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.

Benefit Summary

The following information is only a summary. 

• Benefits Summary starting January 1, 2026
• Benefits Summary for January 1, 2025 - December 31, 2025

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 (Starting January 1, 2026, provider will be Anthem)
• Delta Dental
• Vision Service Plan