Legal Notices & Documents

Important documents and forms are provided for your convenience below.

Life and Disability Certificates can be found on MyMosaic.

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2025 IL EHB Disclosure Notice

2025 Active Additional Notices

2025 Medical Consumer Plan Summary of Benefits and Coverage (SBC)

2025 Medical Traditional Plan Summary of Benefits and Coverage (SBC)

2025 Mosaic CHIP Notice

2025 Notice of Creditable Coverage

2023 Summary Annual Report

2025 Surprise Billing Notice

2024 Prescription Drug Coverage Summary Plan Description (SPD)

2024 - 2025 Summary of Material Modifications

2025 Cigna Medical Certificate Rider (MA)

2025 Cigna Medical – Traditional Plan Certificate

2025 Cigna Medical – Consumer Plan Certificate

Mosaic Wrap Summary Plan Description (SPD) 7/2022

Guardian Basic Dental Plan Certificate – Non-Carlsbad

Guardian Comprehensive Dental Plan Certificate – Non-Carlsbad

2025 Cigna Basic Dental Plan Certificate - Carlsbad Only

2025 Cigna Comprehensive Dental Plan Certificate - Carlsbad Only

EyeMed Vision Certificate – Non-Carlsbad

2024 VSP Vision Certificate - Carlsbad Only

This link leads to the machine readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

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