Silver | |||
Select $5,300 Plus Silver | Select $5,300 Plus Silver | |||
Select Zero Cost Share Silver (IE762) | Select Zero Cost Share Silver (IE762) | |||
Select $5,300 Plus Limited Cost Share Silver | Select $5,300 Plus Limited Cost Share Silver | |||
Select $100 Cost Share Silver (IE764) | Select $100 Cost Share Silver (IE764) | |||
Select $1000 Cost Share Silver (IE765) | Select $1000 Cost Share Silver (IE765) | |||
Select $3,000 Cost Share Silver | Select $3,000 Cost Share Silver | |||
Select $6,250 Plus Bronze | Select $6,250 Plus Bronze | |||
Select Zero Cost Share Bronze (IE695) | Select Zero Cost Share Bronze (IE695) | |||
Select $6,250 Plus Limited Cost Share Bronze | Select $6,250 Plus Limited Cost Share Bronze | |||
Select $3,000 w/Copay P-S Silver | Select $3,000 w/Copay P-S Silver | |||
Select Zero Cost Share Silver (IE713) | Select Zero Cost Share Silver (IE713) | |||
Select $3,000 w/Copay P-S Limited Cost Share Silver | Select $3,000 w/Copay P-S Limited Cost Share Silver | |||
Select $50 Cost Share Reduction Silver | Select $50 Cost Share Reduction Silver | |||
Select $900 w/ Copay P-S Cost Share Reduction Silver | Select $900 w/ Copay P-S Cost Share Reduction Silver | |||
Select $2,800 Cost Share Reduction Silver | Select $2,800 Cost Share Reduction Silver | |||
Select $3,000 HSA Silver | Select $3,000 HSA Silver | |||
Select Zero Cost Share Silver (IE698) | Select Zero Cost Share Silver (IE698) | |||
Select $3,000 Limited Cost Share Silver | Select $3,000 Limited Cost Share Silver | |||
Select $200 Cost Share Silver | Select $200 Cost Share Silver | |||
Select $1,000 Cost Share Silver (IE701) | Select $1,000 Cost Share Silver (IE701) | |||
Select $2,300 Cost Share Silver | Select $2,300 Cost Share Silver | |||
Select $7,000 HSA Bronze | Select $7,000 HSA Bronze | |||
Select Zero Cost Share Bronze (IE704) | Select Zero Cost Share Bronze (IE704) | |||
Select $7,000 Limited Cost Share Bronze | Select $7,000 Limited Cost Share Bronze |