The Plan provides an extensive package of benefits that helps you pay for everyday medical costs and wellness services, as well as expenses resulting from illness or injury. The Plan pays benefits toward covered Physician charges, Hospital and surgical expenses, laboratory and radiology charges, mental health and substance use disorder treatment, and prescription drugs, among 
other medical expenses.

Effective January 1, 2021, the Plan is combining its Plan I and Plan II benefits into one high-quality plan level. As of January 1, 2021, Plan II is closed and will not be available for enrollment. Plan II benefits remain in effect for Participants and Qualified Dependents covered under Plan II until their eligibility runs out in 2021. 

The Plan’s benefits are subject to the exclusions and limitations described throughout this SPD. Services also must be Medically Necessary in order to be covered. As such, the Plan’s benefits may not cover all treatment prescribed by your Physician.

• Coverage Highlights
• Pre-Authorization
• How to Get Care Quickly - Virtual Visit Options
• How to Access Virtual Care
• The Plan’s Provider Networks Offer Savings and Convenience 
• The Plan’s Hospital Benefit Is Limited to Care From In-network Hospitals Only
• Comprehensive Out-of-pocket Maximum
• Hospital Benefits
• Medical Benefits
• Optum’s Quit for Life® Program
• Prescription Drug Benefits
• Dental Benefits
• Vision Benefits
• Life Insurance Benefits
• Accidental Death and Dismemberment (AD&D) Benefits
• General Exclusions