2021 Small Group Plan Documents

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HMO Core

Core plans feature lower monthly premiums with higher out-of-pocket costs for covered services. These plans generally include higher copayments and annual deductibles, and sometimes feature coinsurance that applies to covered services.

Plan Name Benefit Summary SBC EOC Rx Rider
HMO Core 2000 SG PDF PDF N/A PDF
HMO Core 2000 Copay SG PDF PDF N/A PDF
HMO Core 2000 20% SG PDF PDF N/A PDF
HMO Core 2500 SG PDF PDF N/A PDF
HMO Core 3000 SG PDF PDF N/A PDF
HMO Core 3000 20% SG PDF PDF N/A PDF
HMO Silver A SG PDF PDF N/A PDF

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage

HMO Essential

Essential plans feature intermediate pricing for both monthly premiums and out-of-pocket costs.

Plan Name Benefit Summary SBC EOC Rx Rider
HMO Essential 500 SG PDF PDF N/A PDF
HMO Essential 1000 SG PDF PDF N/A PDF
HMO Essential 1500 SG PDF PDF N/A PDF
HMO Essential 2000 SG PDF PDF N/A PDF
HMO Essential 3000 SG PDF PDF N/A PDF
HMO Essential 4000 SG PDF PDF N/A PDF
HMO Gold SG PDF PDF N/A PDF
HMO Gold 2000 SG PDF PDF N/A PDF

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage

HMO Premium

Premium plans have higher monthly premiums, but lower out-of-pocket costs for covered services. These plans feature low copayments, and typically do not include deductibles.

Plan Name Benefit Summary SBC EOC Rx Rider
HMO Choice Plus SG PDF PDF N/A PDF
HMO Platinum A SG PDF PDF N/A PDF

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage

HMO Thrive

Thrive Plans feature modest premiums with low out-of-pocket expenses for routine and maintenance care paired with significant cost-share for non-routine services. This product line features a zero deductible option.

Plan Name Benefit Summary SBC EOC Rx Rider
HMO Thrive Bronze SG PDF PDF N/A PDF
HMO Thrive Gold 2000 SG PDF PDF N/A PDF
HMO Thrive Platinum Copay SG PDF PDF N/A PDF
HMO Thrive Silver 3000 SG PDF PDF N/A PDF

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage

HMO Wise

Wise plans feature lower monthly premiums with higher out-of-pocket costs for covered services. They require full payment of their deductible before most services are covered. They are typically paired with Health Savings Account that can be used by the member to pay for health related expenses and deductibles.

Plan Name Benefit Summary SBC EOC Rx Rider
HMO Bronze 2 HDHP SG PDF PDF N/A PDF
HMO Silver 2000 HDHP SG PDF PDF N/A PDF
HMO Wise 2000 20% HDHP SG PDF PDF N/A PDF
HMO Wise 3000 10% HDHP SG PDF PDF N/A PDF
HMO Wise Max 2000 HDHP SG PDF PDF N/A PDF
HMO Wise Max 3000 HDHP SG PDF PDF N/A PDF
HMO Wise Saver 3450 HDHP SG PDF PDF N/A PDF

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage

PPO Core

Core plans feature lower monthly premiums with higher out-of-pocket costs for covered services. These plans generally include higher copayments and annual deductibles, and sometimes feature coinsurance that applies to covered services.

Plan Name Benefit Summary SBC EOC Rx Rider
PPO Core 2000 National SG PDF PDF N/A PDF
PPO Core 2000 Copay National SG PDF PDF N/A PDF

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage

PPO Essential

Essential plans feature intermediate pricing for both monthly premiums and out-of- pocket costs.

Plan Name Benefit Summary SBC EOC Rx Rider
PPO Essential 500 National SG PDF PDF N/A PDF
PPO Essential 1000 National SG PDF PDF N/A PDF
PPO Essential 2000 National SG PDF PDF N/A PDF
PPO Essential 2000 Local SG PDF PDF N/A PDF
PPO Essential 3000 National SG PDF PDF N/A PDF

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage

PPO Thrive

Thrive Plans feature modest premiums with low out-of-pocket expenses for routine and maintenance care paired with significant cost-share for non-routine services. This product line features a zero deductible option.

Plan Name Benefit Summary SBC EOC Rx Rider
PPO Thrive Bronze National SG PDF PDF N/A PDF
PPO Thrive Silver 3000 National SG PDF PDF N/A PDF

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage

PPO Wise

Wise plans feature lower monthly premiums with higher out-of-pocket costs for covered services. These plans generally include higher copayments and annual deductibles that apply to covered services.

Plan Name Benefit Summary SBC EOC Rx Rider
PPO Wise 2000/20% National HDHP SG PDF PDF N/A PDF
PPO Wise Max 2000 National HDHP SG PDF PDF N/A PDF
PPO Wise 3000/10% National HDHP SG PDF PDF N/A PDF
PPO Wise Max 3000 National HDHP SG PDF PDF N/A PDF
PPO Wise Saver 3450 National HDHP SG PDF PDF N/A PDF

SBC = Summary of Benefits and Coverage
EOC = Explanation of Coverage