The plan documents below explain what CHPW Individual & Family Cascade Select health insurance plans do and do not cover, how much you’ll pay for care, options to access benefits, and much more.
Access the documents online, or call Customer Service to request a hard copy by mail: 1-866-907-1906.
Evidence of Coverage
The Evidence of Coverage (EOC) is also known as the Health Care Coverage Agreement. It is a binding contract that describes the health care benefits available to you, and your rights and responsibilities, under your plan.
Schedule of Benefits
The Schedule of Benefits (SB) details the fees associated with each type of health care service covered by your plan. This includes your deductible and out-of-pocket maximum amounts.
2023 Schedule of Benefits:
- AI/AN Gold Zero Cost Share
- AI/AN Gold Limited Cost Share
- Silver 73
- Silver 87
- Silver 94
- AI/AN Silver Zero Cost Share
- AI/AN Silver Limited Cost Share
- AI/AN Bronze Zero Cost Share
- AI/AN Bronze Limited Cost Share
Summary of Benefits and Coverage
The Summary of Benefits and Coverage (SBC) gives a snapshot, in plain language, of your health plan’s costs, benefits, covered health care services, and other features.
2023 Summary of Benefits and Coverage:
- Gold | Gold (Spanish)
- AI/AN Gold Zero Cost Share | AI/AN Gold Zero Cost Share (Spanish)
- AI/AN Gold Limited Cost Share | AI/AN Gold Limited Cost Share (Spanish)
- Silver | Silver (Spanish)
- Silver 73 | Silver 73 (Spanish)
- Silver 87 | Silver 87 (Spanish)
- Silver 94 | Silver 94 (Spanish)
- AI/AN Silver Zero Cost Share | AI/AN Silver Zero Cost Share (Spanish)
- AI/AN Silver Limited Cost Share | AI/AN Silver Limited Cost Share (Spanish)
- Bronze | Bronze (Spanish)
- AI/AN Bronze Zero Cost Share | AI/AN Bronze Zero Cost Share (Spanish)
- AI/AN Bronze Limited Cost Share | AI/AN Bronze Limited Cost Share (Spanish)
Online Payment Portal
Our secure E-Bill Express payment portal allows members to pay their monthly premiums and medical bills online.
Standard Consumer Notice
Know your rights under the Balance Billing Protection Act. Beginning January 1, 2020, Washington state law protects you from ‘surprise billing’ or ‘balance billing’ if you receive emergency care or are treated at an in-network hospital or outpatient surgical facility.
Member Rights Forms
As a CHPW Individual & Family plan member, you have certain rights designed to protect you when you get health care.
- Member Rights and Responsibilities
- Notice of Privacy Practices
- Notice of Disclosure
- Request Access to Protected Health Information (PHI)
- Authorization to Disclose Protected Health Information
- Authorization to Release Confidential Substance Use Disorder Treatment Information
- Request for Restriction(s) on the Use and Disclosure of Protected Health Information
- Request for Correction/Amendment of Protected Health Information
- Request for Confidential Communications
- Request for an Accounting of Disclosures
- Privacy/Security Incident Report
- Report Potential Fraud/ID Theft