Summary of Benefits and Coverage

The Summary of Benefits and Coverage (SBC) documents are posted here for easy access to help your clients and their employees better understand their health coverage and can easily compare coverage options. Please visit UnitedeServices to view and download SBCs.

We recommend reviewing the Overview and Frequently Asked Questions documents prior to downloading individual SBCs.

2020
Summary of Coverage and Benefits
PPO Select

BRJ3 Select Plus PPO Gold $0

BRJ4 Select Plus PPO Gold 500

BRJ5 Select Plus PPO Gold 1000

BRJ6 Select Plus PPO Gold 1500_Primary Advantage

BRJ7 Select Plus PPO Silver 1500

BRJ8 Select Plus PPO Silver 2250

BRJF Select Plus PPO Platinum $0

BRJG Select Plus PPO Platinum 250

BRJH Select Plus PPO Platinum 250_Primary Advantage

BRJI Select Plus PPO Silver 2300

BRJJ Select Plus PPO Bronze 6900_HSA with Motion

BRJK Select Plus PPO Bronze 7200

PPO Core

BR5U CORE PPO Platinum $0_State plan

BR5V CORE PPO Gold $250_State plan

BR5W CORE PPO Silver 2250_State plan

BR5X CORE PPO Bronze 6300_State plan

BRJ9 CORE PPO Gold $0

BRJL CORE PPO Platinum $0

BRJM CORE PPO Platinum 250

BRJN CORE PPO Platinum 250_Primary Advantage

BRJO CORE PPO Silver 2300_HSA with Motion

BRJP CORE PPO Bronze 6900_HSA with Motion

BRJQ CORE PPO Bronze 7200

BRKA CORE PPO Gold 500

BRKB CORE PPO Gold 1000

BRKC CORE PPO Gold 1500_Primary Advantage

BRKD CORE PPO Silver 1500

BRKE CORE PPO Silver 2250

BRSK Non-Differential PPO Silver 2250

PPO Navigate

BR52 Navigate Silver $2250_State plan

BR53 Navigate Bronze 6300_State plan

BR5Y Navigate Platinum $0_State plan

BR5Z Navigate Gold $250_State plan

HMO Focus

BHG7 Focus HMO Gold 30-60_1000

BRS4 Focus HMO Platinum 20-40_500

BRS5 Focus HMO Platinum 0-80_$0 ded_Primary Advantage

BRS6 Focus HMO Platinum 20-40_$0 ded

BRS7 Focus HMO Gold 30-60_500 ded

BRS8 Focus HMO Gold 0-80_1500 ded_Primary Advantage

BRS9 Focus HMO Gold 30-60_1250 ded

BRTA Focus HMO Silver 55-80_2250 ded
HMO Harmony

BKD2 Harmony HMO Gold 30-60_1000 ded

BRTD Harmony HMO Platinum 20-40_$0 ded

BRTE Harmony HMO Gold 30-60_500 ded

BRTI Harmony HMO Silver 30%_2250 ded

BRTL Harmony HMO Bronze 40%_7200 ded

HMO Signature Value

BHGT Signature HMO Gold 30-60_1000 d

BRSO Signature HMO Platinum 20-40_500 day

BRSP Signature HMO Platinum 0-80_Primary Advantage

BRSQ Signature HMO Platinum 20-40_$0 ded

BRSR Signature HMO Gold 30-60_500 ded

BRSS Signature HMO Gold 0-80_1500 ded_Primary Advantage

BRST Signature HMO Gold 30-60_1250 ded

BRSU Signature HMO Silver 55-80_2250 ded

HMO Alliance

BHHD Alliance HMO Gold 30-60_1000

BRT2 Alliance HMO Bronze_6900 ded_State plan

BRTM Alliance HMO Platinum 20-40_$500

BRTN Alliance HMO Platinum 0-80_$0 ded_Primary Advantage

BRTO Alliance HMO Platinum 20-40_$0 ded

BRTP Alliance HMO Gold 30-60_500 ded

BRTQ Alliance HMO Gold 0-80_1500 ded_Primary Advantage

BRTR Alliance HMO Gold 30-60_1250 ded

BRTS Alliance HMO Silver 55-80_2250 ded

BRTT Alliance HMO Silver 30%_2250 ded

BRTU Alliance HMO Bronze 0%_6900 ded

BRTW Alliance HMO Bronze 40%_7200

BRTX Alliance HMO Platinum $0 ded_State plan

BRTY Alliance HMO Gold 250_ded_State plan

BRTZ Alliance HMO Silver 2250 ded_State plan

HMO Advantage

BHGZ Advantage HMO Gold 30-60_$0

BRS2 Advantage HMO Gold 30-60_1250 ded

BRS3 Advantage HMO Silver 55-80_2250 ded

BRSV Advantage HMO Platinum 20-40_500

BRSW Advantage HMO Platinum 0-80_$0 ded_Primary Advantage

BRSX Advantage HMO Platinum 20-40_$0 ded

BRSY Advantage HMO Gold 30-60_500 ded

BRSZ Advantage HMO Gold 0-80_1500 ded_Primary Advantage
2021
Summary of Coverage and Benefits
PPO Core

CORE Bronze 6300 ded_CE_MD_C42L

CORE Bronze 7000 ded_Motion_CE_MT_F86

CORE Bronze 7200 ded_CE_MU_F83

CORE Gold 0 ded_CE_M9_F84

CORE Gold 1000 ded_CE_NB_F80

CORE Gold 1500 ded_PA_CE_NC_F81

CORE Gold 350 ded_CE_MB_C40L

CORE Gold 500 ded_CE_NA_F80

CORE Platinum 0 ded_CE_MA_F21L

CORE Platinum 0 ded_CE_MP_F85

CORE Platinum 250 ded_CE_MQ_F85

CORE Platinum 250 ded_PA_CE_MR_F85

CORE Silver 1750_CE_ND_F82

CORE Silver 2250 ded_CE_MC_F22L

CORE Silver 2250 ded_CE_NE_F82

CORE Silver 2550 ded_Motion_CE_MS_F87

PPO Doctors

Doctors Plan_1500 ded_PA_CE_NI_F81

Doctors Plan_Bronze 7000 ded_CE_MZ_F86

Doctors Plan_Bronze 7200 ded_CE_M2_F83

Doctors Plan_Bronze 7200 ded_CE_M2_F83

Doctors Plan_Gold 1000 ded_CE_NH_F80

Doctors Plan_Gold 500 ded_CE_NG_F80

Doctors Plan_Platinum 0 ded_CE_MV_F85

Doctors Plan_Platinum 250 ded_CE_MW_F85

Doctors Plan_Platinum 250 ded_PA_CE_MX_F85

Doctors Plan_Silver 1750 ded_CE_NJ_F82

Doctors Plan_Silver 2250 ded_CE_NK_F82

Doctors Plan_Silver 2550 ded_CE_MY_F87

PPO Navigate

Navigate Bronze 6300 ded_CD_FE_C42L

Navigate Gold 350 ded_CD_FC_C40L

Navigate Platinum 0 ded_CD_FB_F21L

Navigate Silver 2250_CD_FD_F22L

Non-Differential PPO_Silver_CE_MI_F82

PPO Select Plus

Select Plus_Bronze 7000 ded_Motion_CE_MN_F86

Select Plus_Bronze 7200 ded_CE_MO_F83

Select Plus_Gold 0 ded_CE_M3_F84

Select Plus_Gold 1000 ded_CE_M5_F80

Select Plus_Gold 1500 ded_PA_CE_M6_F81

Select Plus_Gold 500 ded_CE_M4_F80

Select Plus_Platinum 0 ded_CE_MJ_F85

Select Plus_Platinum 250 ded_CE_MK_F85

Select Plus_Platinum 250 ded_PA_CE_ML_F85

Select Plus_Silver 1750 ded_CE_M7_F82

Select Plus_Silver 2250 ded_CE_M8_F82

Select Plus_Silver 2550 ded_CE_MM_F87

HMO

CEN2

CEN3

CEN5

CEN6

CEN7

CEN9

CENL

CENM

HMO

CENN

CENO

CENP

CENQ

CENR

CENS

CENT

CENU

HMO

CENV

CENW

CENX

CENY

CENZ

CEOA

CEOB

CEOC

HMO

CEOE

CEOF

CEOG

CEOI

CEOJ

CEOK

CEOL

CEOM

Health plan coverage provided by or through UnitedHealthcare Insurance Company, UHC of California and UnitedHealthcare Benefits Plan of California. Administrative services provided by United Healthcare Services, Inc., OptumRx or OptumHealth Care Solutions, Inc. Behavioral health products are provided by U.S. Behavioral Health Plan, California (USBHPC).

Summary of Benefits and Coverage

2020

2021