Benefits Summary (PDF) July 1, 2021
A detailed list of the level of coverage for covered services (e.g. copay, coinsurance)
Benefits Summary (PDF) July 1, 2020
A detailed list of the level of coverage for covered services (e.g. copay, coinsurance)
Summary of Benefits & Coverage ("SBC") (PDF) July 1, 2021
A summary of the level of coverage for some services (e.g. copay, coinsurance)
Summary of Benefits & Coverage ("SBC") (PDF) July 1, 2020
A summary of the level of coverage for some services (e.g. copay, coinsurance)
Plan Booklet - Medical (PDF) July 1, 2021
A detailed description of what medical services the plan covers
Plan Booklet - Medical (PDF) July 1, 2020
A detailed description of what medical services the plan covers
Plan Booklet - Prescription (PDF) July 1, 2021
A detailed description of what prescription services the plan covers
Plan Booklet - Prescription (PDF) July 1, 2020
A detailed description of what prescription services the plan covers
Rx Copays - Prescription (PDF) July 1, 2021
Rx Copays - Prescription (PDF) July 1, 2020