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2019 Medica with CHI Health Official Documents

To see your summary of benefits and coverage (SBC) and policy of coverage documents, select your state and plan below.

Looking for the 2018 official documents?

Iowa Plans

Document  Care Type    
Summary of Benefits and Coverage (SBC) Gold Copay (PDF)
Silver Copay (PDF)
Bronze Copay (PDF)
Policy of Coverage
Gold Copay (PDF)
Silver Copay (PDF)
Bronze Copay (PDF)
Document Care Type  
Summary of Benefits and Coverage (SBC)
Bronze HSA Plus (PDF)
Bronze HSA (PDF)
Policy of Coverage
Bronze HSA Plus (PDF)
Bronze HSA (PDF)

Nebraska Plans

Document  Care Type    
Summary of Benefits and Coverage (SBC) Gold Copay (PDF)
Silver Copay (PDF)
Bronze Copay (PDF)
Policy of Coverage
Gold Copay (PDF)
Silver Copay (PDF)
Bronze Copay (PDF)
Document Care Type  
Summary of Benefits and Coverage (SBC)
Bronze HSA Plus (PDF)
Bronze HSA (PDF)
Policy of Coverage
Bronze HSA Plus (PDF)
Bronze HSA (PDF)
Document Care Type
Summary of Benefits and Coverage (SBC) Silver Share (PDF)
Policy of Coverage
Silver Share (PDF)
Date: 7/18/2019 11:36:48 PM Version: 4.0.30319.42000 Machine Name: PWIM4-CMSWEB01