Wisconsin individual and family plan documents

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	Amendments/pediatric dental
Atlas $1,000 w/Copay P-S Gold	SBC (PDF)
Atlas $1,500 w/Copay P-S Gold	SBC (PDF)
Atlas $3,200 Plus Silver	SBC (PDF)
Atlas $4,900 Plus Silver	SBC (PDF)
Atlas $6,350 Plus Bronze	SBC (PDF)
Atlas $9,450 Catastrophic	SBC (PDF)
Atlas $3,000 w/Copay P-S Silver	SBC (PDF)
Atlas $7,500 w/Copay P-S Bronze	SBC (PDF)
Atlas $3,800 HSA Silver	SBC (PDF)
Atlas $8,000 HSA Bronze	SBC (PDF)

Plan name	Summary of Benefits and Coverage	Contract	Benefit charts
Atlas $1,000 w/Copay P-S Gold	SBC (PDF)
Atlas Zero Cost Share Gold (IW602)	SBC (PDF)
Atlas $1,000 w/Copay P-S Limited Cost Share Gold	SBC (PDF)
Atlas $1,500 w/Copay Gold	SBC (PDF)
Atlas Zero Cost Share Gold (IW656)	SBC (PDF)
Atlas $1,500 w/Copay Limited Cost Share Gold	SBC (PDF)
Atlas $3,200 Plus Silver	SBC (PDF)
Atlas Zero Cost Share Silver (IW605)	SBC (PDF)
Atlas $3,200 Plus Limited Cost Share Silver	SBC (PDF)
Atlas $50 Plus Cost Share Silver	SBC (PDF)
Atlas $650 Plus Cost Share Silver	SBC (PDF)
Atlas $3,000 Plus Cost Share Silver	SBC (PDF)
Atlas $5,900 w/Copay P-S Silver	SBC (PDF)
Atlas Zero Cost Share Silver (IW659)	SBC (PDF)
Atlas $5,900 w/Copay P-S Limited Cost Share Silver	SBC (PDF)
Atlas $0 w/Copay P-S Cost Share Silver	SBC (PDF)
Atlas $700 w/Copay P-S Cost Share Silver	SBC (PDF)
Atlas $5,700 w/Copay P-S Cost Share Silver	SBC (PDF)
Atlas $6,350 Plus Bronze	SBC (PDF)
Atlas Zero Cost Share Bronze (IW617)	SBC (PDF)
Atlas $6,350 Plus Limited Cost Share Bronze	SBC (PDF)
Atlas $7,500 w/Copay P-S Bronze	SBC (PDF)
Atlas Zero Cost Share Bronze (IW665)	SBC (PDF)
Atlas $7,500 w/Copay P-S Limited Cost Share Bronze	SBC (PDF)
Atlas $9,450 Catastrophic	SBC (PDF)
Atlas $3,000 w/Copay P-S Silver	SBC (PDF)
Atlas Zero Cost Share Silver (IW639)	SBC (PDF)
Atlas $3,000 w/Copay P-S Limited Cost Share Silver	SBC (PDF)
Atlas $50 Cost Share Reduction Silver	SBC (PDF)
Atlas $850 Cost Share Reduction Silver	SBC (PDF)
Atlas $2,800 Cost Share Reduction Silver	SBC (PDF)
Atlas $3,800 HSA Silver	SBC (PDF)
Atlas Zero Cost Share Silver (IW624)	SBC (PDF)
Atlas $3,800 Limited Cost Share Silver	SBC (PDF)
Atlas $200 Cost Share Silver	SBC (PDF)
Atlas $1,200 Cost Share Silver	SBC (PDF)
Atlas $3,000 Cost Share Silver	SBC (PDF)
Atlas $8,000 HSA Bronze	SBC (PDF)
Atlas Zero Cost Share Bronze (IW630)	SBC (PDF)
Atlas $8,000 Limited Cost Share Bronze	SBC (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	SBC (PDF)
Robin Oak $1,500 w/Copay P-S Gold	SBC (PDF)

Plan name	Summary of Benefits and Coverage	Contract	Benefit charts
Robin Oak $1,000 w/Copay P-S Gold	SBC(PDF)
Robin Oak Zero Cost Share Gold (IR602)	SBC (PDF)
Robin Oak $1,000 w/Copay P-S Limited Cost Share Gold	SBC (PDF)
Robin Oak $1,500 w/Copay P-S Gold	SBC (PDF)
Robin Oak Zero Cost Share Gold (IR643)	SBC (PDF)
Robin Oak $1,500 w/Copay P-S Limited Cost Share Gold	SBC (PDF)

Robin Select plans

Plan name	Summary of Benefits and Coverage	Contract	Benefit charts	Amendments/pediatric dental
Robin Select $4,500 Plus Silver	SBC (PDF)
Robin Select $6,350 Plus Bronze	SBC (PDF)
Robin Select $7,500 w/Copay P-S Bronze	SBC (PDF)
Robin Select $9,450 Catastrophic	SBC (PDF)
Robin Select $3,800 HSA Silver	SBC (PDF)
Robin Select $8,000 HSA Bronze	SBC (PDF)

Plan name	Summary of Benefits and Coverage	Contract	Benefit charts
Robin Select $3,600 Plus Silver	SBC (PDF)
Robin Select Zero Cost Share Silver (IR661)	SBC (PDF)
Robin Select $3,600 Plus Limited Cost Share Silver	SBC (PDF)
Robin Select $50 Cost Share Reduction Silver	SBC (PDF)
Robin Select $750 Cost Share Reduction Silver	SBC (PDF)
Robin Select $3,100 Cost Share Reduction Silver	SBC (PDF)
Robin Select $5,900 w/Copay P-S Silver	SBC (PDF)
Robin Select Zero Cost Share Silver (IR667)	SBC (PDF)
Robin Select $5,900 w/Copay P-S Limited Cost Share Silver	SBC (PDF)
Robin Select $0 w/Copay P-S Cost Share Reduction Silver	SBC (PDF)
Robin Select $700 w/Copay P-S Cost Share Reduction Silver	SBC (PDF)
Robin Select $5,700 w/Copay P-S Cost Share Reduction Silver	SBC (PDF)
Robin Select $6,350 Plus Bronze	SBC (PDF)
Robin Select Zero Cost Share Bronze (IR673)	SBC (PDF)
Robin Select $6,350 Plus Limited Cost Share Bronze	SBC (PDF)
Robin Select $7,500 w/Copay P-S Bronze	SBC (PDF)
Robin Select Zero Cost Share Bronze (IR676)	SBC (PDF)
Robin Select $7,500 w/Copay P-S Limited Cost Share Bronze	SBC (PDF)
Robin Select $9,450 Catastrophic	SBC (PDF)
Robin Select $3,800 HSA Silver	SBC (PDF)
Robin Select Zero Cost Share Silver (IR679)	SBC (PDF)
Robin Select $3,800 HSA Limited Cost Share Silver	SBC (PDF)
Robin Select $200 Cost Share Reduction Silver	SBC (PDF)
Robin Select $1,200 Cost Share Reduction Silver	SBC (PDF)
Robin Select $3,000 Cost Share Reduction Silver	SBC (PDF)
Robin Select $8,000 HSA Bronze	SBC (PDF)
Robin Select Zero Cost Share Bronze (IR685)	SBC (PDF)
Robin Select $8,000 HSA Limited Cost Share Bronze	SBC (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)

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)

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)

Wisconsin individual and family plan documents

Find all the documents and details for your plan

2024 Wisconsin plan documents

Atlas plans

Robin Oak plans

Robin Select plans

2023 Wisconsin plan documents

Atlas plans

Robin Oak plans

Robin Select plans

HealthPartners

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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)

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)

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)