Table of Contents Table of Contents
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Contact Information
4

Eligibility
5

Frequently Asked Questions
5

Pre-Notification Information
5

Anthem Providers
6

Medical Insurance
7

Base Plan (QHDHP) Option
4

Buy-Up Plan Option
8

Enhanced Plan Option
9

Prescription Benefits
10

Preventive Care
10

Women's Preventive Care Coverage
10

Summary of Material Modification
10

Health Savings Account (HSA)
11

Dental Insurance
13

Vision Insurance
13

Basic Life and Accidental Death & Dismemberment Insurance
15

Voluntary Life and Accidental Death & Dismemberment Insurance
15

Flexible Spending Accounts (FSAs)
16

Important Notices
18

Glossary of Terms
21