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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.

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 for a complete description of provisions, benefits, exclusions, prior authorization requirements and other important facts.

On-Exchange HMO Plans

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

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)

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

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

 

Pediatric Dental Evidence of Coverage

Off-Exchange HMO Plans

    On-Exchange HMO Plans,

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

     

    Pediatric Dental Evidence of Coverage

    Off-Exchange HMO Plans

    • CCA EOC

      Providers

      To find all providers accepting IEHP Covered, take a look through our directory or use our Find a Doctor tool.