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Plan Materials

Summary of Benefits and Coverage (SBC)

The SBC provides a summary of benefits, cost shares and important coverage details in an easy-to-read format.

On-Exchange HMO Plans

  • Silver 70 (PDF)
  • Silver 73 (PDF)
  • Silver 87 (PDF)
  • Silver 94 (PDF)
  • Gold 80 (PDF)
  • Platinum 90 (PDF)
  • Bronze 60 (PDF)
  • Minimum Coverage (PDF)

On-Exchange American Indian-Alaskan Native (AI-AN) HMO Plans

  • $0 Cost Share AI-AN (PDF)
  • Silver 70 AI-AN (PDF)
  • Gold 80 AI-AN (PDF)
  • Platinum 90 AI-AN (PDF)
  • Bronze 60 AI-AN (PDF)

Off-Exchange HMO Plans

  • Silver 70 (PDF)
  • Gold 80 (PDF)
  • Platinum 90 (PDF)
  • Bronze 60 (PDF)
  • Minimum Coverage (PDF)

Schedule of Benefits (SOB)

The Schedule of Benefits (“SOB”) is part of the Evidence of Coverage (“EOC”) and shows the amount that you will pay for covered services under your benefit plan. Please refer to both documents f

On-Exchange HMO Plans

  • Silver 70 (PDF)
  • Silver 73 (PDF)
  • Silver 87 (PDF)
  • Silver 94 (PDF)
  • Gold 80 (PDF)
  • Platinum 90 (PDF)
  • Bronze 60 (PDF)
  • Minimum Coverage (PDF)

On-Exchange American Indian-Alaskan Native (AI-AN) HMO Plans

  • $0 Cost Share AI-AN (PDF)
  • Silver 70 AI-AN (PDF)
  • Gold 80 AI-AN (PDF)
  • Platinum 90 AI-AN (PDF)
  • Bronze 60 AI-AN (PDF)

Off-Exchange HMO Plans

  • Silver 70 (PDF)
  • Gold 80 (PDF)
  • Platinum 90 (PDF)
  • Bronze 60 (PDF)
  • Minimum Coverage (PDF)

Pediatric Dental Schedule of Benefits

  • Silver 70 (PDF)
  • Silver 73 (PDF)
  • Silver 87 (PDF)
  • Silver 94 (PDF)
  • Gold 80 (PDF)
  • Platinum 90 (PDF)
  • Bronze 60 (PDF)
  • Minimum Coverage (PDF)

Pediatric Dental Schedule of Benefits American Indian-Alaskan Native (AI-AN)

  • Silver 70 (PDF)
  • Silver 73 (PDF)
  • Silver 87 (PDF)
  • Silver 94 (PDF)
  • Gold 80 (PDF)
  • Platinum 90 (PDF)
  • Bronze 60 (PDF)
  • Minimum Coverage (PDF)

Evidence of Coverage (EOC)

The EOC provides a description of health services provided through IEHP. Benefits apply to eligible members according to the terms and conditions of this EOC.

On-Exchange HMO Plans

  • Silver 70 (PDF)
  • Silver 73 (PDF)
  • Silver 87 (PDF)
  • Silver 94 (PDF)
  • Gold 80 (PDF)
  • Platinum 90 (PDF)
  • Bronze 60 (PDF)
  • Minimum Coverage (PDF)

On-Exchange American Indian-Alaskan Native (AI-AN) HMO Plans

  • $0 Cost Share AI-AN (PDF)
  • Silver 70 AI-AN (PDF)
  • Gold 80 AI-AN (PDF)
  • Platinum 90 AI-AN (PDF)
  • Bronze 60 AI-AN (PDF)

Off-Exchange HMO Plans

  • Silver 70 (PDF)
  • Gold 80 (PDF)
  • Platinum 90 (PDF)
  • Bronze 60 (PDF)
  • Minimum Coverage (PDF)