Benefits Summary (PDF) July 1, 2024
A detailed list of the level of coverage for covered services (e.g. copay, coinsurance)
Benefits Summary (PDF) July 1, 2023
A detailed list of the level of coverage for covered services (e.g. copay, coinsurance)
Summary of Benefits & Coverage ("SBC") (PDF) July 1, 2024
A summary of the level of coverage for some services (e.g. copay, coinsurance)
Summary of Benefits & Coverage ("SBC") (PDF) July 1, 2023
A summary of the level of coverage for some services (e.g. copay, coinsurance)
Plan Booklet - Health (PDF) July 1, 2024
A detailed description of what medical services the plan covers
Plan Booklet - Health (PDF) July 1, 2023
A detailed description of what medical services the plan covers
Plan Booklet - Prescription (PDF) July 1, 2024
A detailed description of what prescription services the plan covers
Rx Copays - Prescription (PDF) July 1, 2022