Benefits and coverage by plan

Get plan benefits booklets, find out what is covered, and your costs for care.

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What is a benefits booklet?

The benefits booklets, also called an evidence of coverage (EOC) or a certificate of coverage (COC), are produced by the health plans to provide detailed information about plan benefits and what is and is not covered. They are the primary source of coverage provisions offered under the plan.

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 are not available for Medicare Advantage plans and Medicare Supplement Plans. For PEBB Medicare plan summaries, use the Medical Benefit Comparison tool or the Benefits Comparison for PEBB Medicare plans.

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 PEBB 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.

SBCs don't replace the PEBB Medical Benefit Comparison tool, or the plans' benefits booklet.

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

2025

Summary of Benefits and Coverage

2026

2025

Preauthorization criteria

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 Medicare Supplement Plan

2026

2025

Uniform Medical Plan

Certificate of Coverage

2026

2025

Summary of Benefits and Coverage

2026

2025

Preauthorization criteria

Regence preauthorization requirements (for 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.

UnitedHealthcare

Evidence of Coverage

2026

2025

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