Important Announcement

Anthem Blue Cross and Blue Shield Parent Company has Acquired Indiana University Health Plans

As announced in September 2024, Indiana University Health Plans has been acquired by Elevance Health, the parent company of Anthem Blue Cross and Blue Shield in Indiana, including IU Health Plans Commercial employer-sponsored and Medicare Advantage businesses. More information is available here.

IU Health Plans Medicare Advantage member’s coverage will not change in 2025 due to the change in ownership. The plan you selected during the Annual Enrollment Period (AEP) will continue in 2025. Any terms or provisions communicated as part of a renewal or new enrollment will remain in effect for the entirety of the year 2025. If you made no change to your plan during AEP or otherwise, you will remain in your 2024 plan with updated 2025 benefits. Visit the Tools & Resources section of our website or log in to your Member Portal for details about your 2025 plan.

With questions or for assistance, please continue to call 800.455.9776 (TTY/TDD 711) from 8 am – 8 pm, Monday – Friday to speak with a Member Advocate. Language assistance is available. You may also send a secure message via Member Portal.

H7220_IUHS04_C

If you are a member of an IU Health Plans employer-sponsored plan, your employer will inform you of any changes to your health insurance benefits. Log in to the Member Portal for details about your 2025 plan. If you have questions, please call 800.895.5828 (TTY/TDD 711) from 7 am – 7 pm, Monday – Friday. Language assistance is available.

Important Announcement

Anthem Blue Cross and Blue Shield Parent Company has Acquired Indiana University Health Plans

As announced in September 2024, Indiana University Health Plans has been acquired by Elevance Health, the parent company of Anthem Blue Cross and Blue Shield in Indiana, including IU Health Plans Commercial employer-sponsored and Medicare Advantage businesses. More information is available here.

IU Health Plans Medicare Advantage member’s coverage will not change in 2025 due to the change in ownership. The plan you selected during the Annual Enrollment Period (AEP) will continue in 2025. Any terms or provisions communicated as part of a renewal or new enrollment will remain in effect for the entirety of the year 2025. If you made no change to your plan during AEP or otherwise, you will remain in your 2024 plan with updated 2025 benefits. Visit the Tools & Resources section of our website or log in to your Member Portal for details about your 2025 plan.

With questions or for assistance, please continue to call 800.455.9776 (TTY/TDD 711) from 8 am – 8 pm, Monday – Friday to speak with a Member Advocate. Language assistance is available. You may also send a secure message via Member Portal.

H7220_IUHS04_C

If you are a member of an IU Health Plans employer-sponsored plan, your employer will inform you of any changes to your health insurance benefits. Log in to the Member Portal for details about your 2025 plan. If you have questions, please call 800.895.5828 (TTY/TDD 711) from 7 am – 7 pm, Monday – Friday. Language assistance is available.

Search

Employer Plans - Large Group

Learn more about our large group options to see what plan best suits your needs:

2025 Employer Plans - Large Group

2025 Non-HSA Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
Non-HSA 10001A Download Download
Non-HSA 10001AS Download Download
Non-HSA 10002A Download Download
Non-HSA 10002AS Download Download
Non-HSA 10003A Download Download
Non-HSA 10003AS Download Download
Non-HSA 10004A Download Download
Non-HSA 10004AS Download Download
Non-HSA 10005A Download Download
Non-HSA 10005AS Download Download
Non-HSA 10006A Download Download
Non-HSA 10006AS Download Download
Non-HSA 10007A Download Download
Non-HSA 10007AS Download Download
Non-HSA 10008A Download Download
Non-HSA 10008AS Download Download
Non-HSA 10009A Download Download
Non-HSA 10009AS Download Download
Non-HSA 10010A Download Download
Non-HSA 10010AS Download Download
Non-HSA 10011A Download Download
Non-HSA 10011AS Download Download
Non-HSA 10012A Download Download
Non-HSA 10012AS Download Download
Non-HSA 10013A Download Download
Non-HSA 10013AS Download Download
Non-HSA 10014A Download Download
Non-HSA 10014AS Download Download
Non-HSA 10015A Download Download
Non-HSA 10015AS Download Download
Non-HSA 12001 Download Download
Non-HSA 12001S Download Download
Non-HSA 12002 Download Download
Non-HSA 12002S Download Download
Non-HSA 12003 Download Download
Non-HSA 12003S Download Download
Non-HSA 12004 Download Download
Non-HSA 12004S Download Download
Non-HSA 12005 Download Download
Non-HSA 12005S Download Download
Non-HSA 12006 Download Download
Non-HSA 12006S Download Download
Non-HSA 12007 Download Download
Non-HSA 12007S Download Download
Non-HSA 12008 Download Download
Non-HSA 12008S Download Download
Non-HSA 12009 Download Download
Non-HSA 12009S Download Download
Non-HSA 12010 Download Download
Non-HSA 12010S Download Download
Non-HSA 12011 Download Download
Non-HSA 12011S Download Download
Non-HSA 12012 Download Download
Non-HSA 12012S Download Download
Non-HSA 12013 Download Download
Non-HSA 12013S Download Download
Non-HSA 12014 Download Download
Non-HSA 12014S Download Download
Non-HSA 12015 Download Download
Non-HSA 12015S Download Download
Non-HSA 13001 Download Download
Non-HSA 13001A Download Download
Non-HSA 13001AS Download Download
Non-HSA 13001S Download Download
Non-HSA 13003 Download Download
Non-HSA 13003A Download Download
Non-HSA 13003AS Download Download
Non-HSA 13003S Download Download
Non-HSA 13005 Download Download
Non-HSA 13005A Download Download
Non-HSA 13005AS Download Download
Non-HSA 13005S Download Download
Non-HSA 13007 Download Download
Non-HSA 13007A Download Download
Non-HSA 13007AS Download Download
Non-HSA 13007S Download Download
Non-HSA 13009 Download Download
Non-HSA 13009A Download Download
Non-HSA 13009AS Download Download
Non-HSA 13009S Download Download
Non-HSA 130011 Download Download
Non-HSA 130011A Download Download
Non-HSA 130011AS Download Download
Non-HSA 130011S Download Download
Non-HSA 130012AS Download Download
2025 Non-HSA
Non-HSA 10001A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10001AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10002A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10002AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10003A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10003AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10004A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10004AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10005A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10005AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10006A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10006AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10007A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10007AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10008A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10008AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10009A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10009AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10010A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10010AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10011A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10011AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10012A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10012AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10013A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10013AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10014A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10014AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10015A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10015AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12001

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12001S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12002

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12002S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12003

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12003S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12004

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12004S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12005

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12005S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12006

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12006S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12007

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12007S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12008

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12008S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12009

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12009S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12010

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12010S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12011

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12011S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12012

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12012S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12013

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12013S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12014

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12014S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12015

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12015S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13001

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13001A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13001AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13001S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13003

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13003A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13003AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13003S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13005

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13005A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13005AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13005S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13007

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13007A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13007AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13007S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13009

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13009A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13009AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13009S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 130011

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 130011A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 130011AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 130011S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 130012AS

Summary of Benefits & Coverage

Schedule of Benefits

2025 HSA Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
HSA 00001A Download Download
HSA 00001AS Download Download
HSA 00002A Download Download
HSA 0000AS Download Download
HSA 00003A Download Download
HSA 00003AS Download Download
HSA 00006A Download Download
HSA 00006AS Download Download
HSA 00007A Download Download
HSA 00007AS Download Download
HSA 00008A Download Download
HSA 00008AS Download Download
HSA 00009A Download Download
HSA 00009AS Download Download
HSA 00010A Download Download
HSA 00010AS Download Download
HSA 00011A Download Download
HSA 00011AS Download Download
HSA 02001 Download Download
HSA 02001S Download Download
HSA 02002 Download Download
HSA 02002S Download Download
HSA 02003 Download Download
HSA 02003S Download Download
HSA 02006 Download Download
HSA 02006S Download Download
HSA 02007 Download Download
HSA 02007S Download Download
HSA 02008 Download Download
HSA 02008S Download Download
HSA 02009 Download Download
HSA 02009S Download Download
HSA 02010 Download Download
HSA 02010S Download Download
HSA 02011 Download Download
HSA 02011S Download Download
HSA 03003 Download Download
HSA 03003A Download Download
HSA 03003AS Download Download
HSA 03003S Download Download
HSA 03005A Download Download
HSA 03005AS Download Download
HSA 03007 Download Download
HSA 03007A Download Download
HSA 03007AS Download Download
HSA 03007S Download Download
HSA 03008 Download Download
HSA 03008S Download Download
2025 HSA
HSA 00001A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00001AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00002A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 0000AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00003A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00003AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00006A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00006AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00007A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00007AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00008A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00008AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00009A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00009AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00010A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00010AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00011A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00011AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02001

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02001S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02002

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02002S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02003

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02003S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02006

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02006S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02007

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02007S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02008

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02008S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02009

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02009S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02010

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02010S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02011

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02011S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03003

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03003A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03003AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03003S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03005A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03005AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03007

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03007A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03007AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03007S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03008

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03008S

Summary of Benefits & Coverage

Schedule of Benefits

2024 Employer Plans - Large Group

2024 Non-HSA Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
Non-HSA 10001A Download Download
Non-HSA 10001AS Download Download
Non-HSA 10002A Download Download
Non-HSA 10002AS Download Download
Non-HSA 10003A Download Download
Non-HSA 10003AS Download Download
Non-HSA 10004A Download Download
Non-HSA 10004AS Download Download
Non-HSA 10005A Download Download
Non-HSA 10005AS Download Download
Non-HSA 10006A Download Download
Non-HSA 10006AS Download Download
Non-HSA 10007A Download Download
Non-HSA 10007AS Download Download
Non-HSA 10008A Download Download
Non-HSA 10008AS Download Download
Non-HSA 10009A Download Download
Non-HSA 10009AS Download Download
Non-HSA 10010A Download Download
Non-HSA 10010AS Download Download
Non-HSA 10011A Download Download
Non-HSA 10011AS Download Download
Non-HSA 10012A Download Download
Non-HSA 10012AS Download Download
Non-HSA 10013A Download Download
Non-HSA 10013AS Download Download
Non-HSA 10014A Download Download
Non-HSA 10014AS Download Download
Non-HSA 10015A Download Download
Non-HSA 10015AS Download Download
Non-HSA 12001 Download Download
Non-HSA 12001S Download Download
Non-HSA 12002 Download Download
Non-HSA 12002S Download Download
Non-HSA 12003 Download Download
Non-HSA 12003S Download Download
Non-HSA 12004 Download Download
Non-HSA 12004S Download Download
Non-HSA 12005 Download Download
Non-HSA 12005S Download Download
Non-HSA 12006 Download Download
Non-HSA 12006S Download Download
Non-HSA 12007 Download Download
Non-HSA 12007S Download Download
Non-HSA 12008 Download Download
Non-HSA 12008S Download Download
Non-HSA 12009 Download Download
Non-HSA 12009S Download Download
Non-HSA 12010 Download Download
Non-HSA 12010S Download Download
Non-HSA 12011 Download Download
Non-HSA 12011S Download Download
Non-HSA 12012 Download Download
Non-HSA 12012S Download Download
Non-HSA 12013 Download Download
Non-HSA 12013S Download Download
Non-HSA 12014 Download Download
Non-HSA 12014S Download Download
Non-HSA 12015 Download Download
Non-HSA 12015S Download Download
Non-HSA 13001 Download Download
Non-HSA 13001A Download Download
Non-HSA 13001AS Download Download
Non-HSA 13001S Download Download
Non-HSA 13003 Download Download
Non-HSA 13003A Download Download
Non-HSA 13003AS Download Download
Non-HSA 13003S Download Download
Non-HSA 13005 Download Download
Non-HSA 13005A Download Download
Non-HSA 13005AS Download Download
Non-HSA 13005S Download Download
Non-HSA 13007 Download Download
Non-HSA 13007A Download Download
Non-HSA 13007AS Download Download
Non-HSA 13007S Download Download
Non-HSA 13009 Download Download
Non-HSA 13009A Download Download
Non-HSA 13009AS Download Download
Non-HSA 13009S Download Download
Non-HSA 130011 Download Download
Non-HSA 130011A Download Download
Non-HSA 130011AS Download Download
Non-HSA 130011S Download Download
2024 Non-HSA
Non-HSA 10001A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10001AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10002A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10002AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10003A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10003AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10004A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10004AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10005A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10005AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10006A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10006AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10007A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10007AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10008A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10008AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10009A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10009AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10010A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10010AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10011A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10011AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10012A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10012AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10013A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10013AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10014A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10014AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10015A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 10015AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12001

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12001S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12002

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12002S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12003

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12003S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12004

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12004S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12005

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12005S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12006

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12006S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12007

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12007S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12008

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12008S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12009

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12009S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12010

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12010S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12011

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12011S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12012

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12012S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12013

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12013S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12014

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12014S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12015

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 12015S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13001

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13001A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13001AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13001S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13003

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13003A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13003AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13003S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13005

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13005A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13005AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13005S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13007

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13007A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13007AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13007S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13009

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13009A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13009AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 13009S

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 130011

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 130011A

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 130011AS

Summary of Benefits & Coverage

Schedule of Benefits

Non-HSA 130011S

Summary of Benefits & Coverage

Schedule of Benefits

2024 HSA Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
HSA 00001A Download Download
HSA 00001AS Download Download
HSA 00002A Download Download
HSA00002AS Download Download
HSA 00003A Download Download
HSA 00003AS Download Download
HSA 00006A Download Download
HSA 00006AS Download Download
HSA 00007A Download Download
HSA 00007AS Download Download
HSA 00008A Download Download
HSA 00008AS Download Download
HSA 00009A Download Download
HSA 00009AS Download Download
HSA 00010A Download Download
HSA 00010AS Download Download
HSA 00011A Download Download
HSA 00011AS Download Download
HSA 02001 Download Download
HSA 02001S Download Download
HSA 02002 Download Download
HSA 02002S Download Download
HSA 02003 Download Download
HSA 02003S Download Download
HSA 02006 Download Download
HSA 02006S Download Download
HSA 02007 Download Download
HSA 02007S Download Download
HSA 02008 Download Download
HSA 02008S Download Download
HSA 02009 Download Download
HSA 02009S Download Download
HSA 02010 Download Download
HSA 02010S Download Download
HSA 02011 Download Download
HSA 02011S Download Download
HSA 03003 Download Download
HSA 03003A Download Download
HSA 03003AS Download Download
HSA 03003S Download Download
HSA 03005A Download Download
HSA 03005AS Download Download
HSA 03007 Download Download
HSA 03007A Download Download
HSA 03007AS Download Download
HSA 03007S Download Download
HSA 03008 Download Download
HSA 03008S Download Download
2024 HSA
HSA 00001A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00001AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00002A

Summary of Benefits & Coverage

Schedule of Benefits

HSA00002AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00003A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00003AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00006A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00006AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00007A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00007AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00008A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00008AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00009A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00009AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00010A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00010AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00011A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 00011AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02001

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02001S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02002

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02002S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02003

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02003S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02006

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02006S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02007

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02007S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02008

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02008S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02009

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02009S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02010

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02010S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02011

Summary of Benefits & Coverage

Schedule of Benefits

HSA 02011S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03003

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03003A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03003AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03003S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03005A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03005AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03007

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03007A

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03007AS

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03007S

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03008

Summary of Benefits & Coverage

Schedule of Benefits

HSA 03008S

Summary of Benefits & Coverage

Schedule of Benefits

Drug Formulary - Large Group

Formulary Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
2024 Large Group Formulary Guide Download N/A
2024 Drugs Requiring Prior Authorization and Step Therapy Download N/A
2025 Large Group Formulary Guide Download N/A
2025 Drugs Requiring Prior Authorization and Step Therapy Download N/A
Formulary Summary of Benefits & Coverage (SBC) Schedule of Benefits (SOB)
2024 Large Group Formulary Guide

Summary of Benefits & Coverage HEY

N/A

2024 Drugs Requiring Prior Authorization and Step Therapy

Summary of Benefits & Coverage HEY

N/A

2025 Large Group Formulary Guide

Summary of Benefits & Coverage HEY

N/A

2025 Drugs Requiring Prior Authorization and Step Therapy

Summary of Benefits & Coverage HEY

N/A