AMT - Summary Plan Descriptions

(SPD) Plan 25X: 80/60 PPO HSCP $1000 DEDUCTIBLE

80/60 PPO HSCP $1000 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 32X: PPO - 100/80 $250 DEDUCTIBLE

PPO - 100/80 $250 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 33X: PPO - 100/80 $500 DEDUCTIBLE

PPO - 100/80 $500 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 34X: PPO – 90/70 $250 DEDUCTIBLE

PPO – 90/70 $250 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 35X: PPO – 90/70 $500 DEDUCTIBLE

PPO – 90/70 $500 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 36X: PPO – 80/60 $250 DEDUCTIBLE

PPO – 80/60 $250 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 37X: PPO – 80/60 $500 DEDUCTIBLE

PPO – 80/60 $500 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 38X: PPO - 100/80 $1,000 DEDUCTIBLE

PPO - 100/80 $1,000 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 39X: PPO – 90/70 $1,000 DEDUCTIBLE

PPO – 90/70 $1,000 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 40X: PPO – 80/60 $1,000 DEDUCTIBLE

PPO – 80/60 $1,000 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 41X: Direct Access-100/60 $1000 DEDUCTIBLE

Plan 41X Direct Access-100/60 $1000 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 42X: Direct Access-90/60 $500/$1000 DEDUCTIBLE

Plan 42X Direct Access-90/60 $500/$1000 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 43X: Direct Access-90/60 HSCP $1000 DEDUCTIBLE

Plan 43X Direct Access-90/60- HSCP $1000 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 44X: Direct Access-80/60 HSCP $1000 DEDUCTIBLE

Plan 44X Direct Access-80/60- HSCP $1000 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 45X: Direct Access-100/60-R HSCP $1000 DEDUCTIBLE

Plan 45X: Direct Access-100/60-R HSCP $1000 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 46X: Direct Access-80/60-R HSCP $1000 DEDUCTIBLE

Plan 46X Direct Access-80/60- R HSCP $1000 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 47X: Direct Access-80/60 $1500 HIGH DEDUCTIBLE

Plan 47X Direct Access-80/60 $1500 HIGH DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 48X: Direct Access-80/60 $2500 HIGH DEDUCTIBLE

Plan 48X Direct Access-80/60 $2500 HIGH DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 49X: Direct Access-100/60-R HSCP $1500 DEDUCTIBLE

Plan 49X Direct Access-100/60-R HSCP $1500 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 508: 100/80/60 HSA $1,500 DEDUCTIBLE

100/80/60 HSA $1,500 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 59X: Direct Access-50/50-R HSCP $2500 DEDUCTIBLE

Plan 59X: Direct Access-50/50-R HSCP $2500 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 608: Direct Access-100/80/60 HSA $1,500 DEDUCTIBLE

Direct Access-100/80/60 HSA $1,500 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 609: Direct Access-100/80/60 HSA $2,500 DEDUCTIBLE

Direct Access-100/80/60 HSA $2,500 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 611: Direct Access-50/50 HSA $2,500 DEDUCTIBLE

Direct Access-50/50 HSA $2,500 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 618: Direct Access-100/70 HSA $1,500 DEDUCTIBLE

Direct Access-100/70 HSA $1,500 DEDUCTIBLE (PLAN 618)

Last Updated: Apr 23, 2021

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(SPD) Plan 619: Direct Access-100/70 HSA $2,500 DEDUCTIBLE

Direct Access-100/70 HSA $2,500 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 620: Direct Access-100% HSA $1,500 DEDUCTIBLE

Direct Access-100% HSA $1,500 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 621: Direct Access-100% HSA $2,500 DEDUCTIBLE

Direct Access-100% HSA $2,500 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 623: Direct Access-70% HSA $2,500 DEDUCTIBLE

Direct Access-70% HSA $2,500 DEDUCTIBLE

Last Updated: Apr 23, 2021

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(SPD) Plan 81X: Advantage EPO DIRECT ACCESS 100%

Advantage EPO DIRECT ACCESS 100%

Last Updated: Apr 27, 2021

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(SPD) Plan 82X: Advantage EPO DIRECT ACCESS 80%

Advantage EPO DIRECT ACCESS 80%

Last Updated: Apr 27, 2021

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(SPD) Plan 83X: Advantage EPO DIRECT ACCESS 80%

Advantage EPO DIRECT ACCESS 80%

Last Updated: Apr 27, 2021

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(SPD) Plan 84X: Advantage EPO DIRECT ACCESS 80%

Advantage EPO DIRECT ACCESS 80%

Last Updated: Apr 27, 2021

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(SPD) Plan 85X: Advantage EPO DIRECT ACCESS 100%

Advantage EPO DIRECT ACCESS 100%

Last Updated: Apr 27, 2021

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(SPD) Plan 86X: Advantage EPO DIRECT ACCESS 50%

Advantage EPO DIRECT ACCESS 50%

Last Updated: Apr 27, 2021

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(SPD) Plan 87X: Advantage EPO DIRECT ACCESS 50%

Advantage EPO DIRECT ACCESS 50%

Last Updated: Apr 27, 2021

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(SPD) Plan 913: OMNIA 100/60

OMNIA 100/60

Last Updated: Apr 23, 2021

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(SPD) Plan 929: OMNIA HSA Compatible 80/50

OMNIA HSA Compatible 80/50

Last Updated: Apr 23, 2021

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(SPD) Plan 934: OMNIA 100/50

OMNIA 100/50

Last Updated: Apr 23, 2021

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(SPD) Plan 949: OMNIA HSA Compatible 90/70

OMNIA HSA Compatible 90/70

Last Updated: Apr 23, 2021

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(SPD) Plan 950: OMNIA 65/55

OMNIA 65/55

Last Updated: Apr 23, 2021

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(SPD) Plan 958: OMNIA 50/50

OMNIA 50/50

Last Updated: Apr 23, 2021

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(SPD) Plan(s) 1, 2 & 100: Hospital,Medical Surgical, Major Medical

Hospital,Medical Surgical, Major Medical

Last Updated: Apr 23, 2021

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(SPD) Plan(s) 11 & 12: COMPREHENSIVE HEALTH PLAN 80%

COMPREHENSIVE HEALTH PLAN 80%

Last Updated: Apr 23, 2021

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(SPD) Plan(s) 13 & 14: COMPREHENSIVE HEALTH PLAN 80%

COMPREHENSIVE HEALTH PLAN 80%

Last Updated: Apr 23, 2021

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(SPD) Plan(s) 19 & 20: COMPREHENSIVE HEALTH PLAN 50%

COMPREHENSIVE HEALTH PLAN 50%

Last Updated: Apr 23, 2021

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(SPD) Rx Plan XX1: Prescription Drug $15/$25

Prescription Drug $15/$25

Last Updated: Apr 27, 2021

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(SPD) Rx Plan XX3: Prescription Drug - $10/$50/$75

Prescription Drug - $10/$50/$75

Last Updated: Apr 27, 2021

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(SPD) Rx Plan XX5: Prescription Drug 70/30

Prescription Drug 70/30

Last Updated: Apr 27, 2021

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(SPD) Rx Plan XX6: Prescription Drug $15/$35/$50

Prescription Drug $15/$35/$50

Last Updated: Apr 27, 2021

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(SPD) Rx Plan XX7: Prescription Drug 50/50

Prescription Drug 50/50

Last Updated: Apr 27, 2021

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Forms & Documents

Summary Plan Descriptions