Plan Summaries

Summary of Benefits and Coverage (SBC)

2025 PPO 20

2025 PPO 25

2025 HMO 25

2025 PPO HRA

2025 PPO 2000

2025 HMO 3500

2025 PPO 3500

2025 PPO 5000

prescription drug coverage

National Plus Drug List

ACA Preventive Drug List

Understanding Cost Transparency (No Surprises Act)

Plan Booklets

PPO 20 Booklet

HMO 25 Booklet

PPO 25 Booklet

PPO HRA Booklet

PPO 2000 Booklet

PPO 3500 Booklet

HMO 3500 Booklet

PPO 5000 Booklet

Anthem BlueView Vision

Anthem BlueView Vision EOC

Blue View Vision HK Booklet

Blue View Vision PPO Booklet

Summaries

2025 Delta Dental Basic Plan

2025 Delta Dental Comprehensive Plan

2025 Delta Dental Indemnity Plan

2025 Delta Dental Voluntary Plan

Booklets

Delta Dental Basic Booklet

Delta Dental Enhanced Indemnity Booklet

Delta Dental Comprehensive Booklet

Delta Dental Voluntary Booklet

Summaries

2025 VSP Basic Vision Coverage

2025 VSP Enhanced Vision Coverage

certificates

VSP Evidence of Coverage Certificate

Life Insurance Summary

Life Insurance Booklet

Voluntary AD&D Certificate

LTD Cert Class 1: LTD 60-day 60% plan

LTD Cert Class 2: LTD 60-day 70% plan

LTD Cert Class 3: LTD 90-day 60% plan

LTD Cert Class 4: LTD 90-day 70% plan

LTD Cert Class 5: LTD 180-day 60% plan

LTD Cert Class 6: LTD 180-day 70% plan

ERISA Summary Plan Description Update 4-1-18

Life Insurance Waiver of Premium Certificate