document library

summary of benefits and coverage (SBC)

for retirees and survivors eligible for U.S. pre-65 health benefits.

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Learn more about your health plans, including resources that may be available.

summary plan descriptions

Summary Plan Descriptions (SPDs) provide specific details about your Chevron benefits, such as eligibility, covered services and participation rules.

plan contacts

Access phone numbers and websites for all your benefits.

Summary of Benefits and Coverage (SBCs) provide summary information about your pre-65 health plans, such as benefits, copayments, deductibles, coinsurance and plan contact information. You may not be eligible for all the plans listed below; see the summary plan descriptions for eligibility 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.

2025

Medical PPO Plan (300)
Medical PPO Plan - Medicare eligible (400)

High Deductible Health Plan (HDHP) (305)
HDHP - Medicare eligible (405)

High Deductible Health Plan Basic (HDHP Basic) (310)
HDHP Basic - Medicare eligible (410)

HMO Blue Texas (135)
Kaiser Colorado (150)
Kaiser Hawaii (155)
Kaiser WA (160)
Kaiser Northern California (165)
Kaiser Southern California (170)
Kaiser Northwest (185)
Kaiser USW Local 5 $500 Deductible HMO Plan (180)
Kaiser USW Local 5 $15 HMO Plan (175)

For pre-65 participants enrolled in the Medical PPO plan (300)
Forpre-65 participants enrolled in the HDHP (305)
For pre-65 participants enrolled in the HDHP Basic (310)


2024

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