Plan Summaries

You can find Medical & Rx, Dental, Vision, Life Insurance and Disability plan summaries and booklets here.

Medical & Prescription Drug

Summary of Benefits and Coverage (SBC)

2024 PPO 20 SBC

2024 PPO 25 SBC

2024 HMO 25 SBC

2024 PPO HRA SBC

2024 PPO $2000 SBC

2024 PPO $3500 SBC

2024 HMO $3500 SBC

2024 PPO $5000 SBC

prescription drug coverage

2024 PreventiveRx Plus 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

Dental

Summaries

2024 Delta Dental Basic Plan

2024 Delta Dental Comprehensive Plan

2024 Delta Dental Indemnity Plan

2024 Delta Dental Voluntary Plan

Booklets

Delta Dental Basic Booklet

Delta Dental Enhanced Indemnity Booklet

Delta Dental Comprehensive Booklet

Delta Dental Voluntary Booklet

Vision  

Summary

VSP Basic & Enhanced Comparison

certificates

VSP Evidence of Coverage Certificate

Life Insurance

Life Insurance Summary

Life Insurance Booklet

Voluntary AD&D Certificate

Disability

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