Partial federal government shutdown
HCA does not anticipate any immediate impacts to our services or disruption to provider payments at this time. We will continue to monitor the situation and share updates if anything changes.
PEBB and SEBB open enrollment is Monday, October 27 through Monday, November 24, 2025.
Find information on the open enrollment page that’s right for you: PEBB retirees, PEBB employees and PEBB continuation coverage subscribers, and SEBB employees and SEBB continuation coverage subscribers.
Benefits and coverage by plan
On this page
What is a benefits booklet?
The benefits booklets, also called a certificate of coverage (COC) or evidence of coverage (EOC), are produced by the health plans to provide detailed information about plan benefits and what is and is not covered.
What is a summary of benefits and coverage (SBC)?
Summaries of Benefits and Coverage (SBCs) are required under the federal Affordable Care Act to help members understand plan benefits and medical terms.
SBCs help you compare things like:
- Whether there are services a plan doesn't cover
- What isn't included in a plan's out-of-pocket limit
- Whether you need a referral to see a specialist
The SEBB Program and/or medical plans provide SBCs, or notice of how to get one, at different times throughout the year (like when you apply for coverage, renew your plan, or request an SBC). SBCs are available (upon request) in English, Spanish, Tagalog, Chinese, and Navajo.
SBC's don't replace medical benefits comparisons or the plans' benefits booklets.
What are preauthorization criteria?
Preauthorization is when you seek approval from your health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. Preauthorization is not a guarantee, however, that your plan will pay for those services, supplies or drugs.
The criteria included in the preauthorization requirements below state how a plan determines when a service, supply, or drug is medically necessary and will be covered.
Documentation by plan
- Kaiser Permanente NW
-
Evidence of Coverage
2026
2025
Summary of Benefits and Coverage
2026
2025
Preauthorization criteria
Kaiser Permanente NW preauthorization requirements
These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.
- Kaiser Permanente WA
-
Evidence of Coverage
2026
- Core 1 EOC (2026)
- Core 2 EOC (2026)
- Core 3 EOC (2026)
- SoundChoice EOC (2026)
- Summit PPO 1 EOC (2026)
- Summit PPO 2 EOC (2026)
- Summit PPO 3 EOC (2026)
2025
- Core 1 EOC (2025)
- Core 2 EOC (2025)
- Core 3 EOC (2025)
- SoundChoice EOC (2025)
- Summit PPO 1 EOC (2025)
- Summit PPO 2 EOC (2025)
- Summit PPO 3 EOC (2025)
Summary of Benefits and Coverage
2026
- Core 1 SBC (2026)
- Core 2 SBC (2026)
- Core 3 SBC (2026)
- SoundChoice SBC (2026)
- Summit PPO 1 SBC (2026)
- Summit PPO 2 SBC (2026)
- Summit PPO 3 SBC (2026)
2025
- Core 1 SBC (2025)
- Core 2 SBC (2025)
- Core 3 SBC (2025)
- SoundChoice SBC (2025)
- Summit PPO 1 SBC (2025)
- Summit PPO 2 SBC (2025)
- Summit PPO 3 SBC (2025)
Preauthorization criteria
Kaiser Permanente WA
Kaiser Permanente WA Options
These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.
- Premera
-
Benefits Booklet
2026
2025
Summary of Benefits and Coverage
2026
2025
Preauthorization criteria
Premera preauthorization requirements
These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.
- Uniform Medical Plan
-
Certificate of Coverage
2026
2025
- Achieve 1 COC (2025)
- Achieve 2 COC (2025)
- High Deductible COC (2025)
- UMP Plus-Puget Sound High Value Network COC (2025)
- UMP Plus-UW Medicine Accountable Care Network COC (2025)
Summary of Benefits and Coverage
2026
2025
- Achieve 1 SBC (2025)
- Achieve 2 SBC (2025)
- High Deductible SBC (2025)
- UMP Plus-Puget Sound High Value Network SBC (2025)
- UMP Plus-UW Medicine Accountable Care Network SBC (2025)
Preauthorization criteria
Regence preauthorization requirements (for medical)
- Document 1: Guidelines, inpatient admissions, radiology, sleep, physical medicine, lab, maternity medicine, and genetic testing
- Document 2: Substance use disorder, mental health, DME, surgery and transplants
- Medications covered under medical
ArrayRx preauthorization requirements (for pharmacy)
These criteria do not imply or guarantee approval. Please check with your plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.