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Plan Documents for Members

For specific information on your benefits, services, cost-shares, and health plan operations please review your Plan Documents shown below.  You can also download a PDF to save on your computer or print out a copy for your records.

The Summary of Benefits is an easy-to-understand short listing of benefits, services, and costs for the benefit plan selected.

The Annual Notice of Change tells you how your benefits and costs will change for the new year to be effective in January.

The Evidence of Coverage gives you details about what the plan covers, how much you pay, how to use the health plan services, and much more.

Simply click on the “Year” underneath of Document you which to view and/or download and print.

Summary of Benefits            Annual Notice of Change                Evidence of Coverage

              2021                                          2021                                                       2021