Plan Documents: Generic
(Must have Acrobat Reader to view PDF documents, download is free)
If your plan is a grandfathered small employer plan (50 or fewer employees):
1500 60/45 plan (PDF)If your plan is a non-grandfathered transitional small employer plan (50 or fewer employees):
1500 60/45 plan* (PDF)High Deductible Health Plan 2* (PDF)
*List of specific preventive services to include with the non-grandfathered plan document: 2025 Preventive Services (PDF)
If your plan is a non-grandfathered large employer plan (51 or more employees):
High Deductible Health Plan 1* (PDF)
High Deductible Health Plan 2* (PDF)
*List of specific preventive services to include with the non-grandfathered plan document: 2025 Preventive Services (PDF)
High Deductible Health Plan 2* (PDF)
- Amendment to HDHP 2
Plan 1 = $2,500 family deductible (as of 1/1/26)
Plan 2 = $1,700 (single deductible) & $3,400 (family deductible) (as of 1/1/26)