Plan Summaries

You can find Medical & Rx, Dental, Vision, Life Insurance and Disability plan summaries and booklets here.

Medical & RX

• Summary of Benefits and Coverage (SBC)
  • 2021 PPO 20 SBC
  • 2021 PPO 25 SBC
  • 2021 HMO 25 SBC
  • 2021 PPO HRA SBC
  • 2021 PPO 2000 SBC
  • 2021 PPO 3000 SBC
  • 2021 HMO 3000 SBC
  • 2021 PPO 4000 SBC
  • 2021 PPO 5000 SBC
• Booklets
  • PPO 20 Booklet
  • PPO 25 Booklet
  • HMO 25 Booklet
  • PPO HRA Booklet
  • PPO 2000 Booklet
  • PPO 3000 Booklet
  • HMO 3000 Booklet
  • PPO 4000 Booklet
  • PPO 5000 Booklet
  • Blue View Vision HK Booklet
  • Blue View Vision PPO Booklet
• VBA Rx Communications
  • VBA Overview of Transition to Rx Benefits
  • ESI ACA Drug List 2020
  • ESI Barcode Mobile Flyer
  • ESI Claim Form
  • 2021 ESI Standard Plus Preventive Medication List
  • 2021 ESI National Preferred Drug List
• Anthem BlueView Vision
  • Anthem BlueView Vision EOC

Dental

• Summaries
  • 2021 Delta Dental Basic Plan
  • 2021 Delta Dental Comprehensive Plan
  • 2021 Delta Dental Enhanced Indemnity
• Booklets
  • Delta Dental Basic Booklet
  • Delta Dental Enhanced Indemnity Booklet
  • Delta Dental Comprehensive Booklet

Vision  

• Summaries
  • 2021 VSP Basic Plan
  • 2021 VSP Enhanced Plan
• VBA 2019 MBS
• VBA Evidence Certificate of Coverage Jan. 2018

Life Insurance

• Life Insurance Summary 10-2018
• Life Insurance Booklet

Disability

• LTD Cert Class 1: LTD 60-day 60% plan
• LTD Cert Class 2: LTD 60-day 70% plan
• LTD Cert Class 3: LTD 90-day 60% plan
• LTD Cert Class 4: LTD 90-day 70% plan
• LTD Cert Class 5: LTD 180-day 60% plan
• LTD Cert Class 6: LTD 180-day 70% plan
• ERISA Summary Plan Description Update 4-1-18