Forms & Documents

Summary Plan Descriptions

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80/60 PPO HSCP $1000 DEDUCTIBLE

Last Updated: Apr 23, 2021

PPO - 100/80 $250 DEDUCTIBLE

Last Updated: Feb 13, 2023

PPO - 100/80 $500 DEDUCTIBLE

Last Updated: Feb 13, 2023

PPO – 90/70 $250 DEDUCTIBLE

Last Updated: Feb 13, 2023

PPO – 90/70 $500 DEDUCTIBLE

Last Updated: Feb 13, 2023

PPO – 80/60 $250 DEDUCTIBLE

Last Updated: Feb 13, 2023

PPO – 80/60 $500 DEDUCTIBLE

Last Updated: Feb 13, 2023

PPO - 100/80 $1,000 DEDUCTIBLE

Last Updated: Feb 13, 2023

PPO – 90/70 $1,000 DEDUCTIBLE

Last Updated: Feb 13, 2023

PPO – 80/60 $1,000 DEDUCTIBLE

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

100/80/60 HSA $1,500 DEDUCTIBLE

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

Direct Access-100/70 HSA $1,500 DEDUCTIBLE

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

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

Last Updated: Feb 13, 2023

Direct Access-100% HSA $1,500 DEDUCTIBLE

Last Updated: Feb 13, 2023

Direct Access-100% HSA $2,500 DEDUCTIBLE

Last Updated: Feb 13, 2023

Direct Access-70% HSA $2,500 DEDUCTIBLE

Last Updated: Feb 13, 2023

Advantage EPO DIRECT ACCESS 100%

Last Updated: Feb 13, 2023

Advantage EPO DIRECT ACCESS 80%

Last Updated: Feb 13, 2023

Advantage EPO DIRECT ACCESS 80%

Last Updated: Feb 13, 2023

Advantage EPO DIRECT ACCESS 80%

Last Updated: Feb 13, 2023

Advantage EPO DIRECT ACCESS 100%

Last Updated: Feb 13, 2023

Advantage EPO DIRECT ACCESS 50%

Last Updated: Feb 13, 2023

Advantage EPO DIRECT ACCESS 50%

Last Updated: Feb 13, 2023

OMNIA 100/60

Last Updated: Feb 13, 2023

OMNIA HSA Compatible 80/50

Last Updated: Feb 13, 2023

OMNIA 100/50

Last Updated: Feb 13, 2023

OMNIA HSA Compatible 90/70

Last Updated: Feb 13, 2023

OMNIA 65/55

Last Updated: Feb 13, 2023

OMNIA 50/50

Last Updated: Feb 13, 2023

Hospital,Medical Surgical, Major Medical

Last Updated: Apr 23, 2021

COMPREHENSIVE HEALTH PLAN 80%

Last Updated: Feb 13, 2023

COMPREHENSIVE HEALTH PLAN 80%

Last Updated: Apr 23, 2021

COMPREHENSIVE HEALTH PLAN 50%

Last Updated: Apr 23, 2021

Prescription Drug $15/$25

Last Updated: Apr 27, 2021

Prescription Drug - $10/$50/$75

Last Updated: Apr 27, 2021

Prescription Drug 70/30

Last Updated: Apr 27, 2021

Prescription Drug $15/$35/$50

Last Updated: Apr 27, 2021

Prescription Drug 50/50

Last Updated: Apr 27, 2021