Get your insurance plan documents

This is all the “fine print” about the employer-sponsored insurance plans we offer. (If you’re looking for Medicare documents, please visit our Medicare resources instead.)

You’ll find these documents below:

  • Summary of Benefits and Coverage (SBC) – This is information that’s easiest to read. It includes detailed information about your plan’s benefits and coverage. All SBCs are legally required to include the same information, so it’s easy to use SBCs to compare plans.
  • Contract – This is the legal contract between you and HealthPartners UnityPoint Health. It includes all the details about your insurance plan.
  • Benefit charts – Use these charts to find the exact legal terms of everything your plan covers.
  • Amendments and pediatric dental – Some insurance plans have dental benefits that only apply to people younger than 19. Those benefits are explained here. This also shows you if things have changed with your plans.
Deductible-Copay Plans
Plan name SBCs Contract Benefit Chart Amendments/Pediatric Dental
$500-$20 Platinum

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

$500-$60 Gold

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Deductible-Copay Primary Specialty
Plan name SBCs Contract Benefit Chart Amendments/Pediatric Dental
$1,500-$30/$60 Gold

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

$2,000-$30/$60 Gold

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

$3,000-$30/$60 Gold

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

$4,000-$30/$60 Gold

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

$5,500-$50/$100 Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

$6,500-$50/$100 Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

$7,500-$50/$100 Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Three for Free plans
Plan name SBCs Contract Benefit Chart Amendment/Pediatric Dental
$2,000-70% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

$4,000-70% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

$5,000-70% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

HSA-Copay Embedded plans
Plan name SBCs Contract Benefit Chart Amendment/Pediatric Dental
$3,000-100% $40/$80 Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

$6,250-100% $40/$80 Bronze

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

HSA Non-Embedded Plans
Plan name SBCs Contract Benefit Chart Amendment/Pediatric Dental
$2,500-100% Gold

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

$4,500-100% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

HSA Embedded plans
Plan name SBCs Contract Benefit Chart Amendment/Pediatric Dental
$3,000-100% Gold

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

$5,000-100% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

$6,850-100% Bronze

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

$3,000-70% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

HSA Plus Non-Embedded plans
Plan name SBCs Contract Benefit Chart Amendment/Pediatric Dental
$3,000-100% Gold

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

HSA Plus Embedded plans
Plan name SBCs Contract Benefit Chart Amendment/Pediatric Dental
$3,000-100% Gold

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

$5,000-100% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

$5,000-70% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

HRA Embedded plans
Plan name SBCs Contract Benefit Chart Amendment/Pediatric Dental
$6,850-100% Bronze

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Copay and Deductible-Copay plans
Plan name SBCs Contract Benefit Chart Amendments/Pediatric Dental
$500-$25 Platinum SBC (Bridges network) (PDF) Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
$500-$50 Gold

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
$1,500-$30/$60 Gold

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
$3,000-$30/$60 Gold

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
$4,000-$30/$70 Gold

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
$5,000-$40/$80 Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
$6,000-$40/$80 Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
$7,500-$50/$100 Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
Three for Free plans
Plan name SBCs Contract Benefit Chart Amendment/Pediatric Dental
$3,500-70% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
$5,000-70% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
HSA-Copay Embedded plans
Plan name SBCs Contract Benefit Chart Amendment/Pediatric Dental
$3,000-100% $40/$80 Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
$6,250-100% $30/$60 Bronze

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
HSA Non-Embedded plans
Plan name SBCs Contract Benefit Chart Amendment/Pediatric Dental
$2,500-100% Gold

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)

$4,500-100% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
HSA Embedded plans
Plan name SBCs Contract Benefit Chart Amendment/Pediatric Dental
$3,000-100% Gold

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)

$5,000-100% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)

$6,850-100% Bronze

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)

$3,000-70% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
$6,500-70% Bronze

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
HSA Plus Non-Embedded plans
Plan name SBCs Contract Benefit Chart Amendment/Pediatric Dental
$3,000-100% Gold

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
HSA Plus Embedded plans
Plan name SBCs Contract Benefit Chart Amendment/Pediatric Dental
$3,000-100% Gold

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
$4,500-100% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
$6,000-100% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
$3,000-70% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
$5,000-70% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
$5,500-70% Silver

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
HRA Embedded plans
Plan name SBCs Contract Benefit Chart Amendment/Pediatric Dental
$6,850-100% Bronze

SBC (Open Access network) (PDF)

SBC (Bridges network) (PDF)

Contract (PDF) Benefit Chart (PDF) Amendments/Pediatric Dental (PDF)
Need help?

If you need help finding a document, our team can assist. Call the Member Services number on the back of your HealthPartners UnityPoint Health insurance ID card or 866-843-3461.

To request copies of your plan documents, please contact us.

If you need help, call the Member Services number on the back of your HealthPartners UnityPoint Health insurance ID card or 866-843-3461.