*Annual Deductible: this is the yearly amount you are required to pay before anything except preventive care is covered.
**Coinsurance: a percentage of the medical and pharmacy costs you are required to pay after your annual deductible is met.
2025
2025 Summary of Benefits and Coverage (PDF) »
2025 Summary of Benefits and Coverage (Spanish) (PDF) »
2025 Summary Plan Description (PDF) »
2024
2024 Summary of Benefits and Coverage (PDF) »
2024 Summary of Benefits and Coverage (Spanish) (PDF) »
2024 Summary Plan Description (PDF) »
More information about the Open Access Plan: English (PDF) | Spanish (PDF)
No Annual Deductible: Individual $1,600 / Family $3,200
What you pay for care received after meeting your deductiblePreventive care: Covered 100% (for specific services, frequency limitations may apply)
After you meet your deductible and your out-of-pocket maximum, the plan pays 100% for covered care for the rest of the year