Benefit Booklets

View and Search Current Benefit Booklets

Here you can find the details regarding your plan coverage. Please choose the plan you are interested in from the options below. After clicking on a link, use your browser's FIND menu item to search for specific words within the booklet.

Medical Summary of Benefits and Coverage (SBC)

1/1/2024 - Current

UMR SBCs

EPO3 EPO4 EPO5 EPO6 EPO Select PPO 2 PPO 3 PPO 4 PPO 5 PPO 6 PPO 7 PPO 8 PPO Select HDHP 2 HDHP25 HD2800 HDHP3 HD3500 HDHP4 HDHP5

UHC Surest SBCs

Surest 7 Surest 5

Kaiser SBCs

KP-HMO 5 KP-HMO 10 KP-HMO 15 KP-HMO 20 KP-HMO 40 KP-HMO 45 KP-HMO 50 KP-DHMO 750 KP-DHMO 1000 KP-DHMO 1500 KP-DHMO 2500 KP-HDHP 1600 KP-HDHP 2500

Medical Summary Plan Descriptions (SPD)

EPO3 Medical Benefit Plan EPO4 Medical Benefit Plan EPO5 Medical Benefit Plan EPO6 Medical Benefit Plan EPO Select Medical Benefit Plan EPO COVID-19 Testing Plan Amendment

PPO2 Medical Benefit Plan PPO3 Medical Benefit Plan PPO4 Medical Benefit Plan PPO5 Medical Benefit Plan PPO6 Medical Benefit Plan PPO7 Medical Benefit Plan PPO8 Medical Benefit Plan PPO Select Medical Benefit Plan PPO COVID-19 Testing Plan Amendment

HDHP2 Single Medical Benefit Plan HDHP2 Family Medical Benefit Plan HDHP25 Single Medical Benefit Plan HDHP25 Family Medical Benefit Plan HD2800 Single Medical Benefit Plan HD2800 Family Medical Benefit Plan HDHP3 Single Medical Benefit Plan HDHP3 Family Medical Benefit Plan HD3500 Medical Benefit Plan HDHP4 Medical Benefit Plan HDHP5 Medical Benefit Plan

CEBT Employee Assistance Program (EAP)SurgeryPlus Benefit Plan SurgeryPlus Plan Amendment (PPO)SurgeryPlus Plan Amendment (EPO)

KP-HMO 40 Medical Benefit Plan KP-HMO 45 Medical Benefit Plan KP-DHMO 750 Medical Benefit Plan KP-DHMO 1000 Medical Benefit Plan KP-DHMO 1500 Medical Benefit Plan KP-DHMO 2500 Medical Benefit Plan KP-HDHP 1500 Medical Benefit Plan KP-HDHP 2500 Medical Benefit Plan

Dental Plan Documents

Dental Plan Document (Plans A, B & C)Dental Plan A Summary Dental Plan B Summary Dental Plan C Summary

Vision Plan Documents

VSP Summary Plan Description Vision A (UMR)Vision B (VSP)Vision C (VSP)

Prescription Information: CVS/Caremark & Kaiser Permanente

CVS/Caremark Specialty Medications Commonly Prescribed Medications

Please note this drug list represents a summary of prescription coverage and is not an all-inclusive list to drugs covered by CEBT. Please contact CEBT customer service to confirm coverage.

For a list of covered drugs under your Kaiser plan, please access the Drug Formulary (Covered Drugs) on the kp.org website. Once you are directed to the page, click the Large Employer Group (50+ Employees) to access the drug lists.

Preventative Services Information

Preventative Services Men/Women Preventative Services Children

The Standard Life Coverage Plan Documents

Basic Life Certificate Voluntary Life Certificate CEBT Voluntary Life Benefit Booklet Travel Assistance Policies

The Standard Disability Plan Documents