Policy and Plan Documents

Select your plan type to view available policies. Not all plans have the same policies or options. Not sure which plan you have? Check your benefit summary or with your employer to determine your benefit plan.

To request another copy of your Benefit Summary, contact our Customer Service Team at CustomerServiceCorrespondence@HealthTradition.com or 877.832.1823.

Health Tradition Large Group HMO

As of 2022, riders have been incorporated into the benefit summary. Please reference your benefit summary for any corresponding riders.

To request a copy of your benefit summary, contact our Customer Service Team at CustomerServiceCorrespondence@HealthTradition.com or 877.832.1823.

Plan Year	Certificate	Amendment(s)	Rider(s)
2022	2022 Health Tradition Large Group HMO Certificate	2022 Health Tradition Large Group HMO Amendment	2022 Health Tradition Large Group HMO Disabled Employee Continuation Rider 2022 Health Tradition Large Group HMO Disabled Employee Continuation – Limited Duration Rider 2022 Health Tradition Large Group HMO Domestic Partner Rider 2022 Health Tradition Large Group HMO Drug Plan Amendment Rider 2022 Health Tradition Large Group HMO Global Office Visit Rider 2022 Health Tradition Large Group HMO Retired Employee Continuation Rider 2022 Health Tradition Large Group HMO Retired Employee Continuation – Limited Duration Rider 2022 Health Tradition Large Group HMO Retired Employee Continuation – Consecutive COBRA Rider 2022 Health Tradition Large Group HMO Retired Employee Spousal Continuation Rider 2022 Health Tradition Large Group HMO Return Eligibility Rider 2022 Health Tradition Large Group HMO Surviving Dependent Continuation Rider 2022 Health Tradition Large Group HMO Surviving Dependent Continuation – Limited Duration Rider 2022 Health Tradition Large Group HMO Termination RiderA
2021	2021 Health Tradition Large Group HMO Certificate	N/A	2021 Health Tradition Large Group HMO Disabled Employee Continuation Rider 2021 Health Tradition Large Group HMO Disabled Employee Continuation – Limited Duration Rider 2021 Health Tradition Large Group HMO Domestic Partner Rider 2021 Health Tradition Large Group HMO Drug Plan Amendment Rider 2021 Health Tradition Large Group HMO Retired Employee Continuation Rider 2021 Health Tradition Large Group HMO Retired Employee Continuation – Limited Duration Rider 2021 Health Tradition Large Group HMO Retired Employee Continuation – Consecutive COBRA Rider 2021 Health Tradition Large Group HMO Retired Employee Spousal Continuation Rider 2021 Health Tradition Large Group HMO Return Eligibility Rider 2021 Surviving Dependent Continuation Rider 2021 Health Tradition Large Group HMO Surviving Dependent Continuation – Limited Duration Rider 2021 Health Tradition Large Group HMO Termination Rider

Health Tradition Large Group HMO CarePlus

As of 2022, riders have been incorporated into the benefit summary. Please reference your benefit summary for any corresponding riders.

To request a copy of your benefit summary, contact our Customer Service Team at CustomerServiceCorrespondence@HealthTradition.com or 877.832.1823.

Plan Year	Certificate	Amendment(s)	Rider(s)
2022	2022 Health Tradition Large Group HMO CarePlus Certificate	2022 Health Tradition Large Group HMO CarePlus Amendment	2022 Health Tradition Large Group HMO CarePlus Disabled Employee Continuation Rider 2022 Health Tradition Large Group HMO CarePlus Disabled Employee Continuation – Limited Duration Rider 2022 Health Tradition Large Group HMO CarePlus Domestic Partner Rider 2022 Health Tradition Large Group HMO CarePlus Drug Plan Amendment Rider 2022 Health Tradition Large Group HMO CarePlus Retired Employee Continuation Rider 2022 Health Tradition Large Group HMO CarePlus Retired Employee Continuation – Limited Duration Rider 2022 Health Tradition Large Group HMO CarePlus Retired Employee Continuation – Consecutive COBRA Rider 2022 Health Tradition Large Group HMO CarePlus Retired Employee Spousal Continuation Rider 2022 Health Tradition Large Group HMO CarePlus Return Eligibility Rider 2022 Health Tradition Large Group HMO CarePlus Surviving Dependent Continuation Rider 2022 Health Tradition Large Group HMO CarePlus Surviving Dependent Continuation – Limited Duration Rider 2022 Health Tradition Large Group HMO CarePlus Termination Rider
2021	2021 Health Tradition Large Group HMO CarePlus Certificate	N/A	2021 Health Tradition Large Group HMO CarePlus Disabled Employee Continuation Rider 2021 Health Tradition Large Group HMO CarePlus Disabled Employee Continuation – Limited Duration Rider 2021 Health Tradition Large Group HMO CarePlus Domestic Partner Rider 2021 Health Tradition Large Group HMO CarePlus Drug Plan Amendment Rider 2021 Health Tradition Large Group HMO CarePlus Retired Employee Continuation Rider 2021 Health Tradition Large Group HMO CarePlus Retired Employee Continuation – Limited Duration Rider 2021 Health Tradition Large Group HMO CarePlus Retired Employee Continuation – Consecutive COBRA Rider 2021 Health Tradition Large Group HMO CarePlus Retired Employee Spousal Continuation Rider 2021 Health Tradition Large Group HMO CarePlus Return Eligibility Rider 2021 Health Tradition Large Group HMO CarePlus Surviving Dependent Continuation Rider 2021 Health Tradition Large Group HMO CarePlus Surviving Dependent Continuation – Limited Duration Rider 2021 Health Tradition Large Group HMO CarePlus Termination Rider

Plan Year

Certificate

Amendment(s)

Rider(s)

2022

2022 Health Tradition Large Group HMO CarePlus Certificate

2022 Health Tradition Large Group HMO CarePlus Amendment

2021

2021 Health Tradition Large Group HMO CarePlus Certificate

N/A

Health Tradition Large Group POS

As of 2022, riders have been incorporated into the benefit summary. Please reference your benefit summary for any corresponding riders.

To request a copy of your benefit summary, contact our Customer Service Team at CustomerServiceCorrespondence@HealthTradition.com or 877.832.1823.

Plan Year	Certificate	Amendment(s)	Rider(s)
2022	2022 Health Tradition Large Group POS Certificate	2022 Health Tradition Large Group POS Amendment	2022 Health Tradition Large Group POS Disabled Employee Continuation Rider 2022 Health Tradition Large Group POS Disabled Employee Continuation – Limited Duration 2022 Health Tradition Large Group POS Domestic Partner Rider 2022 Health Tradition Large Group POS Drug Plan Amendment Rider 2022 Health Tradition Large Group POS Global Office Visit Rider 2022 Health Tradition Large Group POS Out of Area Coverage Rider 2022 Health Tradition Large Group POS Preventive Health Services Rider 2022 Health Tradition Large Group POS Retired Employee Continuation Rider 2022 Health Tradition Large Group POS Retired Employee Continuation – Limited Duration Rider 2022 Health Tradition Large Group POS Retired Employee Continuation – Consecutive COBRA Rider 2022 Health Tradition Large Group POS Retired Employee Spousal Continuation 2022 Health Tradition Large Group POS Return Eligibility Rider 2022 Health Tradition Large Group POS Surviving Dependent Continuation Rider 2022 Health Tradition Large Group POS Surviving Dependent Continuation – Limited Duration Rider 2022 Health Tradition Large Group POS Termination Rider
2021	2021 Health Tradition Large Group POS Certificate	N/A	2021 Health Tradition Large Group POS Disabled Employee Continuation Rider 2021 Health Tradition Large Group POS Disabled Employee Continuation – Limited Duration 2021 Health Tradition Large Group POS Domestic Partner Rider 2021 Health Tradition Large Group POS Drug Plan Amendment Rider 2021 Health Tradition Large Group POS Out of Area Coverage Rider 2021 Health Tradition Large Group POS Preventive Health Services Rider 2021 Health Tradition Large Group POS Retired Employee Continuation Rider 2021 Health Tradition Large Group POS Retired Employee Continuation – Limited Duration Rider 2021 Health Tradition Large Group POS Retired Employee Continuation – Consecutive COBRA Rider 2021 Health Tradition Large Group POS Retired Employee Spousal Continuation 2021 Health Tradition Large Group POS Return Eligibility Rider 2021 Health Tradition Large Group POS Surviving Dependent Continuation Rider 2021 Health Tradition Large Group POS Surviving Dependent Continuation – Limited Duration Rider 2021 Health Tradition Large Group POS Termination Rider

Plan Year

Certificate

Amendment(s)

Rider(s)

2022

2022 Health Tradition Large Group POS Certificate

2022 Health Tradition Large Group POS Amendment

2021

2021 Health Tradition Large Group POS Certificate

N/A

Health Tradition Small Group HMO

Plan Year	Certificate	Amendment(s)	Rider(s)
2022	2022 Health Tradition Small Group HMO Certificate	N/A	N/A
2021	2021 Health Tradition Small Group HMO Certificate	N/A	N/A

Plan Year

Certificate

Amendment(s)

Rider(s)

2022

2022 Health Tradition Small Group HMO Certificate

N/A

2021

2021 Health Tradition Small Group HMO Certificate

N/A

Health Tradition Small Group POS

Plan Year	Certificate	Amendment(s)	Rider(s)
2022	2022 Health Tradition Small Group POS Certificate	N/A	N/A
2021	2021 Health Tradition Small Group POS Certificate	N/A	N/A

Plan Year

Certificate

Amendment(s)

Rider(s)

2022

2022 Health Tradition Small Group POS Certificate

N/A

2021

2021 Health Tradition Small Group POS Certificate

N/A

Health Tradition 65Plus Platinum

Plan Year	Certificate	Amendment(s)	Rider(s)
2022	2022 Medicare Select 65Plus Platinum Policy	N/A	N/A
2021	N/A	N/A	N/A

Plan Year

Certificate

Amendment(s)

Rider(s)

2022

2022 Medicare Select 65Plus Platinum Policy

N/A

2021

N/A

Health Tradition 65Plus Premier

Plan Year	Certificate	Amendment(s)	Rider(s)
2022	2022 Medicare Select 65Plus Premier Policy	N/A	N/A
2021	N/A	N/A	N/A

Plan Year

Certificate

Amendment(s)

Rider(s)

2022

2022 Medicare Select 65Plus Premier Policy

N/A

2021

N/A

New Member Information

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Health Tradition Large Group HMO

Health Tradition Large Group HMO

Health Tradition Large Group HMO CarePlus

Health Tradition Large Group HMO CarePlus

Health Tradition Large Group POS

Health Tradition Large Group POS

Health Tradition Small Group HMO

Health Tradition Small Group HMO

Health Tradition Small Group POS

Health Tradition Small Group POS

Health Tradition 65Plus Platinum

Health Tradition 65Plus Platinum

Health Tradition 65Plus Premier

Health Tradition 65Plus Premier

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Policy and Plan Documents

Health Tradition Large Group HMO

Health Tradition Large Group HMO CarePlus

Health Tradition Large Group POS

Health Tradition Small Group HMO

Health Tradition Small Group POS

Health Tradition 65Plus Platinum

Health Tradition 65Plus Premier

We Make It Easy To Talk With An Expert.

Call Us Monday Through Friday 7:30 a.m. to 5:00 p.m. CST

Customer Service for Members

Customer Service for Providers

Medicare 65Plus Platinum Enrollment & Application Questions

Fax Information

We Make It Easy To
Talk With An Expert.

Call Us Monday Through Friday
7:30 a.m. to 5:00 p.m. CST

Medicare 65Plus Platinum
Enrollment & Application Questions