AMT - Summary Plan Descriptions

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

80/60 PPO HSCP

Last Updated: Apr 23, 2021

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

PPO - 100/80

Last Updated: Feb 13, 2023

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(SPD) Plan 37X: PPO – 80/60

PPO – 80/60

Last Updated: Feb 13, 2023

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(SPD) Plan 40X: PPO – 80/60

PPO – 80/60

Last Updated: Feb 13, 2023

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

Plan 41X Direct Access-100/60

Last Updated: Feb 13, 2023

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(SPD) Plan 41XL: Direct Access-100/60

Plan 41XL Direct Access-100/60

Last Updated: Feb 13, 2023

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(SPD) Plan 42X: Direct Access-90/60

Plan 42X Direct Access-90/60

Last Updated: Feb 13, 2023

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(SPD) Plan 42XL: Direct Access-90/60

Plan 42XL Direct Access-90/60

Last Updated: Feb 13, 2023

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

Plan 43X Direct Access-90/60- HSCP

Last Updated: Feb 13, 2023

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(SPD) Plan 43XL: Direct Access-90/60 HSCP

Plan 43XL Direct Access-90/60- HSCP

Last Updated: Feb 13, 2023

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

Plan 44X Direct Access-80/60- HSCP

Last Updated: Feb 13, 2023

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(SPD) Plan 44XL: Direct Access-80/60 HSCP

Plan 44XL Direct Access-80/60- HSCP

Last Updated: Feb 13, 2023

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

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

Last Updated: Feb 13, 2023

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(SPD) Plan 45XL: Direct Access-100/60-R HSCP

Plan 45XL Direct Access-100/60-R HSCP

Last Updated: Feb 13, 2023

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

Plan 46X Direct Access-80/60- R HSCP

Last Updated: Feb 13, 2023

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(SPD) Plan 46XL: Direct Access-80/60-R HSCP

Plan 46XL Direct Access-80/60- R HSCP

Last Updated: Feb 13, 2023

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(SPD) Plan 47X: Direct Access-80/60

Plan 47X Direct Access-80/60

Last Updated: Feb 13, 2023

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(SPD) Plan 47XL: Direct Access-80/60

Plan 47XL Direct Access-80/60

Last Updated: Feb 13, 2023

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(SPD) Plan 48X: Direct Access-80/60

Plan 48X Direct Access-80/60

Last Updated: Feb 13, 2023

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(SPD) Plan 48XL: Direct Access-80/60

Plan 48XL Direct Access-80/60

Last Updated: Feb 13, 2023

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

Plan 49X Direct Access-100/60-R HSCP

Last Updated: Feb 13, 2023

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(SPD) Plan 49XL: Direct Access-100/60-R HSCP

Plan 49XL Direct Access-100/60-R HSCP

Last Updated: Feb 13, 2023

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(SPD) Plan 508: 100/80/60 Health Savings Account

100/80/60 Health Savings Account

Last Updated: Feb 13, 2023

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

Plan 59X: Direct Access-50/50-R HSCP

Last Updated: Feb 13, 2023

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(SPD) Plan 608/638: Direct Access-100/80/60 Health Savings Account

Direct Access-100/80/60 Health Savings Account

Last Updated: Feb 13, 2023

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(SPD) Plan 608L/638L: Direct Access-100/80/60 Health Savings Account

Direct Access-100/80/60 Health Savings Account

Last Updated: Feb 13, 2023

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(SPD) Plan 609/639: Direct Access-100/80/60 Health Savings Account

Direct Access-100/80/60 Health Savings Account

Last Updated: Feb 13, 2023

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(SPD) Plan 609L/639L: Direct Access-100/80/60Health Savings Account

Direct Access-100/80/60 Health Savings Account

Last Updated: Feb 13, 2023

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(SPD) Plan 611: Direct Access-50/50 Health Savings Account

Direct Access-50/50 Health Savings Account

Last Updated: Feb 13, 2023

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(SPD) Plan 611L: Direct Access-50/50 Health Savings Account

Direct Access-50/50 Health Savings Account

Last Updated: Feb 13, 2023

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(SPD) Plan 618/638: Direct Access-100/70 Health Savings Account

Direct Access-100/70 Health Savings Account

Last Updated: Feb 13, 2023

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(SPD) Plan 618L/638L: Direct Access-100/70 Health Savings Account

Direct Access-100/70 Health Savings Account

Last Updated: Feb 13, 2023

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(SPD) Plan 619/629: Direct Access-100/70 Health Savings Account

Direct Access-100/70 Health Savings Account

Last Updated: Feb 13, 2023

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(SPD) Plan 619L/629L: Direct Access-100/70 Health Savings Account

Direct Access-100/70 Health Savings Account

Last Updated: Feb 13, 2023

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(SPD) Plan 620/630: Direct Access-100% Health Savings Account

Direct Access-100% Health Savings Account

Last Updated: Feb 13, 2023

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(SPD) Plan 621/631: Direct Access-100% Health Savings Account

Direct Access-100% Health Savings Account

Last Updated: Feb 13, 2023

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(SPD) Plan 623/633: Direct Access-70% Health Savings Account

Direct Access-70% Health Savings Account

Last Updated: Feb 13, 2023

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

Advantage EPO DIRECT ACCESS 100%

Last Updated: Feb 13, 2023

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

Advantage EPO DIRECT ACCESS 80%

Last Updated: Feb 13, 2023

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

Advantage EPO DIRECT ACCESS 80%

Last Updated: Feb 13, 2023

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

Advantage EPO DIRECT ACCESS 80%

Last Updated: Feb 13, 2023

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

Advantage EPO DIRECT ACCESS 100%

Last Updated: Feb 13, 2023

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

Advantage EPO DIRECT ACCESS 50%

Last Updated: Feb 13, 2023

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

Advantage EPO DIRECT ACCESS 50%

Last Updated: Feb 13, 2023

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(SPD) Plan 913: OMNIA 100/60

Summary Plan Description - OMNIA - 100/60 - Plan 913

Last Updated: Feb 13, 2023

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(SPD) Plan 929: OMNIA Health Savings Account Compatible 80/50

Summary Plan Description - OMNIA HSA Compatible 80/50 - Plan 929

Last Updated: Feb 13, 2023

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(SPD) Plan 934: OMNIA 100/50

Summary Plan Description - OMNIA 100/50 - Plan 934

Last Updated: Feb 13, 2023

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(SPD) Plan 949/959: OMNIA Health Savings Account

Summary Plan Description - OMNIA HSA Compatible 90/70 - Plan 949/959

Last Updated: Feb 13, 2023

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(SPD) Plan 950: OMNIA 65/55

Summary Plan Description - OMNIA 65/55 - Plan 950

Last Updated: Feb 13, 2023

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(SPD) Plan 952: OMNIA 55/45

Summary Plan Description - OMNIA 55/45 - Plan 952

Last Updated: Jan 10, 2024

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(SPD) Plan 958: OMNIA 50/50

Summary Plan Description - OMNIA 50/50 - Plan 958

Last Updated: Feb 13, 2023

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(SPD) Plan 968: OMNIA 50/50

Summary Plan Description - OMNIA 50/50 - Plan 968

Last Updated: Jan 10, 2024

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

COMPREHENSIVE HEALTH PLAN 80%

Last Updated: Feb 13, 2023

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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