If you need additional copies of your member materials, please contact Customer Service.

Your Plan Benefits

Click on the link below to download our Summary of Benefits and review details about your plan’s medical, dental and prescription drug benefits, copays, coinsurance and more.

2023 Summary of Benefits - Conventional, Premier and Premier Plus Plans (updated 4/13/2023)
2023 Summary of Benefits - Special Needs Plan (updated 4/13/2023)

For more detailed plan information including how to use the plan’s coverage to obtain medical services, your rights and responsibilities as a member, important phone numbers and other resources, see your plan’s Evidence of Coverage.

2023 Evidence of Coverage - Conventional Plan (updated 4/13/2023)
2023 Evidence of Coverage - Premier Plan (updated 4/13/2023)
2023 Evidence of Coverage - Premier Plan Plus (updated 4/13/2023)
2023 Evidence of Coverage - Special Needs Plan (updated 4/13/2023)

To see how your plan benefits have changed from year to year, see your plan’s Annual Notice of Changes.

2023 Annual Notice of Changes - Conventional Plan (updated 4/13/2023)
2023 Annual Notice of Changes - Premier Plan (updated 4/13/2023)
2023 Annual Notice of Changes - Premier Plan Plus (updated 4/13/2023)
2023 Annual Notice of Changes - Special Needs Plan (updated 4/13/2023)

To learn which medical services, procedures, supplies and equipment require our written authorization before being performed or supplied, review our 2023 Prior Authorization List.