Summary of Benefits Coverage October 2021 English: Summary of Benefits Coverage (SBC) October 2021 (1/1 – 9/30/2021) 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) Octubre 2021 (1/1 – 9/30/2021) 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)
