Get your insurance plan documents

Find the plan information you’re looking for

Here you’ll find all the specifics about your plan – including benefits, what’s covered and legal information – plus additional member forms and documents.

The documents here are for our employer-sponsored plans. 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
$500-$20 Platinum	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB311C-24 (PDF)
$500-$60 Gold	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB317C-24 (PDF)

Deductible-Copay Primary Specialty

Plan name	SBCs	Contract	Benefit Chart
$1,500-$30/$60 Gold	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB323C-24 (PDF)
$2,000-$30/$60 Gold	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB329C-24 (PDF)
$3,000-$30/$60 Gold	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB335C-24 (PDF)
$4,000-$30/$60 Gold	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB341C-24 (PDF)
$5,500-$50/$100 Silver	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB347C-24 (PDF)
$6,500-$50/$100 Silver	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB353C-24 (PDF)
$7,500-$50/$100 Silver	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB359C-24 (PDF)

Three for Free plans

Plan name	SBCs	Contract	Benefit Chart
$2,000-70% Silver	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB365C-24 (PDF)
$4,000-70% Silver	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB371C-24 (PDF)
$5,000-70% Silver	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB377C-24 (PDF)

HSA-Copay Embedded plans

Plan name	SBCs	Contract	Benefit Chart
$3,200-100% $50/$100 Silver	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB443C-24 (PDF)
$6,250-100% $50/$100 Bronze	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB449C-24 (PDF)

HSA Non-Embedded Plans

Plan name	SBCs	Contract	Benefit Chart
$2,500-100% Gold	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB383C-24 (PDF)
$4,500-100% Silver	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB389C-24 (PDF)

HSA Embedded plans

Plan name	SBCs	Contract	Benefit Chart
$3,200-100% Gold	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB395C-24 (PDF)
$5,000-100% Silver	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB401C-24 (PDF)
$7,000-100% Bronze	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB407C-24 (PDF)
$3,200-70% Silver	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB413C-24 (PDF)

HSA Plus Non-Embedded plans

Plan name	SBCs	Contract	Benefit Chart
$3,000-100% Gold	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB419C-24 (PDF)

HSA Plus Embedded plans

Plan name	SBCs	Contract	Benefit Chart
$3,200-100% Gold	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB425C-24 (PDF)
$5,200-100% Silver	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB431C-24 (PDF)
$5,000-70% Silver	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	MGC-900.2-HPUPH-SE-24 (PDF)	BCH-900.2-HPUPH-SE-BB437C-24 (PDF)

Deductible-Copay Plans

Plan name	SBCs	Contract	Benefit Chart	Amendments/Pediatric Dental
$500-$20 Platinum	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	Contract (PDF)	Benefit Chart (PDF)	Amendments/Pediatric Dental (PDF)
$500-$60 Gold	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	Contract (PDF)	Benefit Chart (PDF)	Amendments/Pediatric Dental (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)	Contract (PDF)	Benefit Chart (PDF)	Amendments/Pediatric Dental (PDF)
$2,000-$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/$60 Gold	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	Contract (PDF)	Benefit Chart (PDF)	Amendments/Pediatric Dental (PDF)
$5,500-$50/$100 Silver	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	Contract (PDF)	Benefit Chart (PDF)	Amendments/Pediatric Dental (PDF)
$6,500-$50/$100 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
$2,000-70% Silver	SBC (Open Access network) (PDF) SBC (Bridges network) (PDF)	Contract (PDF)	Benefit Chart (PDF)	Amendments/Pediatric Dental (PDF)
$4,000-70% 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)

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% $40/$80 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)

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)
$5,000-100% 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)

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)

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.

Looking for a form to help manage your plan or spending account? These documents are available when you sign in or at healthpartners.com.

Get your insurance plan documents

Find the plan information you’re looking for

Deductible-Copay Plans

Deductible-Copay Primary Specialty

Three for Free plans

HSA-Copay Embedded plans

HSA Non-Embedded Plans

HSA Embedded plans

HSA Plus Non-Embedded plans

HSA Plus Embedded plans

Deductible-Copay Plans

Deductible-Copay Primary Specialty

Three for Free plans

HSA-Copay Embedded plans

HSA Non-Embedded Plans

HSA Embedded plans

HSA Plus Non-Embedded plans

HSA Plus Embedded plans

HRA Embedded plans

Copay and Deductible-Copay plans

Three for Free plans

HSA-Copay Embedded plans

HSA Non-Embedded plans

HSA Embedded plans

HSA Plus Non-Embedded plans

HSA Plus Embedded plans

HRA Embedded plans

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