This is all the “fine print” about the employer-sponsored insurance plans we offer. (If you’re looking for Medicare documents, please visit our
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 | ||||
| $500-$60 Gold |
Deductible-Copay Primary Specialty
| Plan name | SBCs | Contract | Benefit Chart | Amendments/Pediatric Dental |
|---|---|---|---|---|
| $1,500-$30/$60 Gold | ||||
| $2,000-$30/$60 Gold | ||||
| $3,000-$30/$60 Gold | ||||
| $4,000-$30/$60 Gold | ||||
| $5,500-$50/$100 Silver | ||||
| $6,500-$50/$100 Silver | ||||
| $7,500-$50/$100 Silver |
Three for Free plans
| Plan name | SBCs | Contract | Benefit Chart | Amendment/Pediatric Dental |
|---|---|---|---|---|
| $2,000-70% Silver | ||||
| $4,000-70% Silver | ||||
| $5,000-70% Silver |
HSA-Copay Embedded plans
| Plan name | SBCs | Contract | Benefit Chart | Amendment/Pediatric Dental |
|---|---|---|---|---|
| $3,000-100% $40/$80 Silver | ||||
| $6,250-100% $40/$80 Bronze |
HSA Non-Embedded Plans
| Plan name | SBCs | Contract | Benefit Chart | Amendment/Pediatric Dental |
|---|---|---|---|---|
| $2,500-100% Gold | ||||
$4,500-100% Silver |
HSA Embedded plans
| Plan name | SBCs | Contract | Benefit Chart | Amendment/Pediatric Dental |
|---|---|---|---|---|
| $3,000-100% Gold | ||||
$5,000-100% Silver | ||||
$6,850-100% Bronze | ||||
$3,000-70% Silver |
HSA Plus Non-Embedded plans
| Plan name | SBCs | Contract | Benefit Chart | Amendment/Pediatric Dental |
|---|---|---|---|---|
| $3,000-100% Gold |
HSA Plus Embedded plans
| Plan name | SBCs | Contract | Benefit Chart | Amendment/Pediatric Dental |
|---|---|---|---|---|
| $3,000-100% Gold | ||||
| $5,000-100% Silver | ||||
| $5,000-70% Silver |
HRA Embedded plans
| Plan name | SBCs | Contract | Benefit Chart | Amendment/Pediatric Dental |
|---|---|---|---|---|
| $6,850-100% Bronze |
Copay and Deductible-Copay plans
| Plan name | SBCs | Contract | Benefit Chart | Amendments/Pediatric Dental |
|---|---|---|---|---|
| $500-$25 Platinum | ||||
| $500-$50 Gold | ||||
| $1,500-$30/$60 Gold | ||||
| $3,000-$30/$60 Gold | ||||
| $4,000-$30/$70 Gold | ||||
| $5,000-$40/$80 Silver | ||||
| $6,000-$40/$80 Silver | ||||
| $7,500-$50/$100 Silver |
Three for Free plans
| Plan name | SBCs | Contract | Benefit Chart | Amendment/Pediatric Dental |
|---|---|---|---|---|
| $3,500-70% Silver | ||||
| $5,000-70% Silver |
HSA-Copay Embedded plans
| Plan name | SBCs | Contract | Benefit Chart | Amendment/Pediatric Dental |
|---|---|---|---|---|
| $3,000-100% $40/$80 Silver | ||||
| $6,250-100% $30/$60 Bronze |
HSA Non-Embedded plans
| Plan name | SBCs | Contract | Benefit Chart | Amendment/Pediatric Dental |
|---|---|---|---|---|
| $2,500-100% Gold | ||||
$4,500-100% Silver |
HSA Embedded plans
| Plan name | SBCs | Contract | Benefit Chart | Amendment/Pediatric Dental |
|---|---|---|---|---|
| $3,000-100% Gold | ||||
$5,000-100% Silver | ||||
$6,850-100% Bronze | ||||
$3,000-70% Silver | ||||
| $6,500-70% Bronze |
HSA Plus Non-Embedded plans
| Plan name | SBCs | Contract | Benefit Chart | Amendment/Pediatric Dental |
|---|---|---|---|---|
| $3,000-100% Gold |
HSA Plus Embedded plans
| Plan name | SBCs | Contract | Benefit Chart | Amendment/Pediatric Dental |
|---|---|---|---|---|
| $3,000-100% Gold | ||||
| $4,500-100% Silver | ||||
| $6,000-100% Silver | ||||
| $3,000-70% Silver | ||||
| $5,000-70% Silver | ||||
| $5,500-70% Silver |
HRA Embedded plans
| Plan name | SBCs | Contract | Benefit Chart | Amendment/Pediatric Dental |
|---|---|---|---|---|
| $6,850-100% Bronze |
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
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.