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Forms & Documents: Summary Plan Descriptions

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Summary Plan Descriptions
(SPD) Plan 25X: 80/60 PPO HSCP $1000 DEDUCTIBLE
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(SPD) Plan 32X: PPO - 100/80 $250 DEDUCTIBLE
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(SPD) Plan 33X: PPO - 100/80 $500 DEDUCTIBLE
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(SPD) Plan 34X: PPO – 90/70 $250 DEDUCTIBLE
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(SPD) Plan 35X: PPO – 90/70 $500 DEDUCTIBLE
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(SPD) Plan 36X: PPO – 80/60 $250 DEDUCTIBLE
View File | Download File Last Updated: Mar 25, 2020
(SPD) Plan 37X: PPO – 80/60 $500 DEDUCTIBLE
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(SPD) Plan 38X: PPO - 100/80 $1,000 DEDUCTIBLE
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(SPD) Plan 39X: PPO – 90/70 $1,000 DEDUCTIBLE
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(SPD) Plan 40X: PPO – 80/60 $1,000 DEDUCTIBLE
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(SPD) Plan 41X: Direct Access-100/60 $1000 DEDUCTIBLE
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(SPD) Plan 42X: Direct Access-90/60 $500/$1000 DEDUCTIBLE
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(SPD) Plan 43X: Direct Access-90/60 HSCP $1000 DEDUCTIBLE
View File | Download File Last Updated: Mar 25, 2020
(SPD) Plan 44X: Direct Access-80/60 HSCP $1000 DEDUCTIBLE
View File | Download File Last Updated: Mar 25, 2020
(SPD) Plan 45X: Direct Access-100/60-R HSCP $1000 DEDUCTIBLE
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(SPD) Plan 46X: Direct Access-80/60-R HSCP $1000 DEDUCTIBLE
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(SPD) Plan 47X: Direct Access-80/60 $1500 HIGH DEDUCTIBLE
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(SPD) Plan 48X: Direct Access-80/60 $2500 HIGH DEDUCTIBLE
View File | Download File Last Updated: Mar 25, 2020
(SPD) Plan 49X: Direct Access-100/60-R HSCP $1500 DEDUCTIBLE
View File | Download File Last Updated: Mar 25, 2020
(SPD) Plan 508: 100/80/60 HSA $1,500 DEDUCTIBLE
View File | Download File Last Updated: Mar 26, 2020
(SPD) Plan 59X: Direct Access-50/50-R HSCP $2500 DEDUCTIBLE
View File | Download File Last Updated: Mar 25, 2020
(SPD) Plan 608: Direct Access-100/80/60 HSA $1,500 DEDUCTIBLE
View File | Download File Last Updated: Mar 26, 2020
(SPD) Plan 609: Direct Access-100/80/60 HSA $2,500 DEDUCTIBLE
View File | Download File Last Updated: Mar 26, 2020
(SPD) Plan 611: Direct Access-50/50 HSA $2,500 DEDUCTIBLE
View File | Download File Last Updated: Mar 26, 2020
(SPD) Plan 618: Direct Access-100/70 HSA $1,500 DEDUCTIBLE
View File | Download File Last Updated: Mar 26, 2020
(SPD) Plan 619: Direct Access-100/70 HSA $2,500 DEDUCTIBLE
View File | Download File Last Updated: Mar 26, 2020
(SPD) Plan 620: Direct Access-100% HSA $1,500 DEDUCTIBLE
View File | Download File Last Updated: Mar 26, 2020
(SPD) Plan 621: Direct Access-100% HSA $2,500 DEDUCTIBLE
View File | Download File Last Updated: Mar 26, 2020
(SPD) Plan 623: Direct Access-70% HSA $2,500 DEDUCTIBLE
View File | Download File Last Updated: Mar 26, 2020
(SPD) Plan 81X: Advantage EPO DIRECT ACCESS 100%
View File | Download File Last Updated: Mar 25, 2020
(SPD) Plan 82X: Advantage EPO DIRECT ACCESS 80%
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(SPD) Plan 83X: Advantage EPO DIRECT ACCESS 80%
View File | Download File Last Updated: Mar 25, 2020
(SPD) Plan 84X: Advantage EPO DIRECT ACCESS 80%
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(SPD) Plan 85X: Advantage EPO DIRECT ACCESS 100%
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(SPD) Plan 86X: Advantage EPO DIRECT ACCESS 50%
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(SPD) Plan 87X: Advantage EPO DIRECT ACCESS 50%
View File | Download File Last Updated: Mar 25, 2020
(SPD) Plan 913: OMNIA 100/60
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(SPD) Plan 929: OMNIA HSA Compatible 80/50
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(SPD) Plan 934: OMNIA 100/50
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(SPD) Plan 949: OMNIA HSA Compatible 90/70
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(SPD) Plan 958: OMNIA 50/50
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(SPD) Plan(s) 1, 2 & 100: Hospital,Medical Surgical, Major Medical
View File | Download File Last Updated: Mar 26, 2020
(SPD) Plan(s) 11 & 12: COMPREHENSIVE HEALTH PLAN 80%
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(SPD) Plan(s) 13 & 14: COMPREHENSIVE HEALTH PLAN 80%
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(SPD) Plan(s) 19 & 20: COMPREHENSIVE HEALTH PLAN 50%
View File | Download File Last Updated: Mar 26, 2020
(SPD) Rx Plan XX1: Prescription Drug $15/$25
View File | Download File Last Updated: Jan 8, 2020
(SPD) Rx Plan XX3: Prescription Drug - $10/$50/$75
View File | Download File Last Updated: Jan 8, 2020
(SPD) Rx Plan XX5: Prescription Drug 70/30
View File | Download File Last Updated: Jan 8, 2020
(SPD) Rx Plan XX6: Prescription Drug $15/$35/$50
View File | Download File Last Updated: Jan 8, 2020
(SPD) Rx Plan XX7: Prescription Drug 50/50
View File | Download File Last Updated: Jan 8, 2020

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