Your Health Plan Documents

Samples of your health plan documents can be found below.  See your human resources team for specifics.

• Summary Benefits and Coverage (SBC)
  The Summary of Benefits and Coverage is a standard document that helps you determine which plan will work for you, before you select a plan.  
• Benefit Description Document (BDD) for Gold and Silver CDHP
  The Benefit Description Document (BDD) is one of the documents that comprise your official plan documents.  In an effort to remain “green” the BDD is available to you when you are logged into the Member Resource Center.  
• Benefit Description Document (BDD) for Platinum and Gold EPO
  The Benefit Description Document (BDD) is one of the documents that comprise your official plan documents.  In an effort to remain “green” the BDD is available to you when you are logged into the Member Resource Center.  
• Benefit Description Document (BDD) Wrap Template
  The BDD Wrap is the second document that makes up your official plan documents.  This is a sample only. Your personalized BDD Wrap is available to you from your human resources team, with specifics for you and your colleagues.  
• Sample Outline of Coverage
  The Outline of Coverage is the final piece of your official plan documents.  An Outline of Coverage is mailed to your home and explains the specifics on your cost-sharing responsibilities.  See your personalized Outline of Coverage for details on your plan. Samples below:
  • • • • Platinum Outline of Coverage
        • Gold Outline of Coverage
        • Gold CDHP Outline of Coverage
        • Silver CDHP Outline of Coverage
• Sample ID Card
  The ID card is the third piece of your plan documents.  An ID card is sent to your home when you change your benefits or plan type.  This is a sample of your ID card.  You should present your ID card to your provider or pharmacy when you seek care.