These charts provide a detailed list of services that are covered or not covered, and the percentages the insurance company will pay for in-network and out-of-network providers.

2026 SBC & EOC will added as soon as they are available.  

Please see  Benefits eGuide for weekly contributions.

Flexible Spending Accounts

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Medical Plans
Anthem Blue Cross Resources Express Scripts Resources Health Savings Account (HSA) Information for CDHP members
Anthem PPO	SBC	Grid
Anthem CDHP	SBC (Premium HSA) SBC (Basic HSA)	Grid Grid
Anthem EPO (Non CA)	SBC	Grid
Anthem HMO (CA)	SBC	Grid
Kaiser Permanente Resources
Kaiser California	SBC	Grid
Kaiser Colorado	SBC	Grid
Kaiser Mid-Atlantic	SBC	Grid
Tricare Supplement	Grid

Dental and Vision
Delta Dental Resources
Delta Dental PPO	DPPO Premium Grid DPPO Basic Grid
Delta Dental HMO	DeltaCare DHMO Grid Summary of Benefits and Coverage Disclosure Matrix
VSP EasyOptions	VSP Basic Grid VSP Premium Grid