Find all the documents and details for your plan

The documents below provide up-to-date details about your plan:

  • Summary of Benefits and Coverage (SBC) – Your SBC gives you general information about your plan, such as what’s covered, your out-of-pocket limits, prescription drug coverage, where to find in-network providers and more. This document is often the easiest-to-read summary of your plan.
  • Your legal contract with HealthPartners – Your contract contains all of the details about your insurance plan, including terms and conditions of your plan, your rights and responsibilities, and more.
  • Benefit chart – Your benefit chart includes the exact legal definition of coverage-related terms used in your plan documents. It also contains complete and comprehensive information about what your plan does and doesn’t cover.
  • Pediatric dental amendment – Some of our plans have dental benefits that only apply to people younger than 19. Those benefits are explained in this amendment.
2024 Wisconsin plan documents Atlas plans

Plan name

 Summary of Benefits and Coverage Contract Benefit charts
Atlas $1,000 w/Copay P-S Gold SBC (PDF) MGC-200.7-WI-IND-OMK-24 (PDF) BCH-200.7-WI-IND-IW110-24 (PDF)
Atlas $1,500 w/Copay P-S Gold SBC (PDF) MGC-200.7-WI-IND-OMK-24 (PDF) BCH-200.7-WI-IND-IW113-24 (PDF)
Atlas $3,200 Plus Silver  SBC (PDF) MGC-200.7-WI-IND-OMK-24 (PDF) BCH-200.7-WI-IND-IW102-24 (PDF)
Atlas $4,900 Plus Silver SBC (PDF) MGC-200.7-WI-IND-OMK-24 (PDF) BCH-200.7-WI-IND-IW112-24 (PDF)
Atlas $6,350 Plus Bronze  SBC (PDF) MGC-200.7-WI-IND-OMK-24 (PDF) BCH-200.7-WI-IND-IW103-24 (PDF)
Atlas $9,450 Catastrophic  SBC (PDF) MGC-200.7-WI-IND-OMK-24 (PDF) BCH-200.7-WI-IND-IW105-24 (PDF)
Atlas $3,000 w/Copay P-S Silver  SBC (PDF) MGC-200.7-WI-IND-OMK-24 (PDF) BCH-200.7-WI-IND-IW109-24 (PDF)
Atlas $7,500 w/Copay P-S Bronze  SBC (PDF) MGC-200.7-WI-IND-OMK-24 (PDF) BCH-200.7-WI-IND-IW114-24 (PDF)
Atlas $3,800 HSA Silver  SBC (PDF) MGC-200.7-WI-IND-OMK-24 (PDF) BCH-200.7-WI-IND-IW106-24 (PDF)
Atlas $8,000 HSA Bronze  SBC (PDF) MGC-200.7-WI-IND-OMK-24 (PDF) BCH-200.7-WI-IND-IW107-24 (PDF)

Plan name

 Summary of Benefits and Coverage Contract Benefit charts
Atlas $1,000 w/Copay P-S Gold SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW644-24 (PDF)
Atlas Zero Cost Share Gold (IW602) SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW602-24 (PDF)
Atlas $1,000 w/Copay P-S Limited Cost Share Gold SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW645-24 (PDF)
Atlas $1,500 w/Copay Gold SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW655-24 (PDF)
Atlas Zero Cost Share Gold (IW656) SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW656-24 (PDF)
Atlas $1,500 w/Copay Limited Cost Share Gold SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW657-24 (PDF)
Atlas $3,200 Plus Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW604-24 (PDF)
Atlas Zero Cost Share Silver (IW605) SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW605-24 (PDF)
Atlas $3,200 Plus Limited Cost Share Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW606-24 (PDF)
Atlas $50 Plus Cost Share Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW607-24 (PDF)
Atlas $650 Plus Cost Share Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW608-24 (PDF)
Atlas $3,000 Plus Cost Share Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW609-24 (PDF)
Atlas $5,900 w/Copay P-S Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW658-24 (PDF)
Atlas Zero Cost Share Silver (IW659) SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW659-24 (PDF)
Atlas $5,900 w/Copay P-S Limited Cost Share Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW660-24 (PDF)
Atlas $0 w/Copay P-S Cost Share Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW661-24 (PDF)
Atlas $700 w/Copay P-S Cost Share Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW662-24 (PDF)
Atlas $5,700 w/Copay P-S Cost Share Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW663-24 (PDF)
Atlas $6,350 Plus Bronze SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW616-24 (PDF)
Atlas Zero Cost Share Bronze (IW617) SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW617-24 (PDF)
Atlas $6,350 Plus Limited Cost Share Bronze SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW618-24 (PDF)
Atlas $7,500 w/Copay P-S Bronze SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW664-24 (PDF)
Atlas Zero Cost Share Bronze (IW665) SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW665-24 (PDF)
Atlas $7,500 w/Copay P-S Limited Cost Share Bronze SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW666-24 (PDF)
Atlas $9,450 Catastrophic SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW622-24 (PDF)
Atlas $3,000 w/Copay P-S Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW638-24 (PDF)
Atlas Zero Cost Share Silver (IW639) SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW639-24 (PDF)
Atlas $3,000 w/Copay P-S Limited Cost Share Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW640-24 (PDF)
Atlas $50 Cost Share Reduction Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW641-24 (PDF)
Atlas $850 Cost Share Reduction Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW642-24 (PDF)
Atlas $2,800 Cost Share Reduction Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW643-24 (PDF)
Atlas $3,800 HSA Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW623-24 (PDF)
Atlas Zero Cost Share Silver (IW624) SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW624-24 (PDF)
Atlas $3,800 Limited Cost Share Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW625-24 (PDF)
Atlas $200 Cost Share Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW626-24 (PDF)
Atlas $1,200 Cost Share Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW627-24 (PDF)
Atlas $3,000 Cost Share Silver SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW628-24 (PDF)
Atlas $8,000 HSA Bronze SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW629-24 (PDF)
Atlas Zero Cost Share Bronze (IW630) SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW630-24 (PDF)
Atlas $8,000 Limited Cost Share Bronze SBC (PDF) MGC-200.7-WI-IND-MK-24 (PDF) BCH-200.7-WI-IND-IW631-24 (PDF)
Robin Oak plans

Plan name

 Summary of Benefits and Coverage Contract Benefit charts
Robin Oak $1,000 w/Copay P-S Gold SBC (PDF) MGC-200.7-WI-IND-RO-OMK-24 (PDF) BCH-200.7-WI-IND-IR107-24 (PDF)
Robin Oak $1,500 w/Copay P-S Gold SBC (PDF) MGC-200.7-WI-IND-RO-OMK-24 (PDF) BCH-200.7-WI-IND-IR112-24 (PDF)

Plan name

 Summary of Benefits and Coverage Contract Benefit charts
Robin Oak $1,000 w/Copay P-S Gold SBC(PDF) MGC-200.7-WI-IND-RO-MK-24 (PDF) BCH-200.7-WI-IND-IR626-24 (PDF)
Robin Oak Zero Cost Share Gold (IR602)  SBC (PDF) MGC-200.7-WI-IND-RO-MK-24 (PDF) BCH-200.7-WI-IND-IR602-24 (PDF)
Robin Oak $1,000 w/Copay P-S Limited Cost Share Gold SBC (PDF) MGC-200.7-WI-IND-RO-MK-24 (PDF) BCH-200.7-WI-IND-IR627-24 (PDF)
Robin Oak $1,500 w/Copay P-S Gold  SBC (PDF) MGC-200.7-WI-IND-RO-MK-24 (PDF) BCH-200.7-WI-IND-IR642-24 (PDF)
Robin Oak Zero Cost Share Gold (IR643)  SBC (PDF) MGC-200.7-WI-IND-RO-MK-24 (PDF) BCH-200.7-WI-IND-IR643-24 (PDF)
Robin Oak $1,500 w/Copay P-S Limited Cost Share Gold  SBC (PDF) MGC-200.7-WI-IND-RO-MK-24 (PDF) BCH-200.7-WI-IND-IR644-24 (PDF)
Robin Select plans

Plan name

 Summary of Benefits and Coverage Contract Benefit charts
Robin Select $4,500 Plus Silver  SBC (PDF) MGC-200.7-WI-IND-RS-OMK-24 (PDF) BCH-200.7-WI-IND-IR116-24 (PDF)
Robin Select $6,350 Plus Bronze  SBC (PDF) MGC-200.7-WI-IND-RS-OMK-24 (PDF) BCH-200.7-WI-IND-IR117-24 (PDF)
Robin Select $7,500 w/Copay P-S Bronze SBC (PDF) MGC-200.7-WI-IND-RS-OMK-24 (PDF) BCH-200.7-WI-IND-IR118-24 (PDF)
Robin Select $9,450 Catastrophic  SBC (PDF) MGC-200.7-WI-IND-RS-OMK-24 (PDF) BCH-200.7-WI-IND-IR121-24 (PDF)
Robin Select $3,800 HSA Silver  SBC (PDF) MGC-200.7-WI-IND-RS-OMK-24 (PDF) BCH-200.7-WI-IND-IR119-24 (PDF)
Robin Select $8,000 HSA Bronze  SBC (PDF) MGC-200.7-WI-IND-RS-OMK-24 (PDF) BCH-200.7-WI-IND-IR120-24 (PDF)

Plan name

 Summary of Benefits and Coverage Contract Benefit charts
Robin Select $3,600 Plus Silver  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR660-24 (PDF)
Robin Select Zero Cost Share Silver (IR661)  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR661-24 (PDF)
Robin Select $3,600 Plus Limited Cost Share Silver  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR662-24 (PDF)
Robin Select $50 Cost Share Reduction Silver  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR663-24 (PDF)
Robin Select $750 Cost Share Reduction Silver  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR664-24 (PDF)
Robin Select $3,100 Cost Share Reduction Silver  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR665-24 (PDF)
Robin Select $5,900 w/Copay P-S Silver SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR666-24 (PDF)
Robin Select Zero Cost Share Silver (IR667)  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR667-24 (PDF)
Robin Select $5,900 w/Copay P-S Limited Cost Share Silver  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR668-24 (PDF)
Robin Select $0 w/Copay P-S Cost Share Reduction Silver SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR669-24 (PDF)
Robin Select $700 w/Copay P-S Cost Share Reduction Silver  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR670-24 (PDF)
Robin Select $5,700 w/Copay P-S Cost Share Reduction Silver  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR671-24 (PDF)
Robin Select $6,350 Plus Bronze SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR672-24 (PDF)
Robin Select Zero Cost Share Bronze (IR673)  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR673-24 (PDF)
Robin Select $6,350 Plus Limited Cost Share Bronze  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR674-24 (PDF)
Robin Select $7,500 w/Copay P-S Bronze  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR675-24 (PDF)
Robin Select Zero Cost Share Bronze (IR676)  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR676-24 (PDF)
Robin Select $7,500 w/Copay P-S Limited Cost Share Bronze  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR677-24 (PDF)
Robin Select $9,450 Catastrophic SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR687-24 (PDF)
Robin Select $3,800 HSA Silver  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR678-24 (PDF)
Robin Select Zero Cost Share Silver (IR679)  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR679-24 (PDF)
Robin Select $3,800 HSA Limited Cost Share Silver  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR680-24 (PDF)
Robin Select $200 Cost Share Reduction Silver  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR681-24 (PDF)
Robin Select $1,200 Cost Share Reduction Silver  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR682-24 (PDF)
Robin Select $3,000 Cost Share Reduction Silver  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR683-24 (PDF)
Robin Select $8,000 HSA Bronze  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR684-24 (PDF)
Robin Select Zero Cost Share Bronze (IR685) SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR685-24 (PDF)
Robin Select $8,000 Limited Cost Share Bronze  SBC (PDF) MGC-200.7-WI-IND-RS-MK-24 (PDF) BCH-200.7-WI-IND-IR686-24 (PDF)
2023 Wisconsin plan documents Atlas plans

Plan name

 Summary of Benefits and Coverage Contract Benefit charts Amendments/pediatric dental
Atlas $1,000 w/Copay P-S Gold Atlas $1,000 w/Copay P-S Gold (PDF) MGC-200.6-WI-IND-OMK-23 (PDF) BCH-200.6-WI-IND-IW110-23 (PDF) PMD-200.6-WI-IND-PED-80P-23 (PDF)
Atlas $2,000 w/Copay P-S Gold Atlas $2,000 w/Copay P-S Gold (PDF) MGC-200.6-WI-IND-OMK-23 (PDF) BCH-200.6-WI-IND-IW113-23 (PDF) PMD-200.6-WI-IND-PED-80P75-23 (PDF)
Atlas $3,500 Plus Silver  Atlas $3,500 Plus Silver (PDF) MGC-200.6-WI-IND-OMK-23 (PDF) BCH-200.6-WI-IND-IW102-23 (PDF) PMD-200.6-WI-IND-PED-80-23 (PDF)
Atlas $4,950 Plus Silver Atlas $4,950 Plus Silver (PDF) MGC-200.6-WI-IND-OMK-23 (PDF) BCH-200.6-WI-IND-IW112-23 (PDF) PMD-200.6-WI-IND-PED-80-23 (PDF)
Atlas $6,250 Plus Bronze  Atlas $6,250 Plus Bronze (PDF) MGC-200.6-WI-IND-OMK-23 (PDF)
 BCH-200.6-WI-IND-IW103-23 (PDF) PMD-200.6-WI-IND-PED-70-23 (PDF)
Atlas $9,100 Catastrophic  Atlas $9,100 Catastrophic (PDF) MGC-200.6-WI-IND-OMK-23 (PDF)
 BCH-200.6-WI-IND-IW105-23 (PDF) PMD-200.6-WI-IND-PED-100-23 (PDF)
Atlas $3,000 w/Copay P-S Silver  Atlas $3,000 w/Copay P-S Silver (PDF) MGC-200.6-WI-IND-OMK-23 (PDF)
 BCH-200.6-WI-IND-IW109-23 (PDF) PMD-200.6-WI-IND-PED-80P75-23 (PDF)
Atlas $7,500 w/Copay P-S Bronze  Atlas $7,500 w/Copay P-S Bronze (PDF) MGC-200.6-WI-IND-OMK-23 (PDF)
 BCH-200.6-WI-IND-IW114-23 (PDF) PMD-200.6-WI-IND-PED-80P50-23 (PDF)
Atlas $3,500 HSA Silver  Atlas $3,500 HSA Silver (PDF) MGC-200.6-WI-IND-OMK-23 (PDF)
 BCH-200.6-WI-IND-IW106-23 (PDF) PMD-200.6-WI-IND-PED-80-23 (PDF)
Atlas $7,500 HSA Bronze  Atlas $7,500 HSA Bronze (PDF) MGC-200.6-WI-IND-OMK-23 (PDF)
 BCH-200.6-WI-IND-IW107-23 (PDF) PMD-200.6-WI-IND-PED-100-23 (PDF)

Plan name

 Summary of Benefits and Coverage Contract Benefit charts
Atlas $1,000 w/Copay P-S Gold Atlas $1,000 w/Copay P-S Gold (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW644-23 (PDF)
Atlas Zero Cost Share Gold (IW602) Atlas Zero Cost Share Gold (IW602) (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW602-23 (PDF)
Atlas $1,000 w/Copay P-S Limited Cost Share Gold Atlas $1,000 w/Copay P-S Limited Cost Share Gold (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW645-23 (PDF)
Atlas $2,000 w/Copay Gold  Atlas $2,000 w/Copay Gold (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW655-23 (PDF)
Atlas Zero Cost Share Gold (IW656) Atlas Zero Cost Share Gold (IW656) (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW656-23 (PDF)
Atlas $2,000 w/Copay Limited Cost Share Gold Atlas $2,000 w/Copay Limited Cost Share Gold (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW657-23 (PDF)
Atlas $3,500 Plus Silver Atlas $3,500 Plus Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW604-23 (PDF)
Atlas Zero Cost Share Silver (IW605) Atlas Zero Cost Share Silver (IW605) (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW605-23 (PDF)
Atlas $3,500 Plus Limited Cost Share Silver Atlas $3,500 Plus Limited Cost Share Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW606-23 (PDF)
Atlas $50 Plus Cost Share Silver Atlas $50 Plus Cost Share Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW607-23 (PDF)
Atlas $750 Plus Cost Share Silver Atlas $750 Plus Cost Share Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW608-23 (PDF)
Atlas $3,250 Plus Cost Share Silver Atlas $3,250 Plus Cost Share Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW609-23 (PDF)
Atlas $5,800 w/Copay P-S Silver Atlas $5,800 w/Copay P-S Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW658-23 (PDF)
Atlas Zero Cost Share Silver (IW659) Atlas Zero Cost Share Silver (IW659) (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW659-23 (PDF)
Atlas $5,800 w/Copay P-S Limited Cost Share Silver Atlas $5,800 w/Copay P-S Limited Cost Share Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW660-23 (PDF)
Atlas $0 w/Copay P-S Cost Share Silver Atlas $0 w/Copay P-S Cost Share Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW661-23 (PDF)
Atlas $800 w/Copay P-S Cost Share Silver Atlas $800 w/Copay P-S Cost Share Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW662-23 (PDF)
Atlas $5,700 w/Copay P-S Cost Share Silver Atlas $5,700 w/Copay P-S Cost Share Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW663-23 (PDF)
Atlas $6,250 Plus Bronze Atlas $6,250 Plus Bronze (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW616-23 (PDF)
Atlas Zero Cost Share Bronze (IW617) Atlas Zero Cost Share Bronze (IW617) (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW617-23 (PDF)
Atlas $6,250 Plus Limited Cost Share Bronze Atlas $6,250 Plus Limited Cost Share Bronze (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW618-23 (PDF)
Atlas $7,500 w/Copay P-S Bronze Atlas $7,500 w/Copay P-S Bronze (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW664-23 (PDF)
Atlas Zero Cost Share Bronze (IW665) Atlas Zero Cost Share Bronze (IW665) (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW665-23 (PDF)
Atlas $7,500 w/Copay P-S Limited Cost Share Bronze Atlas $7,500 w/Copay P-S Limited Cost Share Bronze (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW666-23 (PDF)
Atlas $9,100 Catastrophic Atlas $9,100 Catastrophic (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW622-23 (PDF)
Atlas $3,000 w/Copay P-S Silver Atlas $3,000 w/Copay P-S Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW638-23 (PDF)
Atlas Zero Cost Share Silver (IW639) Atlas Zero Cost Share Silver (IW639) (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW639-23 (PDF)
Atlas $3,000 w/Copay P-S Limited Cost Share Silver Atlas $3,000 w/Copay P-S Limited Cost Share Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW640-23 (PDF)
Atlas $50 Cost Share Reduction Silver Atlas $50 Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW641-23 (PDF)
Atlas $850 Cost Share Reduction Silver Atlas $850 Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW642-23 (PDF)
Atlas $2,800 Cost Share Reduction Silver Atlas $2,800 Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW643-23 (PDF)
Atlas $3,500 HSA Silver Atlas $3,500 HSA Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW623-23 (PDF)
Atlas Zero Cost Share Silver (IW624) Atlas Zero Cost Share Silver (IW624) (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW624-23 (PDF)
Atlas $3,500 Limited Cost Share Silver Atlas $3,500 Limited Cost Share Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW625-23 (PDF)
Atlas $200 Cost Share Silver Atlas $200 Cost Share Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW626-23 (PDF)
Atlas $1,050 Cost Share Silver  Atlas $1,050 Cost Share Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW627-23 (PDF)
Atlas $2,750 Cost Share Silver Atlas $2,750 Cost Share Silver (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW628-23 (PDF)
Atlas $7,500 HSA Bronze Atlas $7,500 HSA Bronze (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW629-23 (PDF)
Atlas Zero Cost Share Bronze (IW630) Atlas Zero Cost Share Bronze (IW630) (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW630-23 (PDF)
Atlas $7,500 Limited Cost Share Bronze Atlas $7,500 Limited Cost Share Bronze (PDF) MGC-200.6-WI-IND-MK-23 (PDF) BCH-200.6-WI-IND-IW631-23 (PDF)
Robin Oak plans

Plan name

 Summary of Benefits and Coverage Contract Benefit charts Amendments/pediatric dental
Robin Oak $1,000 w/Copay P-S Gold Robin Oak $1,000 w/Copay P-S Gold (PDF) MGC-200.6-WI-IND-RO-OMK-23 (PDF) BCH-200.6-WI-IND-IR107-23 (PDF) PMD-200.6-WI-IND-PED-80P-23 (PDF)
Robin Oak $2,000 w/Copay P-S Gold  Robin Oak $2,000 w/Copay P-S Gold (PDF) MGC-200.6-WI-IND-RO-OMK-23 (PDF)
 BCH-200.6-WI-IND-IR112-23 (PDF) PMD-200.6-WI-IND-PED-80P75-23 (PDF)
Robin Oak $7,000 w/Copay P-S Silver  Robin Oak $7,000 w/Copay P-S Silver (PDF) MGC-200.6-WI-IND-RO-OMK-23 (PDF)
 BCH-200.6-WI-IND-IR102-23 (PDF) PMD-200.6-WI-IND-PED-80P75-23 (PDF)
Robin Oak $4,750 Plus Silver  Robin Oak $4,750 Plus Silver (PDF) MGC-200.6-WI-IND-RO-OMK-23 (PDF)
 BCH-200.6-WI-IND-IR109-23 (PDF) PMD-200.6-WI-IND-PED-80-23 (PDF)
Robin Oak $6,250 Plus Bronze  Robin Oak $6,250 Plus Bronze (PDF) MGC-200.6-WI-IND-RO-OMK-23 (PDF)
 BCH-200.6-WI-IND-IR105-23 (PDF) PMD-200.6-WI-IND-PED-70-23 (PDF)
Robin Oak $7,500 w/Copay P-S Bronze  Robin Oak $7,500 w/Copay P-S Bronze (PDF) MGC-200.6-WI-IND-RO-OMK-23 (PDF)
 BCH-200.6-WI-IND-IR113-23 (PDF) PMD-200.6-WI-IND-PED-80P50-23 (PDF)
Robin Oak $9,100 Catastrophic Robin Oak $9,100 Catastrophic (PDF) MGC-200.6-WI-IND-RO-OMK-23 (PDF)
 BCH-200.6-WI-IND-IR106-23 (PDF) PMD-200.6-WI-IND-PED-100-23 (PDF)
Robin Oak $3,500 HSA Silver Robin Oak $3,500 HSA Silver (PDF) MGC-200.6-WI-IND-RO-OMK-23 (PDF)
 BCH-200.6-WI-IND-IR114-23 (PDF) PMD-200.6-WI-IND-PED-100P80-23 (PDF)
Robin Oak $7,500 HSA Bronze Robin Oak $7,500 HSA Bronze (PDF) MGC-200.6-WI-IND-RO-OMK-23 (PDF) BCH-200.6-WI-IND-IR111-23 (PDF) PMD-200.6-WI-IND-PED-100P-23 (PDF)

Plan name

 Summary of Benefits and Coverage Contract Benefit charts
Robin Oak $1,000 w/Copay P-S Gold Robin Oak $1,000 w/Copay P-S Gold (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR626-23 (PDF)
Robin Oak Zero Cost Share Gold (IR602)  Robin Oak Zero Cost Share Gold (IR602) (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF)
 BCH-200.6-WI-IND-IR602-23 (PDF)
Robin Oak $1,000 w/Copay P-S Limited Cost Share Gold Robin Oak $1,000 w/Copay P-S Limited Cost Share Gold (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF)
 BCH-200.6-WI-IND-IR627-23 (PDF)
Robin Oak $2,000 w/Copay P-S Gold  Robin Oak $2,000 w/Copay P-S Gold (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF)
 BCH-200.6-WI-IND-IR642-23 (PDF)
Robin Oak Zero Cost Share Gold (IR643)  Robin Oak Zero Cost Share Gold (IR643) (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF)
 BCH-200.6-WI-IND-IR643-23 (PDF)
Robin Oak $2,000 w/Copay P-S Limited Cost Share Gold  Robin Oak $2,000 w/Copay P-S Limited Cost Share Gold (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF)
 BCH-200.6-WI-IND-IR644-23 (PDF)
Robin Oak $3,800 Plus Silver Robin Oak $3,800 Plus Silver (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF)
 BCH-200.6-WI-IND-IR634-23 (PDF)

Robin Oak Zero Cost Share Silver (IR617)

 Robin Oak Zero Cost Share Silver (IR617) (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF)
 BCH-200.6-WI-IND-IR617-23 (PDF)
Robin Oak $3,800 Plus Limited Cost Share Silver  Robin Oak $3,800 Plus Limited Cost Share Silver (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF)
 BCH-200.6-WI-IND-IR635-23 (PDF)
Robin Oak $50 Cost Share Reduction Silver  Robin Oak $50 Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF)
 BCH-200.6-WI-IND-IR619-23 (PDF)
Robin Oak $850 Cost Share Reduction Silver  Robin Oak $850 Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR620-23 (PDF)
Robin Oak $3,300 Cost Share Reduction Silver  Robin Oak $3,300 Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR621-23 (PDF)
Robin Oak $5,800 w/Copay P-S Silver  Robin Oak $5,800 w/Copay P-S Silver (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR645-23 (PDF)
Robin Oak Zero Cost Share Silver (IR646)  Robin Oak Zero Cost Share Silver (IR646) (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR646-23 (PDF)
Robin Oak $5,800 w/Copay P-S Limited Cost Share Silver Robin Oak $5,800 w/Copay P-S Limited Cost Share Silver (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR647-23 (PDF)
Robin Oak $0 w/Copay P-S Cost Share Reduction Silver  Robin Oak $0 w/Copay P-S Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR648-23 (PDF)
Robin Oak $800 w/Copay P-S Cost Share Reduction Silver  Robin Oak $800 w/Copay P-S Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR649-23 (PDF)
Robin Oak $5,700 w/Copay P-S Cost Share Reduction Silver  Robin Oak $5,700 w/Copay P-S Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR650-23 (PDF)
Robin Oak $6,250 Plus Bronze  Robin Oak $6,250 Plus Bronze (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR622-23 (PDF)
Robin Oak Zero Cost Share Bronze (IR623)  Robin Oak Zero Cost Share Bronze (IR623) (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR623-23 (PDF)
Robin Oak $6,250 Plus Limited Cost Share Bronze  Robin Oak $6,250 Plus Limited Cost Share Bronze (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR624-23 (PDF)
Robin Oak $7,500 w/Copay P-S Bronze  Robin Oak $7,500 w/Copay P-S Bronze (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR651-23 (PDF)
Robin Oak Zero Cost Share Bronze (IR652)  Robin Oak Zero Cost Share Bronze (IR652) (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR652-23 (PDF)
Robin Oak $7,500 w/Copay P-S Limited Cost Share Bronze  Robin Oak $7,500 w/Copay P-S Limited Cost Share Bronze (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR653-23 (PDF)
Robin Oak $9,100 Catastrophic  Robin Oak $9,100 Catastrophic (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR625-23 (PDF)
Robin Oak $3,500 HSA Silver  Robin Oak $3,500 HSA Silver (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR654-23 (PDF)
Robin Oak Zero Cost Share Silver (IR655)  Robin Oak Zero Cost Share Silver (IR655) (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR655-23 (PDF)
Robin Oak $3,500 HSA Limited Cost Share Silver  Robin Oak $3,500 HSA Limited Cost Share Silver (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR656-23 (PDF)
Robin Oak $200 Cost Share Reduction Silver  Robin Oak $200 Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR657-23 (PDF)
Robin Oak $1,050 Cost Share Reduction Silver  Robin Oak $1,050 Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR658-23 (PDF)
Robin Oak $2,750 Cost Share Reduction Silver  Robin Oak $2,750 Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR659-23 (PDF)
Robin Oak $7,500 HSA Bronze Robin Oak $7,500 HSA Bronze (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR639-23 (PDF)
Robin Oak Zero Cost Share Bronze (IR640) Robin Oak Zero Cost Share Bronze (IR640) (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR640-23 (PDF)
Robin Oak $7,500 HSA Limited Cost Share Bronze  Robin Oak $7,500 HSA Limited Cost Share Bronze (PDF) MGC-200.6-WI-IND-RO-MK-23 (PDF) BCH-200.6-WI-IND-IR641-23 (PDF)
Robin Select plans

Plan name

 Summary of Benefits and Coverage Contract Benefit charts Amendments/pediatric dental
Robin Select $7,000 w/Copay P-S Silver Robin Select $7,000 w/Copay P-S Silver (PDF) MGC-200.6-WI-IND-RS-OMK-23 (PDF) BCH-200.6-WI-IND-IR115-23 (PDF) PMD-200.6-WI-IND-PED-80P-23 (PDF)
Robin Select $4,750 Plus Silver  Robin Select $4,750 Plus Silver (PDF) MGC-200.6-WI-IND-RS-OMK-23 (PDF) BCH-200.6-WI-IND-IR116-23 (PDF) PMD-200.6-WI-IND-PED-80-23 (PDF)
Robin Select $6,250 Plus Bronze  Robin Select $6,250 Plus Bronze (PDF) MGC-200.6-WI-IND-RS-OMK-23 (PDF) BCH-200.6-WI-IND-IR117-23 (PDF) PMD-200.6-WI-IND-PED-80P70-23 (PDF)
Robin Select $7,500 w/Copay P-S Bronze Robin Select $7,500 w/Copay P-S Bronze (PDF) MGC-200.6-WI-IND-RS-OMK-23 (PDF) BCH-200.6-WI-IND-IR118-23 (PDF) PMD-200.6-WI-IND-PED-80P50-23 (PDF)
Robin Select $9,100 Catastrophic  Robin Select $9,100 Catastrophic (PDF) MGC-200.6-WI-IND-RS-OMK-23 (PDF) BCH-200.6-WI-IND-IR121-23 (PDF) PMD-200.6-WI-IND-PED-100-23 (PDF)
Robin Select $3,500 HSA Silver  Robin Select $3,500 HSA Silver (PDF) MGC-200.6-WI-IND-RS-OMK-23 (PDF) BCH-200.6-WI-IND-IR119-23 (PDF) PMD-200.6-WI-IND-PED-100P80-23 (PDF)
Robin Select $7,500 HSA Bronze  Robin Select $7,500 HSA Bronze (PDF) MGC-200.6-WI-IND-RS-OMK-23 (PDF) BCH-200.6-WI-IND-IR120-23 (PDF) PMD-200.6-WI-IND-PED-100P-23 (PDF)

Plan name

 Summary of Benefits and Coverage Contract Benefit charts
Robin Select $3,800 Plus Silver  Robin Select $3,800 Plus Silver (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR660-23 (PDF)
Robin Select Zero Cost Share Silver (IR661)  Robin Select Zero Cost Share Silver (IR661) (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR661-23 (PDF)
Robin Select $3,800 Plus Limited Cost Share Silver  Robin Select $3,800 Plus Limited Cost Share Silver (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR662-23 (PDF)
Robin Select $50 Cost Share Reduction Silver  Robin Select $50 Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR663-23 (PDF)
Robin Select $850 Cost Share Reduction Silver  Robin Select $850 Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR664-23 (PDF)
Robin Select $3,300 Cost Share Reduction Silver  Robin Select $3,300 Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR665-23 (PDF)
Robin Select $5,800 w/Copay P-S Silver Robin Select $5,800 w/Copay P-S Silver (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR666-23 (PDF)
Robin Select Zero Cost Share Silver (IR667)  Robin Select Zero Cost Share Silver (IR667) (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR667-23 (PDF)
Robin Select $5,800 w/Copay P-S Limited Cost Share Silver  Robin Select $5,800 w/Copay P-S Limited Cost Share Silver (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR668-23 (PDF)
Robin Select $0 w/Copay P-S Cost Share Reduction Silver Robin Select $0 w/Copay P-S Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR669-23 (PDF)
Robin Select $800 w/Copay P-S Cost Share Reduction Silver  Robin Select $800 w/Copay P-S Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR670-23 (PDF)
Robin Select $5,700 w/Copay P-S Cost Share Reduction Silver  Robin Select $5,700 w/Copay P-S Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR671-23 (PDF)

Robin Select $6,250 Plus Bronze 

 Robin Select $6,250 Plus Bronze (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR672-23 (PDF)
Robin Select Zero Cost Share Bronze (IR673)  Robin Select Zero Cost Share Bronze (IR673) (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR673-23 (PDF)
Robin Select $6,250 Plus Limited Cost Share Bronze  Robin Select $6,250 Plus Limited Cost Share Bronze (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR674-23 (PDF)
Robin Select $7,500 w/Copay P-S Bronze  Robin Select $7,500 w/Copay P-S Bronze (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR675-23 (PDF)
Robin Select Zero Cost Share Bronze (IR676)  Robin Select Zero Cost Share Bronze (IR676) (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR676-23 (PDF)
Robin Select $7,500 w/Copay P-S Limited Cost Share Bronze  Robin Select $7,500 w/Copay P-S Limited Cost Share Bronze (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR677-23 (PDF)

Robin Select $9,100 Catastrophic

 Robin Select $9,100 Catastrophic (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR687-23 (PDF)
Robin Select $3,500 HSA Silver  Robin Select $3,500 HSA Silver (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR678-23 (PDF)
Robin Select Zero Cost Share Silver (IR679)  Robin Select Zero Cost Share Silver (IR679) (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR679-23 (PDF)
Robin Select $3,500 HSA Limited Cost Share Silver  Robin Select $3,500 HSA Limited Cost Share Silver (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR680-23 (PDF)
Robin Select $200 Cost Share Reduction Silver  Robin Select $200 Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR681-23 (PDF)
Robin Select $1,050 Cost Share Reduction Silver  Robin Select $1,050 Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR682-23 (PDF)
Robin Select $2,750 Cost Share Reduction Silver  Robin Select $2,750 Cost Share Reduction Silver (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR683-23 (PDF)
Robin Select $7,500 HSA Bronze  Robin Select $7,500 HSA Bronze (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR684-23 (PDF)
Robin Select Zero Cost Share Bronze (IR685) Robin Select Zero Cost Share Bronze (IR685) (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR685-23 (PDF)
Robin Select $7,500 HSA Limited Cost Share Bronze  Robin Select $7,500 HSA Limited Cost Share Bronze (PDF) MGC-200.6-WI-IND-RS-MK-23 (PDF) BCH-200.6-WI-IND-IR686-23 (PDF)