2021 Plan Documents for Members

Standard Individual and Family, as well as Small Group 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 2020 plan document? View 2020 Plan Documents.

Looking for a 2019 plan document? View 2019 Plan Documents Archive.

Looking for a 2018 plan document? View 2018 Plan Document Archive.

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

Need any help? Contact Support at 1-800-321-7947 (TTY: 711).

Individual - Summary of Benefits and Coverage

• BSW Elite Gold HMO 001
• BSW Elite Gold HMO 001 (Spanish)
• BSW Elite Gold HMO 001 - Native American Limited
• BSW Elite Gold HMO 001 - Native American Zero
• BSW Elite Gold HMO 001 Off Exchange
• BSW Elite Gold HMO 002
• BSW Elite Gold HMO 002 (Spanish)
• BSW Elite Gold HMO 004
• BSW Elite Gold HMO 004 (Spanish)
• BSW Elite Gold HMO 004 - Native American Limited
• BSW Elite Gold HMO 004 - Native American Zero
• BSW Elite Gold HMO 004 Off Exchange
• BSW Prime Silver HMO 003 - CSR 94% AV
• BSW Prime Silver HMO 003 - CSR 94% AV (Spanish)
• BSW Prime Silver HMO 005 - CSR 94% AV
• BSW Prime Silver HMO 005 - CSR 94% AV (Spanish)
• BSW Prime Silver HMO 005 - CSR 73% AV
• BSW Prime Silver HMO 005 - CSR 73% AV (Spanish)
• BSW Prime Silver HMO 005 - CSR 87% AV
• BSW Prime Silver HMO 005 - CSR 87% AV (Spanish)
• BSW Prime Silver HMO 008
• BSW Prime Silver HMO 008 (Spanish)
• BSW Prime Silver HMO 008 - Native American Limited
• BSW Prime Silver HMO 008 - Native American Zero
• BSW Prime Silver HMO 008- CSR 94% AV
• BSW Prime Silver HMO 008- CSR 94% AV (Spanish)
• BSW Prime Silver HMO 008 Off Exchange
• BSW Prime Silver HMO 003
• BSW Prime Silver HMO 003 (Spanish)
• BSW Prime Silver HMO 003 - CSR 73% AV
• BSW Prime Silver HMO 003 - CSR 73% AV (Spanish)
• BSW Prime Silver HMO 003 - CSR 87% AV
• BSW Prime Silver HMO 003 - CSR 87% AV (Spanish)
• BSW Prime Silver HMO 003 - Native American Limited
• BSW Prime Silver HMO 003 - Native American Zero
• BSW Prime Silver HMO 003 Off Exchange
• BSW Prime Silver HMO 005
• BSW Prime Silver HMO 005 (Spanish)
• BSW Prime Silver HMO 005 - Native American Limited
• BSW Prime Silver HMO 005 - Native American Zero
• BSW Prime Silver HMO 005 Off Exchange
• BSW Prime Silver HMO 008 - CSR 87% AV
• BSW Prime Silver HMO 008 - CSR 87% AV (Spanish)
• BSW Prime Silver HMO 008 - CSR 73% AV
• BSW Prime Silver HMO 008 - CSR 73% AV (Spanish)
• BSW Prime Silver HMO 010
• BSW Prime Silver HMO 010 (Spanish)
• BSW Prime Silver HMO 011
• BSW Prime Silver HMO 011 (Spanish)
• BSW Savers Bronze HMO 006 - Native American Zero
• BSW Savers Bronze HMO HSA 006
• BSW Savers Bronze HMO HSA 006 (Spanish)
• BSW Savers Bronze HMO HSA 006 - Native American Limited
• BSW Savers Bronze HMO HSA 006 Off Exchange
• BSW Vital Bronze EPO 001
• BSW Vital Bronze HMO 001
• BSW Vital Bronze HMO 009 - Native American Limited
• BSW Vital Bronze HMO 009 - Native American Zero
• BSW Vital Bronze HMO 007
• BSW Vital Bronze HMO 007 (Spanish)
• BSW Vital Bronze HMO 007 - Native American Limited
• BSW Vital Bronze HMO 007 - Native American Zero
• BSW Vital Bronze HMO 007 Off Exchange
• BSW Vital Bronze HMO 009
• BSW Vital Bronze HMO 009 (Spanish)
• BSW Vital Bronze HMO 009 Off Exchange

Individual - Evidence of Coverage

• BSW Elite Gold HMO 001
• BSW Elite Gold HMO 001 (Spanish)
• BSW Elite Gold HMO 001 - Native American Limited
• BSW Elite Gold HMO 001 - Native American Zero
• BSW Elite Gold HMO 001 Off Exchange
• BSW Elite Gold HMO 002
• BSW Elite Gold HMO 002 (Spanish)
• BSW Elite Gold HMO 004
• BSW Elite Gold HMO 004 (Spanish)
• BSW Elite Gold HMO 004 - Native American Limited
• BSW Elite Gold HMO 004 - Native American Zero
• BSW Elite Gold HMO 004 Off Exchange
• BSW Prime Silver HMO 003 - CSR 94% AV
• BSW Prime Silver HMO 003- CSR 94% AV (Spanish)
• BSW Prime Silver HMO 005 - CSR 94% AV
• BSW Prime Silver HMO 005 - CSR 94% AV (Spanish)
• BSW Prime Silver HMO 005 - CSR 73% AV
• BSW Prime Silver HMO 005 - CSR 73% AV (Spanish)
• BSW Prime Silver HMO 005 - CSR 87% AV
• BSW Prime Silver HMO 005 - CSR 87% AV (Spanish)
• BSW Prime Silver HMO 008
• BSW Prime Silver HMO 008 (Spanish)
• BSW Prime Silver HMO 008 - Native American Limited
• BSW Prime Silver HMO 008 - Native American Zero
• BSW Prime Silver HMO 008 - CSR 94% AV
• BSW Prime Silver HMO 008 - CSR 94% AV (Spanish)
• BSW Prime Silver HMO 008 Off Exchange
• BSW Prime Silver HMO 003
• BSW Prime Silver HMO 003 (Spanish)
• BSW Prime Silver HMO 003 - CSR 73% AV
• BSW Prime Silver HMO 003 - CSR 73% AV (Spanish)
• BSW Prime Silver HMO 003 - CSR 87% AV
• BSW Prime Silver HMO 003 - CSR 87% AV (Spanish)
• BSW Prime Silver HMO 003 - Native American Limited
• BSW Prime Silver HMO 003 - Native American Zero
• BSW Prime Silver HMO 003 Off Exchange
• BSW Prime Silver HMO 005
• BSW Prime Silver HMO 005 (Spanish)
• BSW Prime Silver HMO 005 - Native American Limited
• BSW Prime Silver HMO 005 - Native American Zero
• BSW Prime Silver HMO 005 Off Exchange
• BSW Prime Silver HMO 008 - CSR 87% AV
• BSW Prime Silver HMO 008 - CSR 87% AV (Spanish)
• BSW Prime Silver HMO 008 - CSR 73% AV
• BSW Prime Silver HMO 008 - CSR 73% AV (Spanish)
• BSW Prime Silver HMO 010
• BSW Prime Silver HMO 010 (Spanish)
BSW Prime Silver HMO 011
• BSW Prime Silver HMO 011 (Spanish)
• BSW Savers Bronze HMO 006 - Native American Zero
• BSW Savers Bronze HMO HSA 006
• BSW Savers Bronze HMO HSA 006 (Spanish)
• BSW Savers Bronze HMO HSA 006 - Native American Limited
• BSW Savers Bronze HMO HSA 006 Off Exchange
• BSW Vital Bronze EPO 001
• BSW Vital Bronze HMO 001
• BSW Vital Bronze HMO 009 - Native American Limited
• BSW Vital Bronze HMO 009 - Native American Zero
• BSW Vital Bronze HMO 007
• BSW Vital Bronze HMO 007 (Spanish)
• BSW Vital Bronze HMO 007 - Native American Limited
• BSW Vital Bronze HMO 007 - Native American Zero
• BSW Vital Bronze HMO 007 Off Exchange
• BSW Vital Bronze HMO 009
• BSW Vital Bronze HMO 009 (Spanish)
• BSW Vital Bronze HMO 009 Off Exchange

Small Group - Summary of Benefits and Coverage

• Bronze HMO 100 7900 BSW Plus
• Bronze HMO 100 7900 BSW Preferred
• Bronze HMO 100 8150 BSW Plus
• Bronze HMO 100 8150 BSW Preferred
• Bronze HMO 100 8550 BSW Plus
• Bronze HMO 100 8550 BSW Preferred
• Bronze HMO 80 7250 BSW Plus
• Bronze HMO 80 7250 BSW Preferred
• Bronze HMO 80 7900 BSW Plus
• Bronze HMO 80 7900 BSW Preferred
• Bronze HMO HSA 6900 BSW Plus
• Bronze HMO HSA 6900 BSW Preferred
• Bronze POS 100 7900 BSW Plus
• Bronze POS 100 8150 BSW Plus
• Bronze POS 100 8550 BSW Plus
• Bronze POS 80 7250 BSW Plus
• Bronze POS 80 7900 BSW Plus
• Bronze POS HSA 6900 BSW Plus
• Bronze PPO 100 7900 BSW Plus
• Bronze PPO 100 8150 BSW Plus
• Bronze PPO 100 8550 BSW Plus
• Bronze PPO 80 7250 BSW Plus
• Bronze PPO 80 7900 BSW Plus
• Bronze PPO HSA 6900 BSW Plus
• Gold HMO 100 2100 BSW Plus
• Gold HMO 100 2100 BSW Preferred
• Gold HMO 100 3000 BSW Plus
• Gold HMO 100 3000 BSW Preferred
• Gold HMO 100 3500 BSW Plus
• Gold HMO 100 3500 BSW Preferred
• Gold HMO 80 1000 BSW Plus
• Gold HMO 80 1000 BSW Preferred
• Gold HMO 80 1500 BSW Plus
• Gold HMO 80 1500 BSW Preferred
• Gold HMO 90 1800 BSW Plus
• Gold HMO 90 1800 BSW Preferred
• Gold HMO 90 2000 BSW Plus
• Gold HMO 90 2000 BSW Preferred
• Gold HMO copayment 0 5500 BSW Plus
• Gold HMO copayment 0 5500 BSW Preferred
• Gold HMO copayment 0 7000 BSW Plus
• Gold HMO copayment 0 7000 BSW Preferred
• Gold HMO HSA 3000 BSW Plus
• Gold HMO HSA 3000 BSW Preferred
• Gold HMO HSA 4000 BSW Plus
• Gold HMO HSA 4000 BSW Preferred
• Gold HMO SM 0 8550 BSW Plus
• Gold HMO SM 0 8550 BSW Preferred
• Gold POS 100 2100 BSW Plus
• Gold POS 100 3000 BSW Plus
• Gold POS 100 3500 BSW Plus
• Gold POS 80 1000 BSW Plus
• Gold POS 80 1500 BSW Plus
• Gold POS 90 1800 BSW Plus
• Gold POS 90 2000 BSW Plus
• Gold POS copayment 0 5500 BSW Plus
• Gold POS copayment 0 7000 BSW Plus
• Gold POS HSA 3000 BSW Plus
• Gold POS HSA 4000 BSW Plus
• Gold PPO 100 2100 BSW Plus
• Gold PPO 100 3000 BSW Plus
• Gold PPO 100 3500 BSW Plus
• Gold PPO 80 1000 BSW Plus
• Gold PPO 80 1500 BSW Plus
• Gold PPO 90 1800 BSW Plus
• Gold PPO 90 2000 BSW Plus
• Gold PPO copayment 0 5500 BSW Plus
• Gold PPO copayment 0 7000 BSW Plus
• Gold PPO HSA 3000 BSW Plus
• Gold PPO HSA 4000 BSW Plus
• Silver HMO 100 5700 BSW Plus
• Silver HMO 100 5700 BSW Preferred
• Silver HMO 100 6200 BSW Plus
• Silver HMO 100 6200 BSW Preferred
• Silver HMO 100 7300 BSW Plus
• Silver HMO 100 7300 BSW Preferred
• Silver HMO 70 3100 BSW Plus
• Silver HMO 70 3100 BSW Preferred
• Silver HMO 70 4000 BSW Plus
• Silver HMO 70 4000 BSW Preferred
• Silver HMO 80 4800 BSW Plus
• Silver HMO 80 4800 BSW Preferred
• Silver HMO 80 6000 BSW Plus
• Silver HMO 80 6000 BSW Preferred
• Silver HMO 80 6900 BSW Plus
• Silver HMO 80 6900 BSW Preferred
• Silver HMO copayment 0 BSW Plus
• Silver HMO copayment 0 BSW Preferred
• Silver HMO HSA 4300 BSW Plus
• Silver HMO HSA 4300 BSW Preferred
• Silver HMO HSA 5000 BSW Plus
• Silver HMO HSA 5000 BSW Preferred
• Silver POS 100 5700 BSW Plus
• Silver POS 100 6200 BSW Plus
• Silver POS 100 7300 BSW Plus
• Silver POS 70 3100 BSW Plus
• Silver POS 70 4000 BSW Plus
• Silver POS 80 4800 BSW Plus
• Silver POS 80 6000 BSW Plus
• Silver POS 80 6900 BSW Plus
• Silver POS copayment 0 BSW Plus
• Silver POS HSA 4300 BSW Plus
• Silver POS HSA 5000 BSW Plus
• Silver PPO 100 5700 BSW Plus
• Silver PPO 100 6200 BSW Plus
• Silver PPO 100 7300 BSW Plus
• Silver PPO 70 3100 BSW Plus
• Silver PPO 70 4000 BSW Plus
• Silver PPO 80 4800 BSW Plus
• Silver PPO 80 6000 BSW Plus
• Silver PPO 80 6900 BSW Plus
• Silver PPO copayment 0 BSW Plus
• Silver PPO HSA 4300 BSW Plus
• Silver PPO HSA 5000 BSW Plus

Small Group - Evidence of Coverage

Large Group - Summary of Benefits and Coverage

Large Group - Evidence of Coverage