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Summary of Benefits and Coverage

2019 summaries of benefits and coverage will be added soon. Please check back.

As part of the Affordable Care Act, all health plans must provide a summary of benefits and coverage (SBC). These summaries help you understand how a plan works and compare plans more easily.

Coverage glossary and medical terms

Sign in current member Plan by county

Alaska individual and family plans

If you're shopping for a plan, you can compare plans using these summary of benefits and coverage booklets. If you're a Premera member, you can sign in and view your plan details.
2019 Individual plans
In Exchange

For plans purchased on HealthCare.gov

Summary of benefits and coverage

PCP plans

Preferred Gold 1500

Preferred Gold 1500 AI/AN

Preferred Gold 1500 AI/AN 300%

Preferred Silver 4500

Preferred Silver 4500 AI/AN

Preferred Silver 4500 AI/AN 300%

Preferred Silver 4500 CSR1

Preferred Silver 4500 CSR2

Preferred Silver 4500 CSR3

Preferred Bronze 6350

Preferred Bronze 6350 AI/AN

Preferred Bronze 6350 AI/AN 300%

HSA plans

Preferred Bronze 5250 HSA

Preferred Bronze 5250 HSA AI/AN

Preferred Bronze 5250 HSA AI/AN 300%

Preferred Silver 3000 HSA

Preferred Silver 3000 HSA AI/AN

Preferred Silver 3000 HSA AI/AN 300%

Preferred Silver 3000 HSA CSR1

Preferred Silver 3000 NQHSA CSR2

Preferred Silver 3000 NQHSA CSR3

In Exchange

For plans purchased on HealthCare.gov

Benefit booklets

PCP plans

Preferred Gold 1500

Preferred Gold 1500 AI/AN

Preferred Gold 1500 AI/AN 300%

Preferred Silver 4500

Preferred Silver 4500 AI/AN

Preferred Silver 4500 AI/AN 300%

Preferred Silver 4500 CSR1

Preferred Silver 4500 CSR2

Preferred Silver 4500 CSR3

Preferred Bronze 6350

Preferred Bronze 6350 AI/AN

Preferred Bronze 6350 AI/AN 300%

HSA plans

Preferred Bronze 5250 HSA

Preferred Bronze 5250 HSA AI/AN

Preferred Bronze 5250 HSA AI/AN 300%

Preferred Silver 3000 HSA

Preferred Silver 3000 HSA AI/AN

Preferred Silver 3000 HSA AI/AN 300%

Preferred Silver 3000 HSA CSR1

Preferred Silver 3000 NQHSA CSR2

Preferred Silver 3000 NQHSA CSR3

Off Exchange

For plans NOT purchased on HealthCare.gov

PPO plans

Preferred Gold 1500

Preferred Silver 3500

Preferred Bronze 6350

HSA plan

Preferred Bronze 5250 HSA

Off Exchange

For plans NOT purchased on HealthCare.gov

PPO plans

Preferred Gold 1500

Preferred Silver 3500

Preferred Bronze 6350

HSA plan

Preferred Bronze 5250 HSA

Plans no longer for sale

In-Exchange PCP Plus plans—Discontinued 12/31/18

Blue Cross Blue Shield Plus 1500

Blue Cross Blue Shield Plus 1500 AI/AN

Blue Cross Blue Shield Plus 1500 AI/AN 300%

Blue Cross Blue Shield Plus 4500

Blue Cross Blue Shield Plus 4500 AI/AN

Blue Cross Blue Shield Plus 4500 AI/AN 300%

Blue Cross Blue Shield Plus 4500 CSR1

Blue Cross Blue Shield Plus 4500 CSR2

Blue Cross Blue Shield Plus 4500 CSR3

Blue Cross Blue Shield Plus 6350

Blue Cross Blue Shield Plus 6350 AI/AN

Blue Cross Blue Shield Plus 6350 AI/AN 300%

In-Exchange HSA Plus plans—Discontinued 12/31/18

Blue Cross Blue Shield Plus 5250

Blue Cross Blue Shield Plus 5250 AI/AN

Blue Cross Blue Shield Plus 5250 AI/AN 300%

Blue Cross Blue Shield Plus 3000 HSA

Blue Cross Blue Shield Plus 3000 HSA AI/AN

Blue Cross Blue Shield Plus 3000 HSA AI/AN 300%

Blue Cross Blue Shield Plus 3000 HSA CSR1

Blue Cross Blue Shield Plus 3000 HSA CSR2

Blue Cross Blue Shield Plus 3000 HSA CSR3

Off Exchange PPO Preferred plans—Discontinued 12/31/18

Blue Cross Blue Shield Plus 1500

Blue Cross Blue Shield Plus 4500

Blue Cross Blue Shield Plus 6350

Blue Cross Blue Shield Plus 3000 HSA

Blue Cross Blue Shield Plus 5250 HSA

Grandfathered plans—Closed 05/2010

HSA RX Plan GF $5,000 Deductible

HSA RX 20 Plan GF $1,350 Deductible

HSA 20 Plan GF $2,500 Deductible

HSA 20 Plan GF $1,700 Deductible

Value Care 25 Plan GF $5,000 Deductible

Value Care 25 Plan GF $2,500 Deductible

Value Care 25 Plan GF $1,500 Deductible

Global Start 50 Plan GF $1,000 Deductible

Global Start 50 Plan GF $500 Deductible

Global 20 Plan GF $5,000 Deductible

Global 20 Plan GF $2,500 Deductible

Global 20 Plan GF $1,000 Deductible

Global 20 Plan GF $500 Deductible

Best Care 20 Plan GF $7,500 Deductible

Best Care 20 Plan GF $5,000 Deductible

Best Care 20 Plan GF $2,500 Deductible

Best Care 20 Plan GF $1,000 Deductible

Best Care 20 Plan GF $500 Deductible

Non-Grandfathered "1 month" plans—Closed 05/2010

HSA RX Plan $5,000 Deductible

HSA 20 Plan $2,500 Deductible

Value Care 25 Plan $5,000 Deductible

Value Care 25 Plan $2,500 Deductible

Best Care 20 Plan $7,500 Deductible

Best Care 20 Plan $5,000 Deductible

Best Care 20 Plan $2,500 Deductible

Non-Grandfathered plans "Newest"—Closed 12/2013

Access NGF $10,000 Deductible

Secure HSA NGF $5,500 Deductible

Active HSA NGF $2,500 Deductible

Safeguard NGF $7,500 Deductible

Safeguard NGF $5,000 Deductible

Safeguard NGF $2,500 Deductible

Peak Plan NGF $7,500 Deductible

Peak Plan NGF $5,000 Deductible

Peak Plan NGF $2,500 Deductible

Peak Plan NGF $1,000 Deductible

Safeguard III NGF $3,000 Deductible

Safeguard III NGF $6,000 Deductible

Peak III NGF $3,000 Deductible

Peak III NGF $6,000 Deductible

Active HSA III NGF $3,250 Deductible

Non-Grandfathered "Alaska" plans—Closed 05/2011

Access NGF $10,000 Deductible

Secure HSA NGF $5,500 Deductible

Active HSA NGF $2,500 Deductible

Safeguard NGF $7,500 Deductible

Safeguard NGF $5,000 Deductible

Safeguard NGF $2,500 Deductible

Peak Plan NGF $7,500 Deductible

Peak Plan NGF $5,000 Deductible

Peak Plan NGF $2,500 Deductible

Peak Plan NGF $1,000 Deductible

Supplemental guide

Grandfathered and non-grandfathered individual healthcare coverage plan

Plans no longer for sale

In-Exchange PCP Plus plans—Discontinued 12/31/18

Blue Cross Blue Shield Plus 1500

Blue Cross Blue Shield Plus 1500 AI/AN

Blue Cross Blue Shield Plus 1500 AI/AN 300%

Blue Cross Blue Shield Plus 4500

Blue Cross Blue Shield Plus 4500 AI/AN

Blue Cross Blue Shield Plus 4500 AI/AN 300%

Blue Cross Blue Shield Plus 4500 CSR1

Blue Cross Blue Shield Plus 4500 CSR2

Blue Cross Blue Shield Plus 4500 CSR3

Blue Cross Blue Shield Plus 6350

Blue Cross Blue Shield Plus 6350 AI/AN

Blue Cross Blue Shield Plus 6350 AI/AN 300%

In-Exchange HSA Plus plans—Discontinued 12/31/18

Blue Cross Blue Shield Plus 5250

Blue Cross Blue Shield Plus 5250 AI/AN

Blue Cross Blue Shield Plus 5250 AI/AN 300%

Blue Cross Blue Shield Plus 3000 HSA

Blue Cross Blue Shield Plus 3000 HSA AI/AN

Blue Cross Blue Shield Plus 3000 HSA AI/AN 300%

Blue Cross Blue Shield Plus 3000 HSA CSR1

Blue Cross Blue Shield Plus 3000 HSA CSR2

Blue Cross Blue Shield Plus 3000 HSA CSR3

Off Exchange PPO Preferred plans—Discontinued 12/31/18

Blue Cross Blue Shield Plus 1500

Blue Cross Blue Shield Plus 4500

Blue Cross Blue Shield Plus 6350

Blue Cross Blue Shield Plus 3000 HSA

Blue Cross Blue Shield Plus 5250 HSA

Grandfathered plans—Closed 05/2010

HSA RX Plan GF $5,000 Deductible

HSA RX 20 Plan GF $1,350 Deductible

HSA 20 Plan GF $2,500 Deductible

HSA 20 Plan GF $1,700 Deductible

Value Care 25 Plan GF $5,000 Deductible

Value Care 25 Plan GF $2,500 Deductible

Value Care 25 Plan GF $1,500 Deductible

Global Start 50 Plan GF $1,000 Deductible

Global Start 50 Plan GF $500 Deductible

Global 20 Plan GF $5,000 Deductible

Global 20 Plan GF $2,500 Deductible

Global 20 Plan GF $1,000 Deductible

Global 20 Plan GF $500 Deductible

Best Care 20 Plan GF $7,500 Deductible

Best Care 20 Plan GF $5,000 Deductible

Best Care 20 Plan GF $2,500 Deductible

Best Care 20 Plan GF $1,000 Deductible

Best Care 20 Plan GF $500 Deductible

Non-Grandfathered "1 month" plans—Closed 05/2010

HSA RX Plan $5,000 Deductible

HSA 20 Plan $2,500 Deductible

Value Care 25 Plan $5,000 Deductible

Value Care 25 Plan $2,500 Deductible

Best Care 20 Plan $7,500 Deductible

Best Care 20 Plan $5,000 Deductible

Best Care 20 Plan $2,500 Deductible

Non-Grandfathered plans—Closed 12/2013

Access NGF $10,000 Deductible

Secure HSA NGF $5,500 Deductible

Active HSA NGF $2,500 Deductible

Safeguard NGF $7,500 Deductible

Safeguard NGF $5,000 Deductible

Safeguard NGF $2,500 Deductible

Peak Plan NGF $7,500 Deductible

Peak Plan NGF $5,000 Deductible

Peak Plan NGF $2,500 Deductible

Peak Plan NGF $1,000 Deductible

Safeguard III NGF $3,000 Deductible

Safeguard III NGF $6,000 Deductible

Peak III NGF $3,000 Deductible

Peak III NGF $6,000 Deductible

Active HSA III NGF $3,250 Deductible

Non-Grandfathered plans—Closed 05/2011

Access NGF $10,000 Deductible

Secure HSA NGF $5,500 Deductible

Active HSA NGF $2,500 Deductible

Safeguard NGF $7,500 Deductible

Safeguard NGF $5,000 Deductible

Safeguard NGF $2,500 Deductible

Peak Plan NGF $7,500 Deductible

Peak Plan NGF $5,000 Deductible

Peak Plan NGF $2,500 Deductible

Peak Plan NGF $1,000 Deductible

2018 Individual plans
In Exchange

For plans purchased on HealthCare.gov

Summary of benefits and coverage

PPO Plus plans

Plus 1500

Plus 1500 AI/AN

Plus 1500 AI/AN 300%

Plus 4500

Plus 4500 AI/AN

Plus 4500 AI/AN 300%

Plus 4500 CSR1

Plus 4500 CSR2

Plus 4500 CSR3

Plus 6350

Plus 6350 AI/AN

Plus 6350 AI/AN 300%

HSA Plus plans

Plus 5250 HSA

Plus 5250 HSA AI/AN

Plus 5250 HSA AI/AN 300%

Plus 3000 HSA

Plus 3000 HSA AI/AN

Plus 3000 HSA AI/AN 300%

Plus 3000 HSA CSR1

Plus 3000 NQHSA CSR2

Plus 3000 NQHSA CSR3

In Exchange

For plans purchased on HealthCare.gov

Benefit booklets

PPO Plus plans

Plus 1500

Plus 1500 AI/AN

Plus 1500 AI/AN 300%

Plus 4500

Plus 4500 AI/AN

Plus 4500 AI/AN 300%

Plus 4500 CSR1

Plus 4500 CSR2

Plus 4500 CSR3

Plus 6350

Plus 6350 AI/AN

Plus 6350 AI/AN 300%

HSA Plus plans

Plus 5250 HSA

Plus 5250 HSA AI/AN

Plus 5250 HSA AI/AN 300%

Plus 3000 HSA

Plus 3000 HSA AI/AN

Plus 3000 HSA AI/AN 300%

Plus 3000 HSA CSR1

Plus 3000 NQHSA CSR2

Plus 3000 NQHSA CSR3

Off Exchange

For plans NOT purchased on HealthCare.gov

PPO Preferred plans

Plus 1500

Plus 4500

Plus 6350

HSA Preferred plans

Plus 3000 HSA

Plus 5250 HSA

Off Exchange

For plans NOT purchased on HealthCare.gov

PPO Preferred plans

Plus 1500

Plus 4500

Plus 6350

HSA Preferred plans

Plus 3000 HSA

Plus 5250 HSA

No longer for sale

Grandfathered plans closed 05/2010

HSA RX Plan $5,000 Deductible

HSA RX 20 Plan $1,350 Deductible

HSA 20 Plan $2,500 Deductible

HSA 20 Plan $1,700 Deductible

Value Care 25 Plan $5,000 Deductible

Value Care 25 Plan $2,500 Deductible

Value Care 25 Plan $1,500 Deductible

Global Start 50 Plan $1000 Deductible

Global Start 50 Plan $500 Deductible

Global 20 Plan $5,000 Deductible

Global 20 Plan $2,500 Deductible

Global 20 Plan $1,000 Deductible

Global 20 Plan $500 Deductible

Best Care 20 Plan $7,500 Deductible

Best Care 20 Plan $5,000 Deductible

Best Care 20 Plan $2,500 Deductible

Best Care 20 Plan $1,000 Deductible

Best Care 20 Plan $500 Deductible

Non-Grandfathered "1 month" plans closed 05/2010

HSA RX Plan $5,000 Deductible

HSA 20 Plan $2,500 Deductible

Value Care 25 Plan $5,000 Deductible

Value Care 25 Plan $2,500 Deductible

Best Care 20 Plan $7,500 Deductible

Best Care 20 Plan $5,000 Deductible

Best Care 20 Plan $2,500 Deductible

Non-Grandfathered plans closed 05/2011

Access NGF $10,000 Deductible

Secure HSA NGF $5,500 Deductible

Active HSA NGF $2,500 Deductible

Safeguard NGF $7,500 Deductible

Safeguard NGF $5,000 Deductible

Safeguard NGF $2,500 Deductible

Peak Plan NGF $7,500 Deductible

Peak Plan NGF $5,000 Deductible

Peak Plan NGF $2,500 Deductible

Peak Plan NGF $1,000 Deductible

Non-Grandfathered plans closed 12/2013

Access NGF $10,000 Deductible

Secure HSA NGF $5,500 Deductible

Active HSA NGF $2,500 Deductible

Safeguard NGF $7,500 Deductible

Safeguard NGF $5,000 Deductible

Safeguard NGF $2,500 Deductible

Peak Plan NGF $7,500 Deductible

Peak Plan NGF $5,000 Deductible

Peak Plan NGF $2,500 Deductible

Peak Plan NGF $1,000 Deductible

Safeguard III NGF $3,000 Deductible

Safeguard III NGF $6,000 Deductible

Peak III NGF $3,000 Deductible

Peak III NGF $6,000 Deductible

Active HSA III NGF $3,250 Deductible

Supplemental guide

Grandfathered and non-grandfathered individual healthcare coverage plan

No longer for sale

Grandfathered plans closed 05/2010

HSA RX Plan $5,000 Deductible

HSA RX 20 Plan $1,350 Deductible

HSA 20 Plan $2,500 Deductible

HSA 20 Plan $1,700 Deductible

Value Care 25 Plan $5,000 Deductible

Value Care 25 Plan $2,500 Deductible

Value Care 25 Plan $1,500 Deductible

Global Start 50 Plan $1,000 Deductible

Global Start 50 Plan $500 Deductible

Global 20 Plan $5,000 Deductible

Global 20 Plan $2,500 Deductible

Global 20 Plan $1,000 Deductible

Global 20 Plan $500 Deductible

Best Care 20 Plan $7,500 Deductible

Best Care 20 Plan $5,000 Deductible

Best Care 20 Plan $2,500 Deductible

Best Care 20 Plan $1,000 Deductible

Best Care 20 Plan $500 Deductible

Non-Grandfathered "1 month" plans closed 05/2010

HSA RX Plan $5,000 Deductible

HSA 20 Plan $2,500 Deductible

Value Care 25 Plan $5,000 Deductible

Value Care 25 Plan $2,500 Deductible

Best Care 20 Plan $7,500 Deductible

Best Care 20 Plan $5,000 Deductible

Best Care 20 Plan $2,500 Deductible

Non-Grandfathered plans closed 05/2011

Access NGF $10,000 Deductible

Secure HSA NGF $5,500 Deductible

Active HSA NGF $2,500 Deductible

Safeguard NGF $7,500 Deductible

Safeguard NGF $5,000 Deductible

Safeguard NGF $2,500 Deductible

Peak Plan NGF $7,500 Deductible

Peak Plan NGF $5,000 Deductible

Peak Plan NGF $2,500 Deductible

Peak Plan NGF $1,000 Deductible

Non-Grandfathered plans closed 12/2013

Access NGF $10,000 Deductible

Secure HSA NGF $5,500 Deductible

Active HSA NGF $2,500 Deductible

Safeguard NGF $7,500 Deductible

Safeguard NGF $5,000 Deductible

Safeguard NGF $2,500 Deductible

Peak Plan NGF $7,500 Deductible

Peak Plan NGF $5,000 Deductible

Peak Plan NGF $2,500 Deductible

Peak Plan NGF $1,000 Deductible

Safeguard III NGF $3,000 Deductible

Safeguard III NGF $6,000 Deductible

Peak III NGF $3,000 Deductible

Peak III NGF $6,000 Deductible

Active HSA III NGF $3,250 Deductible

2017 Individual plans
In Exchange

For plans purchased on HealthCare.gov

Summary of benefits and coverage

PPO Plus plans

Plus 1500

Plus 1500 AI/AN

Plus 1500 AI/AN 300%

Plus 3000

Plus 3000 AI/AN

Plus 3000 AI/AN 300%

Plus 3000 CSR1

Plus 3000 CSR2

Plus 3000 CSR3

Plus 6350

Plus 6350 AI/AN

Plus 6350 AI/AN 300%

HSA Plus plans

Plus 5250 HSA

Plus 5250 HSA AI/AN

Plus 5250 HSA AI/AN 300%

Plus 3000 HSA

Plus 3000 HSA AI/AN

Plus 3000 HSA AI/AN 300%

Plus 3000 HSA CSR1

Plus 3000 NQHSA CSR2

Plus 3000 NQHSA CSR3

Off Exchange

For plans NOT purchased on HealthCare.gov

PPO Preferred plans

Plus 1500

Plus 3000

Plus 6350

HSA Preferred plans

Plus 3000 HSA

Plus 5250 HSA

In Exchange

For plans purchased on HealthCare.gov

Benefit booklets

PPO Plus plans

Plus 1500

Plus 1500 AI/AN

Plus 1500 AI/AN 300%

Plus 3000

Plus 3000 AI/AN

Plus 3000 AI/AN 300%

Plus 3000 CSR1

Plus 3000 CSR2

Plus 3000 CSR3

Plus 6350

Plus 6350 AI/AN

Plus 6350 AI/AN 300%

HSA Plus plans

Plus 5250 HSA

Plus 5250 HSA AI/AN

Plus 5250 HSA AI/AN 300%

Plus 3000 HSA

Plus 3000 HSA AI/AN

Plus 3000 HSA AI/AN 300%

Plus 3000 HSA CSR1

Plus 3000 NQHSA CSR2

Plus 3000 NQHSA CSR3

Off Exchange

For plans NOT purchased on HealthCare.gov

PPO Preferred plans

Plus 1500

Plus 3000

Plus 6350

HSA Preferred plans

Plus 3000 HSA

Plus 5250 HSA

No longer for sale

Grandfathered plans closed 05/2010

HSA RX Plan $5,000 Deductible Option

HSA RX 20 Plan $1,300 Deductible Option

HSA 20 Plan $2,500 Deductible Option

HSA 20 Plan $1,700 Deductible Option

Value Care 25 Plan $5,000 Deductible Option

Value Care 25 Plan $2,500 Deductible Option

Value Care 25 Plan $1,500 Deductible Option

Global Start 50 Plan $1000 Deductible Option

Global Start 50 Plan $500 Deductible Option

Global 20 Plan $5,000 Deductible Option

Global 20 Plan $2,500 Deductible Option

Global 20 Plan $1,000 Deductible Option

Global 20 Plan $500 Deductible Option

Best Care 20 Plan $7,500 Deductible Option

Best Care 20 Plan $5,000 Deductible Option

Best Care 20 Plan $2,500 Deductible Option

Best Care 20 Plan $1,000 Deductible Option

Best Care 20 Plan $500 Deductible Option

Non-Grandfathered plans closed 05/2010

HSA RX Plan $5,000 Deductible Option

HSA RX 20 Plan $1,300 Deductible Option

HSA 20 Plan $2,500 Deductible Option

HSA 20 Plan $1,700 Deductible Option

Value Care 25 Plan $5,000 Deductible Option

Value Care 25 Plan $2,500 Deductible Option

Value Care 25 Plan $1,500 Deductible Option

Best Care 20 Plan $7,500 Deductible Option

Best Care 20 Plan $5,000 Deductible Option

Best Care 20 Plan $2,500 Deductible Option

Best Care 20 Plan $1,000 Deductible Option

Non-Grandfathered plans closed 05/2011

Access NGF $10,000 Deductible

Secure HSA NGF $5,500 Deductible

Active HSA NGF $2,500 Deductible

Safeguard NGF $7,500 Deductible

Safeguard NGF $5,000 Deductible

Safeguard NGF $2,500 Deductible

Peak Plan NGF $7,500 Deductible

Peak Plan NGF $5,000 Deductible

Peak Plan NGF $2,500 Deductible

Peak Plan NGF $1,000 Deductible

Non-Grandfathered plans closed 12/2013

Access NGF $10,000 Deductible

Secure HSA NGF $5,500 Deductible

Active HSA NGF $2,500 Deductible

Safeguard NGF $7,500 Deductible

Safeguard NGF $5,000 Deductible

Safeguard NGF $2,500 Deductible

Peak Plan NGF $7,500 Deductible

Peak Plan NGF $5,000 Deductible

Peak Plan NGF $2,500 Deductible

Peak Plan NGF $1,000 Deductible

Safeguard III NGF $3,000 Deductible

Safeguard III NGF $6,000 Deductible

Peak III NGF $3,000 Deductible

Peak III NGF $6,000 Deductible

Active HSA III NGF $3,250 Deductible

Supplemental guide

Grandfathered and non-grandfathered individual healthcare coverage plan

No longer for sale

Grandfathered plans closed 05/2010

HSA RX Plan $5,000 Deductible Option

HSA RX 20 Plan $1,300 Deductible Option

HSA 20 Plan $2,500 Deductible Option

HSA 20 Plan $1,700 Deductible Option

Value Care 25 Plan $5,000 Deductible Option

Value Care 25 Plan $2,500 Deductible Option

Value Care 25 Plan $1,500 Deductible Option

Global Start 50 Plan $1000 Deductible Option

Global Start 50 Plan $500 Deductible Option

Global 20 Plan $5,000 Deductible Option

Global 20 Plan $2,500 Deductible Option

Global 20 Plan $1,000 Deductible Option

Global 20 Plan $500 Deductible Option

Best Care 20 Plan $7,500 Deductible Option

Best Care 20 Plan $5,000 Deductible Option

Best Care 20 Plan $2,500 Deductible Option

Best Care 20 Plan $1,000 Deductible Option

Best Care 20 Plan $500 Deductible Option

Non-Grandfathered plans closed 05/2010

HSA RX Plan $5,000 Deductible Option

HSA 20 Plan $2,500 Deductible Option

Value Care 25 Plan $5,000 Deductible Option

Value Care 25 Plan $2,500 Deductible Option

Value Care 25 Plan $1,500 Deductible Option

Best Care 20 Plan $7,500 Deductible Option

Best Care 20 Plan $5,000 Deductible Option

Best Care 20 Plan $2,500 Deductible Option

Best Care 20 Plan $1,000 Deductible Option

Non-Grandfathered plans closed 05/2011

Access NGF $10,000 Deductible

Secure HSA NGF $5,500 Deductible

Active HSA NGF $2,500 Deductible

Safeguard NGF $7,500 Deductible

Safeguard NGF $5,000 Deductible

Safeguard NGF $2,500 Deductible

Peak Plan NGF $7,500 Deductible

Peak Plan NGF $5,000 Deductible

Peak Plan NGF $2,500 Deductible

Peak Plan NGF $1,000 Deductible

Non-Grandfathered plans closed 12/2013

Access NGF $10,000 Deductible

Secure HSA NGF $5,500 Deductible

Active HSA NGF $2,500 Deductible

Safeguard NGF $7,500 Deductible

Safeguard NGF $5,000 Deductible

Safeguard NGF $2,500 Deductible

Peak Plan NGF $7,500 Deductible

Peak Plan NGF $5,000 Deductible

Peak Plan NGF $2,500 Deductible

Peak Plan NGF $1,000 Deductible

Safeguard III NGF $3,000 Deductible

Safeguard III NGF $6,000 Deductible

Peak III NGF $3,000 Deductible

Peak III NGF $6,000 Deductible

Active HSA III NGF $3,250 Deductible
For small group plans

To find your plan-specific summary of benefits and coverage and benefit booklet you can search a list of group plans. You can also sign onto your personal secure Premera account to view your plan-specific benefit booklet.
2019 Small group plans

Off Exchange

For plans NOT purchased on HealthCare.gov

Summary of benefits and coverage

PPO Preferred plans

Select Gold 1500

Select Silver 3000

Select HSA Qualified Bronze 5250

Plus Gold 500

Plus Gold 1000

Plus Silver 2000

Plus Bronze 5500

Plus Bronze 6360

Plus Silver 3000

Plus Gold 1500

Plus Silver 2500

Plus Silver 4000

HSA Plus plans

Plus HSA Qualified Gold 1500

Plus HSA Qualified Silver 2700

Plus HSA Qualified Silver 3500

Plus HSA Qualified Bronze 5250

Plus Bronze 7900

Plus HSA Bronze 6000

Off Exchange

For plans NOT purchased on HealthCare.gov

Benefit booklets

Select Gold 1500

Select Silver 3000

Select HSA Qualified Bronze 5250

Plus Gold 500

Plus Gold 1000

Plus Silver 2000

Plus Bronze 5500

Plus Bronze 6360

Plus Silver 3000

Plus Gold 1500

Plus Silver 2500

Plus Silver 4000

HSA Plus plans

Plus HSA Qualified Gold 1500

Plus HSA Qualified Silver 2700

Plus HSA Qualified Silver 3500

Plus HSA Qualified Bronze 5250

Plus Bronze 7900

Plus HSA Bronze 6000

Adult Vision Mandated Offering Option

Adult Vision Core Option

2018 Small group plans
Off Exchange

For plans NOT purchased on HealthCare.gov

Summary of benefits and coverage

PPO Preferred plans

Select Gold 1500

Select Silver 3000

Plus Gold 500

Plus Gold 1000

Plus Gold 1500

Plus Silver 2000

Plus Silver 2500

Plus Silver 3000

Plus Silver 4000

Plus Bronze 5500

Plus Bronze 6350

HSA Plus plans

Plus HSA Qualified Gold 1500

Plus HSA Qualified Silver 2700

Plus HSA Qualified Silver 3500

Plus HSA Qualified Bronze 5250

Select HSA Qualified Bronze 5250

Off Exchange

For plans NOT purchased on HealthCare.gov

Benefit booklets

PPO Preferred plans

Select Gold 1500

Select Silver 3000

Plus Gold 500

Plus Gold 1000

Plus Gold 1500

Plus Silver 2000

Plus Silver 2500

Plus Silver 3000

Plus Silver 4000

Plus Bronze 5500

Plus Bronze 6350

HSA Plus plans

Plus HSA Qualified Gold 1500

Plus HSA Qualified Silver 2700

Plus HSA Qualified Silver 3500

Plus HSA Qualified Bronze 5250

Select HSA Qualified Bronze 5250

No longer for sale

Grandfathered plans closed 01/2014

Summary of benefits and coverage

HeritagePlus Envoy GF

HeritagePlus GF

HeritagePlus HSA GF

HeritageSelect Envoy GF

HeritageSelect GF

HeritageSelect HSA GF

No longer for sale

Grandfathered plans closed 01/2014

Benefit booklets

HeritagePlus Envoy GF

HeritagePlus GF

HeritagePlus HSA GF

HeritageSelect Envoy GF

HeritageSelect GF

HeritageSelect HSA GF

Non-Grandfathered plans closed 01/2013

Summary of benefits and coverage

HeritagePlus Copay NGF

HeritagePlus Envoy NGF

HeritagePlus HSA NGF

HeritageSelect Envoy NGF

HeritageSelect HSA NGF

HeritageSelect NGF

Non-Grandfathered plans closed 01/2013

Benefit booklets

HeritagePlus Copay NGF

HeritagePlus Envoy NGF

HeritagePlus HSA NGF

HeritageSelect Envoy NGF

HeritageSelect HSA NGF

HeritageSelect NGF

2017 Small group plans
In Exchange

For plans purchased on HealthCare.gov

Summary of benefits and coverage

PPO Plus plans

Plus 1000

Plus 2000

Off Exchange

For plans NOT purchased on HealthCare.gov

PPO Preferred plans

Plus Gold 500

Plus Gold 1000

Plus Gold 1500

Plus Bronze 5500

Plus Bronze PCP 6350

Plus Bronze PCP 6350 + Family Dental

Plus Silver 2000

Plus Silver 2500

Plus Silver 2500 + Family Dental

Plus Silver 3000

Select Gold 500

Select Gold 1000

Select Gold 1500

Select Silver 2000

Select Silver 3000

HSA Plus plans

Plus Qualified Gold 1500

Plus Qualified Bronze 5250

Plus Qualified Silver 2700

Plus Silver HSA 4000

Plus HSA Silver 4000 + Family Dental

Select Qualified Bronze 5250

Select Qualified Silver 2700

No longer for sale

Grandfathered plans closed 01/2014

HeritagePlus

HeritagePlus Envoy

HeritageSelect

HeritageSelect Envoy

HeritagePlus HSA

HeritageSelect HSA

Non-Grandfathered plans closed 01/2013

HeritagePlus

HeritagePlus Envoy

HeritageSelect

HeritageSelect Envoy

HeritagePlus HSA

HeritageSelect HSA

Supplemental guide

Small group health coverage plan

In Exchange

For plans purchased on healthCare.gov

Benefit booklets

PPO Plus plans

Plus 1000

Plus 2000

Off Exchange

For plans NOT purchased on HealthCare.gov

PPO Preferred plans

Plus Gold 500

Gold 1000

Plus Gold 1500

Plus Bronze 5500

Plus Bronze PCP 6350

Plus Bronze PCP 6350 + Family Dental

Plus Silver 2000

Plus Silver 2500

Plus Silver 2500 + Family Dental

Plus Silver 3000

Select Gold 500

Select Gold 1000

Select Gold 1500

Select Silver 2000

Select Silver 3000

HSA Plus plans

Plus Qualified Gold 1500

Plus Qualified Bronze 5250

Plus Qualified Silver 2700

Plus Silver HSA 4000

Plus HSA Silver 4000 + Family Dental

Select Qualified Bronze 5250

Select Qualified Silver 2700

No longer for sale

Grandfathered plans closed 01/2014

HeritagePlus

HeritagePlus Envoy

HeritageSelect

HeritageSelect Envoy

HeritagePlus HSA

HeritageSelect HSA

Non-Grandfathered plans closed 01/2013

HeritagePlus

HeritagePlus Envoy

HeritageSelect

HeritageSelect Envoy

HeritagePlus HSA

HeritageSelect HSA
For large group plans

To find your plan-specific summary of benefits and coverage and benefit booklet you can search a list of group plans. You can also sign onto your personal secure Premera account to view your plan-specific SBC and benefit booklet.
2018 sample large group SBC and benefit booklets
Non-Grandfathered

Summary of benefits and coverage

HeritagePlus Non-Grandfathered Envoy Fully-Insured

HeritageSelect Non-Grandfathered Envoy Fully-Insured

HeritagePlus Non-Grandfathered Fully-Insured

HeritageSelect Non-Grandfathered Fully-Insured

HeritagePlus Non-Grandfathered HSA Fully-Insured

HeritageSelect Non-Grandfathered HSA Fully-Insured

Non-Grandfathered

Benefit booklets

HeritagePlus Non-Grandfathered Envoy Fully-Insured

HeritageSelect Non-Grandfathered Envoy Fully-Insured

HeritagePlus Non-Grandfathered Fully-Insured

HeritageSelect Non-Grandfathered Fully-Insured

HeritagePlus Non-Grandfathered HSA Fully-Insured

HeritageSelect Non-Grandfathered HSA Fully-Insured

Grandfathered

Summary of benefits and coverage

HeritagePlus Grandfathered Envoy Fully-Insured

HeritageSelect Grandfathered Envoy Fully-Insured

HeritagePlus Grandfathered Fully-Insured

HeritageSelect Grandfathered Fully-Insured

HeritagePlus Grandfathered HSA Fully-Insured

HeritageSelect Grandfathered HSA Fully Insured

Grandfathered

Benefit booklets

HeritagePlus Grandfathered Envoy Fully-Insured

HeritageSelect Grandfathered Envoy Fully-Insured

HeritagePlus Grandfathered Fully-Insured

HeritageSelect Grandfathered Fully-Insured

HeritagePlus Grandfathered HSA Fully-Insured

HeritageSelect Grandfathered HSA Fully Insured

2017 sample large group SBC and benefit booklets
Non-Grandfathered

Summary of benefits and coverage

HeritagePlus Non-Grandfathered Envoy Fully-Insured

HeritagePlus Non-Grandfathered Envoy Self-Funded

HeritageSelect Non-Grandfathered Envoy Fully-Insured

HeritageSelect Non-Grandfathered Envoy Self-Funded

HeritagePlus Non-Grandfathered Fully-Insured

HeritagePlus Non-Grandfathered Self-Funded

HeritageSelect Non-Grandfathered Fully-Insured

HeritageSelect Non-Grandfathered Self-Funded

HeritagePlus Non-Grandfathered HSA Fully-Insured

HeritagePlus Non-Grandfathered HSA Self-Funded

Non-Grandfathered

Benefit booklets

HeritagePlus Non-Grandfathered Envoy Fully-Insured

HeritagePlus Non-Grandfathered Envoy Self-Funded

HeritageSelect Non-Grandfathered Envoy Fully-Insured

HeritageSelect Non-Grandfathered Envoy Self-Funded

HeritagePlus Non-Grandfathered Fully-Insured

HeritagePlus Non-Grandfathered Self-Funded

HeritageSelect Non-Grandfathered Fully-Insured

HeritageSelect Non-Grandfathered Self-Funded

HeritagePlus Non-Grandfathered HSA Fully-Insured

HeritagePlus Non-Grandfathered HSA Self-Funded

Grandfathered

Summary of benefits and coverage

HeritagePlus Grandfathered Envoy Fully-Insured

HeritagePlus Grandfathered Envoy Self-Funded

HeritageSelect Grandfathered Envoy Fully-Insured

HeritageSelect Grandfathered Envoy Self-Funded

HeritagePlus Grandfathered Fully-Insured

HeritagePlus Grandfathered Self-Funded

HeritageSelect Grandfathered Fully-Insured

HeritageSelect Grandfathered Self-Funded

HeritagePlus Grandfathered HSA Fully-Insured

HeritagePlus Grandfathered HSA Self-Funded

HeritageSelect Grandfathered HSA Fully Insured

Grandfathered

Benefit booklets

HeritagePlus Grandfathered Envoy Fully-Insured

HeritagePlus Grandfathered Envoy Self-Funded

HeritageSelect Grandfathered Envoy Fully-Insured

HeritageSelect Grandfathered Envoy Self-Funded

HeritagePlus Grandfathered Fully-Insured

HeritagePlus Grandfathered Self-Funded

HeritageSelect Grandfathered Fully-Insured

HeritageSelect Grandfathered Self-Funded

HeritagePlus Grandfathered HSA Fully-Insured

HeritagePlus Grandfathered HSA Self-Funded

HeritageSelect Grandfathered HSA Fully Insured
Notice of Protection