Summary of Benefits Coverage July 2021

English: Summary of Benefits Coverage (SBC) July 2021 (1/1 – 6/30/2021)

Plan A: Open Access POS Plan Plus

Plan B: Open Access POS Network Plan

Plan D: Facility High Deductible Plan

Plan F: Network Only High Plan

Plan G: Open Access POS Plan Basic

Plan H: Network Only Base Plan

Plan J: Network Only Basic Plan

Plan K: Network Only High Deductible Plan

Plan L: High Deductible Low Plan

Plan M: Aetna Whole Health Network Only (Gold)

Plan N: Aetna Whole Health High Deductible Network Only (HSA Silver)

Plan O: Network Only 70% Plan

Plan P: High Deductible 70% Plan

Plan R: HDHP-HSA Compatible

Plan S: HDHP-HSA Compatible High Option

Plan T: Network Only Plan

Plan U: High Deductible Network Only Plan

Plan V: High Deductible Catastrophic Plan

Plan W: HDHP-HSA Compatible Low Option

Plan X: Aetna Whole Health Network Only High (Silver)

Plan Y: Aetna Whole Health Network Only (Bronze)

Plan Z: Aetna Whole Health Network Only Low (Silver)

Spanish: Summary of Benefits Coverage (SBC) Julio 2021 (1/1 – 6/30/2021)

Plan A: Open Access POS Plan Plus

Plan B: Open Access POS Network Plan

Plan D: Facility High Deductible Plan

Plan F: Network Only High Plan

Plan G: Open Access POS Plan Basic

Plan H: Network Only Base Plan

Plan J: Network Only Basic Plan

Plan K: Network Only High Deductible Plan

Plan L: High Deductible Low Plan

Plan M: Aetna Whole Health Network Only (Gold)

Plan N: Aetna Whole Health High Deductible Network Only (HSA Silver)

Plan O: Network Only 70% Plan

Plan P: High Deductible 70% Plan

Plan R: HDHP-HSA Compatible

Plan S: HDHP-HSA Compatible High Option

Plan T: Network Only Plan

Plan U: High Deductible Network Only Plan

Plan V: High Deductible Catastrophic Plan

Plan W: HDHP-HSA Compatible Low Option

Plan X: Aetna Whole Health Network Only High (Silver)

Plan Y: Aetna Whole Health Network Only (Bronze)

Plan Z: Aetna Whole Health Network Only Low (Silver)