Welcome to Master Benefit Documentation

Click below to download the Summary of Benefits and Coverage PDF file(s).

Documentation for plan year 9/1/2024 – 8/31/2025

Blue Cross and Blue Shield of Illinois:

• MIBAH2010 Blue Advantage HMO $10 Copay
• MIBAH2020 Blue Advantage HMO $20 Copay
• MIBAV2110 Blue Advantage HMO Value Choice $40 Copay
• MIBAV2120 Blue Advantage HMO Value Choice $50 Copay
• MIBCO2000 Blue Choice Options $500-$1500
• MIBCO2040 Blue Choice Options $1500-$4500
• MIBCS2120 Blue Choice Select PPO $2500
• MIBPP2060 BluePrint PPO $1000
• MIBPP2080 BluePrint PPO $1500
• MIBPP2130 BluePrint PPO $2500
• MIBPP2170 BluePrint PPO $5000
• MICOE4064 Blue Choice Options $3200-$9200
• MIEEE3083 BlueEdge HSA $6000
• MIEEE4044 BlueEdge HSA $3200-$3200
• MIEEE4064 BlueEdge HSA $3200-$6200

Blue Cross and Blue Shield of Texas:

• MTBCB038 BC PPO 5000 2024
• MTBCP002 BC PPO 500 2024
• MTBCP011 BC PPO 1000 2024
• MTBCP012H BC HSA 5000 2024
• MTBCP019 BC PPO 2000 2024
• MTBCP026 BC PPO 3000 2024
• MTBCP318H BC HSA 3100 2024
• MTBEE011 BE HMO 1000 2024
• MTBEE027 BE HMO 3000 2024
• MTBEE040 BE HMO 5000 2024
• MTBPA007H BPA HMO HSA 5000 2024
• MTBPA025 BPA HMO 3000 2024

Aetna:

• CMed Indemnity 1,000-80% – 081200-010020-032403
• EPO OA 1,000 70% – 081200-010020-022464
• EPO OA 1,500 100% – 081200-010020-022467
• EPO OA 3,000 100% – 081200-010020-022470
• EPO OA 5,000 100% – 081200-010020-022471
• EPO OA 6,350 100% – 081200-010020-022478
• EPO OA 20 100% – 081200-010020-022457
• EPO OA 30 70% – 081200-010020-022461
• EPO OA HDHP 3,500 80% – 081200-010020-022493
• EPO OA HDHP 5,000 80% – 081200-010020-022494
• EPO OA HDHP 6,000 80% – 081200-010020-032402
• OAMC 1,000 80% – 081200-010020-022435
• OAMC 1,500 70% – 081200-010020-022436
• OAMC 2,000 80% – 081200-010020-022443
• OAMC 3,000 70% – 081200-010020-022446
• OAMC 5,000 70% – 081200-010020-022451
• OAMC 750 90% – 081200-010020-022432
• OAMC HDHP 3,250 90% – 081200-010020-022479
• OAMC HDHP 4,000 80% – 081200-010020-022480
• OAMC HDHP 6,350 100 – 081200-010020-022490
• PPO 1,000 80% – 081200-010020-032404
• PPO 2,000 80% – 081200-010020-032409
• PPO 5,000 70% – 081200-010020-032414
• PPO HDHP 3,250 90% – 081200-010020-032415

Guardian:

• Accident Advantage Plan Summary
• Accident Premier Plan Summary
• Basic Life 1x salary Plan Summary
• Basic Life 2x salary Plan Summary
• Basic Life 20k Plan Summary
• Basic Life 25k Plan Summary
• Basic Life 50k Plan Summary
• Critical Illness Plan Summary
• Dental High Plan – TX Summary
• Dental High Plan Plan Summary
• Dental HMO Plan Summary
• Dental Low Plan – TX Summary
• Dental Low Plan Plan Summary
• EAP FAQs for Managers
• Employee Assistance Brochure
• Global Travel Assistance Benefits_EAP
• Hospital Indemnity Plan Summary
• LTD Option 1 Plan Summary
• LTD Option 2 Plan Summary
• LTD Option 3 Plan Summary
• LTD Option 4 Plan Summary
• LTD Option 5 Plan Summary
• LTD Option 6 Plan Summary
• LTD Option 7 Plan Summary
• LTD Option 8 Plan Summary
• STD Option 1 Plan Summary
• STD Option 2 Plan Summary
• STD Option 3 Plan Summary
• STD Option 4 Plan Summary
• STD Option 5 Plan Summary
• STD Option 6 Plan Summary
• STD Option 7 Plan Summary
• STD Option 8 Plan Summary
• Vision High Plan – TX Summary
• Vision High Plan Summary
• Vision Low Plan – TX Summary
• Vision Low Plan Summary
• Voluntary Life Plan Summary

Quartz:

• HMO 750
• HMO 1500
• HMO 2000
• HMO 6000
• POS 300
• POS 750
• POS 1500
• POS 2000
• POS 6000
• PPO 300
• PPO 750
• PPO 1500
• PPO 2000
• PPO 6000

Documentation for plan year 9/1/2023 – 8/31/2024

Blue Cross and Blue Shield of Illinois:

• BCBSIL – MIBAH2010 HMOI
• BCBSIL – MIBAH2020
• BCBSIL – MIBAV2110
• BCBSIL – MIBAV2120
• BCBSIL – MIBCO2000
• BCBSIL – MIBCO2040
• BCBSIL – MIBCS2120
• BCBSIL – MIBPP2060
• BCBSIL – MIBPP2080
• BCBSIL – MIBPP2130
• BCBSIL – MIBPP2170
• BCBSIL – MICOE3063
• BCBSIL – MIEEE3063
• BCBSIL – MIEEE3083
• BCBSIL -MIEEE3043

Blue Cross and Blue Shield of Texas:

• BCBSTX- MTBCB038 BC PPO 5000
• BCBSTX- MTBCP002 BC PPO 500
• BCBSTX- MTBCP011 BC PPO 1000
• BCBSTX- MTBCP012H BC HSA 5000
• BCBSTX- MTBCP019 BC PPO 2000
• BCBSTX- MTBCP026 BC PPO 3000
• BCBSTX- MTBCP318H BC HSA 3100
• BCBSTX- MTBEE011 BE HMO 1000
• BCBSTX- MTBEE027 BE HMO 3000
• BCBSTX- MTBEE040 BE HMO 5000
• BCBSTX- MTBPA007H BPA HMO HSA 5000
• BCBSTX- MTBPA025 BPA HMO 3000

Quartz:

• Quartz- HMO 300
• Quartz- HMO 750
• Quartz- HMO 1500
• Quartz- HMO HSA 2000
• Quartz- HMO HSA 6000
• Quartz- POS 300
• Quartz- POS 750
• Quartz- POS 1500
• Quartz- POS HSA 2000
• Quartz- POS HSA 6000
• Quartz- PPO 300
• Quartz- PPO 750
• Quartz- PPO 1500
• Quartz- PPO HSA 2000
• Quartz- PPO HSA 6000

Aetna:

• CMed Indemnity 1,000-80%
• EPO OA 1,000 70%
• EPO OA 1,500 100%
• EPO OA 3,000 100%
• EPO OA 5,000 100%
• EPO OA 6,350 100%
• EPO OA 20 100%
• EPO OA 30 70%
• EPO OA HDHP 3,500 80%
• EPO OA HDHP 5,000 80%
• EPO OA HDHP 6,000 80%
• OAMC 1,000 80%
• OAMC 1,500 70%
• OAMC 2,000 80%
• OAMC 3,000 70%
• OAMC 5,000 70%
• OAMC 750 90%
• OAMC HDHP 3,250 90%
• OAMC HDHP 4,000 80%
• OAMC HDHP 6,350 100
• PPO 1,000 80%
• PPO 2,000 80%
• PPO 5,000 70%
• PPO HDHP 3,250 90%

Guardian:

• Accident Advantage Plan Summary
• Accident Premier Plan Summary
• Basic Life 1x salary Plan Summary
• Basic Life 2x salary Plan Summary
• Basic Life 20k Plan Summary
• Basic Life 25k Plan Summary
• Basic Life 50k Plan Summary
• Critical Illness Plan Summary
• Dental High Plan – TX Summary
• Dental High Plan Plan Summary
• Dental HMO Plan Summary
• Dental Low Plan – TX Summary
• Dental Low Plan Plan Summary
• EAP FAQs for Managers
• Employee Assistance Brochure
• Global Travel Assistance Benefits_EAP
• Hospital Indemnity Plan Summary
• LTD Option 1 Plan Summary
• LTD Option 2 Plan Summary
• LTD Option 3 Plan Summary
• LTD Option 4 Plan Summary
• LTD Option 5 Plan Summary
• LTD Option 6 Plan Summary
• LTD Option 7 Plan Summary
• LTD Option 8 Plan Summary
• STD Option 1 Plan Summary
• STD Option 2 Plan Summary
• STD Option 3 Plan Summary
• STD Option 4 Plan Summary
• STD Option 5 Plan Summary
• STD Option 6 Plan Summary
• STD Option 7 Plan Summary
• STD Option 8 Plan Summary
• Vision High Plan – TX Summary
• Vision High Plan Summary
• Vision Low Plan – TX Summary
• Vision Low Plan Summary
• Voluntary Life Plan Summary

Click below to download the Summary Annual Reports PDF file(s).

• 2023 SAR – QTI – 508
• 2023 SAR – Tandem Sec 125 – 501
• 2023 SAR – Short Year – Midwest Sec 125 – 506
• 2023 SAR – Short Year – Tandem Health Welfare – 503
• 2023 SAR – Short Year – Tandem Welfare – 502
• 2022 SAR – Midwest Vol Ins – 505
• 2022 SAR – Midwest Vision – 504
• 2022 SAR – Midwest Dental – 502
• 2022 SAR – Midwest Medical – 501
• 2022 SAR – Midwest Sec 125 – 506
• 2022 SAR – QTI – 508
• 2022 SAR – Tandem Health Welfare – 503
• 2022 SAR – Tandem Sec 125 – 501
• 2022 SAR – Tandem Welfare – 502

Click below to download the Certificate of Insurance PDF file(s).

• 555406 Basic Life 1xSalary