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Plan Documents for Members

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Access plan details on the go, with the new MyBSWHealth app.

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Member Plan Documents

As a member, you can view your specific Plan Documents in the Member Portal, quick and easy.

Simply log in and click "Plan Documents" to view your plan documents.

Member Portal

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2018 Plan Documents for Members

Standard Summary of Benefits and Coverage (SBC) and Evidence of Coverage (EOC) documents, in PDF file format, are available for download here.

Custom plan documents are not included in this directory as they can be accessed on the employer's SWHP sub-site and also from the Member Portal.  

If you are already a member, you may more easily download the documents specific to your plan from the Member Portal. Simply log into the Member Portal and view your plan documents under the header "Plan Documents." After logging in, you will only see the plan documents that apply to you.

Looking for a 2017 plan document? View 2017 Plan Document Archive.

Need any help? Contact Support at 1-800-321-7947 (TTY: 1-800-735-2989).



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Find Your Plan


Summary of Benefits and Coverage (SBC) documents and Evidence of Coverage (EOC) documents are listed separately. In general, the plan names...

  • The $ value in a plan name indicates that plan's annual deductible.
  • The numbers with a dash, for example 80/50, signify the in-network coverage and out-of-network percentage.
  • HMO CC is the abbreviation for HMO Consumer Choice.
  • HDHP is the abbreviation for High-Deductible Health Plan.

Plan names may include a prescription rider code at the end of the file name. For plans with riders, the differences are in the prescription drug co-pay amounts for in-network preferred generic, preferred brand drugs, non-preferred generic drugs and non-preferred brand drugs, and preferred specialty drugs.

  • LRX20001 Medication copays: $5 preferred generic, $30 preferred brand, $50 non-preferred, and $200 on preferred specialty drugs.
  • LRX20002 Medication copays: $8 preferred generic, $35 preferred brand, $70 non-preferred, and 20% on preferred specialty drugs.
  • LRX20006 Medication copays: $10 preferred generic, $40 preferred brand, $80 non-preferred, and 25% on preferred specialty drugs
  • LRX20007 Medication copays: $15 preferred generic, $50 preferred brand, $100 non-preferred, and 25% on preferred specialty drugs

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2018 Summary of Benefits and Coverage

Primary Care Physician (PCP) referrals are not required for any of our plans.




 




2018 Evidence of Coverage (EOC)


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You can also find your specific documents in the Member Portal.

All files are in PDF format, which can be viewed or downloaded with your web browser. You may download and install Adobe Acrobat Reader®, for free, to view PDF files.

Contact Customer Support for assistance at 1-800-321-7947 (TTY: 1-800-735-2989).