Full Plan details and rules are available in the Summary Plan Description (SPD).

• For benefits on and after January 1, 2023, please refer to the January 1, 2023, Summary Plan Description.

The following information is only a summary. 

• Benefits beginning January 1, 2023

Provider Networks

The Plan uses the following provider networks to serve your needs:

• BlueCard PPO (Enhanced access through Sydney's Health app)
• CVS Caremark
• Carelon Behavioral Health
• Delta Dental
• Vision Service Plan