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Health Plan Documents
Summary of Benefits and Coverage and policy
Your health plan documents (sometimes called your “coverage documents”)
begin on the following page. Your coverage documents include:
Summary of Benefits and Coverage (SBC): An overview of health care services covered
under your plan and what your out-of-pocket costs will be.
Policy: Your policy is the full contract that covers the specifics of your health plan.
If you need help reading this document
This information is available free in other languages and formats such as Braille or large print.
We also have free language interpreter services available for non-English speakers. If you need
these services, please call us toll-free 8 a.m. to 8 p.m. Eastern time, Monday through Friday, at
the member phone number on your ID card. TTY users can dial 711.
Dine k’ehji shich’i’ hadoodzih ninizingo, bee neehozin biniiye nanitinigii number bikaa’igii
bich’i’ hodiilnih
Para obtener asistencia en español, llame al número de teléfono en su tarjeta de identificación.
Para sa tulong sa Tagalog, tawagan ang numero sa iyong ID card.
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