Summary of Benefits and Coverage
Large Employer Group Plans
In selecting the appropriate Summary of Benefits and Copayments (SBC) that is applicable to your employer group benefits coverage period, please be aware that coverage periods are based on the employer benefits enrollment anniversary date beginning on or after the dates listed below.
Copayments may or may not change at the time of your group renewal.
If you have any questions regarding your employer group plan SBC, please call the CHP Sales & Account Management Team.
| Plan Name | For Plans Starting 1/1/26 | For Plans Starting 1/1/27 |
|---|---|---|
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Capital Selection 153050 |
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Capital Selection 153050 + 20% ER |
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Capital Selection 1550100 |
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Capital Selection 1550100 + 20% ER |
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CHP High Deductible HMO (HSA Compatible) |
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Primary Selection 6 Tier Rx |
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Principal Choice 1550100 |
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Principal Choice 1550100 + 25% ER |
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Quality Choice 1550100 |
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Quality Choice 1550100 + 25% ER |
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Value Selection HDHP (not HSA Qualified) |
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Uniform Glossary |
Small Employer Group Plans
In selecting the appropriate Summary of Benefits and Copayments (SBC) that is applicable to your employer group benefits coverage period, please be aware that coverage periods are based on the employer benefits enrollment anniversary date beginning on or after the dates listed below.
Copayments may or may not change at the time of your group renewal.
If you have any questions regarding your employer group plan SBC, please call the CHP Sales & Account Management Team.
| Plan Name | For Plans Starting 1/1/26 | For Plans Starting 1/1/27 |
|---|---|---|
|
3101 – Platinum 103050 |
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3102 – Platinum 104060 |
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3104 – Gold 2065100 |
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3107 – Gold 6 Tier Rx |
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3108 – Silver |
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3110 – Silver |
N/A |
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Basic Option I 1050100 |
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Basic Option II 1050100 |
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Essential Selection 153050 |
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Standard Option I 103050 |
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Tiered PCP 153050 |
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Tiered PCP No Rx |
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Uniform Glossary |
Marketplace/Individual Plan
CHP Members can view their plan’s Summary of Benefits & Coverage (SBC) below. The SBC will outline plan details and provide you with copayment and/or coinsurance amounts for services, facilities, therapy options, and testing.
If you have any questions regarding your Individual & Family Plan SBC, please call the CHP Sales & Account Management Team.
| Plan Name | For Plans Starting 1/1/26 | For Plans Starting 1/1/27 |
|---|---|---|
|
Bronze 1000 AI/AN Limited Cost Sharing |
PDF |
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Bronze 1000 OffEx |
PDF |
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Bronze 1000 OnEx |
PDF |
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Bronze 1001 AI/AN Zero Cost Sharing |
PDF |
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Bronze 1100 Limited Cost Sharing |
PDF |
|
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Bronze 1100 OffEx |
PDF |
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Bronze 1100 OnEx |
PDF |
|
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Bronze 1101 AI/AN Zero Cost Share |
PDF |
|
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Gold 3000 AI/AN Limited Cost Sharing |
PDF |
|
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Gold 3000 OffEx |
PDF |
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Gold 3000 OnEx |
PDF |
|
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Gold 3001 AI/AN Zero Cost Sharing |
PDF |
|
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Gold 3100 AI/AN Limited Cost Sharing |
PDF |
|
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Gold 3100 OffEx |
PDF |
|
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Gold 3100 OnEx |
PDF |
|
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Gold 3101 AI/AN Zero Cost Sharing |
PDF |
|
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Platinum 4000 AI/AN Limited Cost Sharing |
PDF |
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Platinum 4000 OffEx |
PDF |
|
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Platinum 4000 OnEx |
PDF |
|
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Platinum 4001 AI/AN Zero Cost Sharing |
PDF |
|
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Silver 2102 |
PDF |
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Silver 2100 AI/AN Limited Cost Sharing |
PDF |
|
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Silver 2100 OffEx |
PDF |
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Silver 2100 OnEx |
PDF |
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Silver 2101 |
PDF |
|
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Silver 2103 No Deductible |
PDF |
|
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Silver 2104 AI/AN Zero Cost Sharing |
PDF |
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Silver 2200 – Off Exchange |
PDF |
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Silver 2300 AI/AN Limited Cost Sharing |
PDF |
|
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Silver 2300 OffEx |
PDF |
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Silver 2300 OnEx |
PDF |
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Silver 2301 |
PDF |
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Silver 2302 |
PDF |
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Silver 2303 |
PDF |
|
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Silver 2304 AI/AN Zero Cost Sharing |
PDF |
|
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Silver 2400 AI/AN Limited Cost Sharing |
PDF |
|
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Silver 2400 OffEx |
PDF |
|
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Silver 2400 OnEx |
PDF |
|
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Silver 2401 |
PDF |
|
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Silver 2402 |
PDF |
|
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Silver 2403 No Deductible |
PDF |
|
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Silver 2404 AI/AN Zero Cost Sharing |
PDF |
|
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Uniform Glossary |