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Plan Documents for Members

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IMPORTANT NOTICE: 2018 Plan Documents

Summary of Benefits and Coverage (SBC) and Evidence of Coverage (EOC) for 2018 Individual, Small Group and Large Group plans will be posted as soon as they can be made available.

View Individual, Small Group and Large Group 2018 Plan Summary of Benefits and Coverage.

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2017 Plan Documents for Members

Standard Summary of Benefits and Coverage (SBC) and Evidence of Coverage (EOC) documents, in PDF file format, are available for download, here and in the Member Portal, after login. Custom plan documents are not included in this directory as they can be accessed on the employer's SWHP sub-site and also from the Member Portal.

Need any help? Contact Support at 1-800-321-7947 (TTY: 1-800-735-2989).


Find Your Plan


 Plan documents are organized by Plan Group Size, then by groupings of Plan Type.

 Summary of Benefits and Coverage (SBC) documents and Evidence of Coverage (EOC) documents are listed separately. In general, the plan names...

  • The $ value in a plan name indicates that plan's annual deductible.
  • The numbers with a dash, for example 80/50, signify the in-network coverage and out-of-network percentage.
  • HMO CC is the abbreviation for HMO Consumer Choice.
  • HDHP is the abbreviation for High-Deductible Health Plan.

 Plan names may include a prescription rider code at the end of the file name. For plans with riders, the differences are in the prescription drug co-pay amounts for in-network preferred generic, preferred brand drugs, non-preferred generic drugs and non-preferred brand drugs, and preferred specialty drugs.

  • LRX20001 Medication copays: $5 preferred generic, $30 preferred brand, $50 non-preferred, and $200 on preferred specialty drugs.
  • LRX20002 Medication copays: $8 preferred generic, $35 preferred brand, $70 non-preferred, and 20% on preferred specialty drugs.
  • LRX20006 Medication copays: $10 preferred generic, $40 preferred brand, $80 non-preferred, and 25% on preferred specialty drugs
  • LRX20007 Medication copays: $15 preferred generic, $50 preferred brand, $100 non-preferred, and 25% on preferred specialty drugs

You can also find your specific documents in the Member Portal.

All files are in PDF format, which can be viewed or downloaded with your web browser. You may download and install Adobe Acrobat Reader®, for free, to view PDF files.

Contact Customer Support for assistance at 1-800-321-7947 (TTY: 1-800-735-2989).



Summary of Benefits and Coverage (SBCs)



Evidence of Coverage (EOCs)