*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.
 Downloads
 Downloads
                2026
				2026 Summary of Benefits and Coverage (PDF) »
				
				2026 Summary of Benefits and Coverage (Spanish) (PDF) »
				
				
				
                2025
				2025 Summary of Benefits and Coverage (PDF) »
				
				2025 Summary of Benefits and Coverage (Spanish) (PDF) »
				
				2025 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