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 1/1/25 For Plans Starting 1/1/26
Capital Selection 153050
PDF
PDF
Capital Selection 153050 + 20% ER
PDF
PDF
Capital Selection 1550100
PDF
PDF
Capital Selection 1550100 + 20% ER
PDF
PDF
CHP High Deductible HMO (HSA Compatible)
PDF
PDF
Primary Selection 6 Tier Rx
PDF
PDF
Principal Choice 1550100
PDF
PDF
Principal Choice 1550100 + 25% ER
PDF
PDF
Quality Choice 1550100
PDF
PDF
Quality Choice 1550100 + 25% ER
PDF
PDF
Value Selection HDHP (not HSA Qualified)
PDF
PDF
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 1/1/25 For Plans Starting 1/1/26
3101 – Platinum 103050
PDF
PDF
3102 – Platinum 104060
PDF
PDF
3104 – Gold 2065100
PDF
PDF
3107 – Gold 6 Tier Rx
PDF
PDF
3108 – Silver
PDF
PDF
Basic Option I 1050100
PDF
PDF
Basic Option II 1050100
PDF
PDF
Essential Selection 153050
PDF
PDF
Standard Option I 103050
PDF
PDF
Tiered PCP 153050
PDF
PDF
Tiered PCP No Rx
PDF
PDF
Uniform Glossary