Large Group Plans

Sample Evidence of Coverage

These samples do not contain the specific terms and conditions of the Evidence of Coverage for your plan. Log in to your secure account to access the Evidence of Coverage for your plan.

Maine

Schedule of Benefits (SOB)
​Summary of Benefits and Coverage (SBC)
​Benefit Handbook
​Prescription Drug Brochure 

Massachusetts

Schedule of Benefits (SOB)
​Summary of Benefits and Coverage (SBC)
​Benefit Handbook
​Prescription Drug Brochure 

New Hampshire

Schedule of Benefits (SOB)
​Summary of Benefits and Coverage (SBC)
​Benefit Handbook
​Prescription Drug Brochure 

Rhode Island

Schedule of Benefits (SOB)
​Summary of Benefits and Coverage (SBC)
​Benefit Handbook
​Prescription Drug Brochure 
 

For more information about your coverage options, you should contact the human resources department of your employer.