summary of benefits and coverage (SBC)
Summary of Benefits and Coverage (SBCs) provide summary information about your health plans, such as benefits, copayments, deductibles, coinsurance and plan contact information. SBCs are not required for all health plans; only those listed below. You can open and print any of the SBCs on this page as desired. You can also call the HR Service Center and ask that an SBC be mailed to you free of charge.
2021
- Health Plan Hawaii (130)
- HMO Blue Texas (135)
- Humana Total Health Choice (145)
- Kaiser Northern California (165)
- Kaiser Southern California (170)
- Kaiser Colorado (150)
- Kaiser Hawaii (155)
- Kaiser Northwest (185)
- Kaiser WA (160)
- Humana USW Local 447 (140)
- Kaiser USW, Local 5 $500 Deductible HMO Plan (180)
- Kaiser USW Local 5 $15 HMO Plan (175)
- For employees not enrolled in a Chevron medical plan option (050)
- For employees enrolled in the Medical PPO plan (100)
- For employees enrolled in the HDHP (105)
- For employees enrolled in the HDHP Basic (110)
- For employees enrolled in the Global Choice (U.S.-payroll expatriates) (115)
- For employees enrolled in the Global Choice (Expatriates in the U.S.) (120)
- For employees enrolled in these Medical HMOs (B130): Health Plan Hawaii, Kaiser Hawaii, Humana USW (Local 447), Kaiser USW (Local 5 $500 Deductible), and Kaiser USW (Local 5 $15)
- For employees enrolled in all other Medical HMO Plans (A125)
2020
- Health Net of California (125)
- Health Plan Hawaii (130)
- HMO Blue Texas (135)
- Humana Total Health Choice (145)
- Kaiser Northern California (165)
- Kaiser Southern California (170)
- Kaiser Colorado (150+)
- Kaiser Hawaii (155)
- Kaiser Northwest (185)
- Kaiser WA (160)
- Humana USW Local 447 (140)
- Kaiser USW, Local 5 $500 Deductible HMO Plan (180)
- Kaiser USW Local 5 $15 HMO Plan (175)
- For employees not enrolled in a Chevron medical plan option (050)
- For employees enrolled in the Medical PPO plan (100)
- For employees enrolled in the HDHP (105)
- For employees enrolled in the HDHP Basic (110)
- For employees enrolled in the Global Choice (U.S.-payroll expatriates) (115)
- For employees enrolled in the Global Choice (Expatriates in the U.S.) (120)
- For employees enrolled in these Medical HMOs (B130): Health Plan Hawaii, Kaiser Hawaii, Humana USW (Local 447), Kaiser USW (Local 5 $500 Deductible), and Kaiser USW (Local 5 $15)
- For employees enrolled in all other Medical HMO Plans (A125)