Aetna

Founded in 1853 in Hartford, CT, Aetna is committed to providing individuals, employers, health care professionals, producers and others with innovative benefits, products and services.

Provider Finder

Form Name Effective Date Download Form
New Group Submission
New Business Submission Checklist 1.22
01/01/2022 Download
New Business Submission Checklist 1.23
01/01/2023 Download
Employer Application 1.22
06/01/2022 Download
Employer Application 1.23
01/01/2023 Download
Small Group ACA Banking Consent Form
01/01/2022 Download
In Force Group Forms
Cal-COBRA Employer Notice of Qualifying Event Form
03/01/2022 Download
Employer Verification Form
01/01/2022 Download
Small Employer Certification Form (FTE Certification)
01/01/2022 Download
Administration
Employer Administrative Handbook
01/01/2022 Download
New Customer Quick Start Guide
01/01/2022 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Enrollment Change Form 1.22
01/01/2022 Download
Employee Enrollment Change Form 1.23
01/01/2023 Download
Request for Continuation of Coverage for Disabled Child
01/01/2022 Download
Disabled Child Attending Physician Statement
01/01/2022 Download
Transition of Care Form (HMO)
01/01/2022 Download
Transition of Care Form (PPO)
01/01/2022 Download
Claim Forms
Authorization to Release Protected Health Information Form
01/01/2022 Download
Medical Claim Form
01/01/2022 Download
Pharmacy Claim Form
01/01/2022 Download
Mail Order Rx Delivery-Registration Form
01/01/2022 Download
Dental Claim Form
01/01/2022 Download
Vision Claim Form (Benefits within a Medical Plan)
01/01/2022 Download
Vision Claim Form (Benefits through Aetna Vision Preferred Plan)
01/01/2022 Download
Form Name Effective Date Download Form
2023 Medical HMO
Full HMO Network
HMO Platinum CA $20/40 0 Ded
01/01/2023 Summary SBC
HMO Platinum CA $20/40 0 Ded wINF
01/01/2023 Summary SBC
HMO Gold CA $30/60 0 Ded
01/01/2023 Summary SBC
HMO Gold CA $30/60 0 Ded wINF
01/01/2023 Summary SBC
HMO Gold CA $35/65 250 Ded
01/01/2023 Summary SBC
HMO Gold CA $35/65 250 Ded wINF
01/01/2023 Summary SBC
HMO Gold CA $25/50 500 Ded
01/01/2023 Summary SBC
HMO Gold CA $25/50 500 Ded wINF
01/01/2023 Summary SBC
HMO Gold CA $30/70 1250 Ded
01/01/2023 Summary SBC
HMO Gold CA $30/70 1250 Ded wINF
01/01/2023 Summary SBC
HMO Silver CA $50/70 0 Ded
01/01/2023 Summary SBC
HMO Silver CA $50/70 0 Ded wINF
01/01/2023 Summary SBC
HMO Silver CA $60/100 2500 Ded
01/01/2023 Summary SBC
HMO Silver CA $60/100 2500 Ded wINF
01/01/2023 Summary SBC
HMO Bronze CA $75/125 7900 Ded
01/01/2023 Summary SBC
HMO Bronze CA $75/125 7900 Ded wINF
01/01/2023 Summary SBC
Aetna Value Network
Aetna Value Network HMO Platinum CA $20/30 0 Ded
01/01/2023 Summary SBC
Aetna Value Network HMO Platinum CA $20/30 0 Ded wINF
01/01/2023 Summary SBC
Aetna Value Network HMO Platinum CA $20/40 0 Ded
01/01/2023 Summary SBC
Aetna Value Network HMO Platinum CA $20/40 0 Ded wINF
01/01/2023 Summary SBC
Aetna Value Network HMO Gold CA $30/60 0 Ded
01/01/2023 Summary SBC
Aetna Value Network HMO Gold CA $30/60 0 Ded wINF
01/01/2023 Summary SBC
Aetna Value Network HMO Gold CA $35/55 250 Ded
01/01/2023 Summary SBC
Aetna Value Network HMO Gold CA $35/55 250 Ded wINF
01/01/2023 Summary SBC
Aetna Value Network HMO Gold CA $35/65 250 Ded
01/01/2023 Summary SBC
Aetna Value Network HMO Gold CA $35/65 250 Ded wINF
01/01/2023 Summary SBC
Aetna Value Network HMO Gold CA $25/50 500 Ded
01/01/2023 Summary SBC
Aetna Value Network HMO Gold CA $25/50 500 Ded wINF
01/01/2023 Summary SBC
Aetna Value Network HMO Gold CA $30/70 1250 Ded
01/01/2023 Summary SBC
Aetna Value Network HMO Gold CA $30/70 1250 Ded wINF
01/01/2023 Summary SBC
Aetna Value Network HMO Silver CA $50/70 0 Ded
01/01/2023 Summary SBC
Aetna Value Network HMO Silver CA $50/70 0 Ded wINF
01/01/2023 Summary SBC
Aetna Value Network HMO Silver CA $55/90 2500 Ded
01/01/2023 Summary SBC
Aetna Value Network HMO Silver CA $55/90 2500 Ded wINF
01/01/2023 Summary SBC
Aetna Value Network HMO Silver CA $60/100 2500 Ded
01/01/2023 Summary SBC
Aetna Value Network HMO Silver CA $60/100 2500 Ded wINF
01/01/2023 Summary SBC
Aetna Value Network HMO Bronze CA $75/125 7900 Ded
01/01/2023 Summary SBC
Aetna Value Network HMO Bronze CA $75/125 7900 Ded wINF
01/01/2023 Summary SBC
Basic Network
HMO Basic Platinum CA $20/40 0 Ded
01/01/2023 Summary SBC
HMO Basic Platinum CA $20/40 0 Ded wINF
01/01/2023 Summary SBC
HMO Basic Gold CA $30/60 0 Ded
01/01/2023 Summary SBC
HMO Basic Gold CA $30/60 0 Ded wINF
01/01/2023 Summary SBC
HMO Basic Gold CA $35/65 250 Ded
01/01/2023 Summary SBC
HMO Basic Gold CA $35/65 250 Ded wINF
01/01/2023 Summary SBC
HMO Basic Gold CA $25/50 500 Ded
01/01/2023 Summary SBC
HMO Basic Gold CA $25/50 500 Ded wINF
01/01/2023 Summary SBC
HMO Basic Gold CA $30/70 1250 Ded
01/01/2023 Summary SBC
HMO Basic Gold CA $30/70 1250 Ded wINF
01/01/2023 Summary SBC
HMO Basic Silver CA $50/70 0 Ded
01/01/2023 Summary SBC
HMO Basic Silver CA $50/70 0 Ded wINF
01/01/2023 Summary SBC
HMO Basic Silver CA $60/100 2500 Ded
01/01/2023 Summary SBC
HMO Basic Silver CA $60/100 2500 Ded wINF
01/01/2023 Summary SBC
HMO Basic Bronze CA $65/95 6300 Ded
01/01/2023 Summary SBC
HMO Basic Bronze CA $65/95 6300 Ded wINF
01/01/2023 Summary SBC
HMO Basic Bronze CA $75/125 7900 Ded
01/01/2023 Summary SBC
HMO Basic Bronze CA $75/125 7900 Ded wINF
01/01/2023 Summary SBC
Aetna Whole Health Network Southern CA
AWH Southern CA HMO Platinum CA $20/30 0 Ded
01/01/2023 Summary SBC
AWH Southern CA HMO Platinum CA $20/30 0 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA HMO Platinum CA $20/40 0 Ded
01/01/2023 Summary SBC
AWH Southern CA HMO Platinum CA $20/40 0 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA HMO Gold CA $30/60 0 Ded
01/01/2023 Summary SBC
AWH Southern CA HMO Gold CA $30/60 0 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA HMO Gold CA $35/55 250 Ded
01/01/2023 Summary SBC
AWH Southern CA HMO Gold CA $35/55 250 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA HMO Gold CA $35/65 250 Ded
01/01/2023 Summary SBC
AWH Southern CA HMO Gold CA $35/65 250 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA HMO Gold CA $25/50 500 Ded
01/01/2023 Summary SBC
AWH Southern CA HMO Gold CA $25/50 500 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA HMO Gold CA $30/70 1250 Ded
01/01/2023 Summary SBC
AWH Southern CA HMO Gold CA $30/70 1250 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA HMO Silver CA $50/70 0 Ded
01/01/2023 Summary SBC
AWH Southern CA HMO Silver CA $50/70 0 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA HMO Silver CA $55/90 2500 Ded
01/01/2023 Summary SBC
AWH Southern CA HMO Silver CA $55/90 2500 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA HMO Silver CA $60/100 2500 Ded
01/01/2023 Summary SBC
AWH Southern CA HMO Silver CA $60/100 2500 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA HMO Bronze CA $75/125 7900 Ded
01/01/2023 Summary SBC
AWH Southern CA HMO Bronze CA $75/125 7900 Ded wINF
01/01/2023 Summary SBC
Aetna Whole Health Network Northern CA
AWH Northern CA HMO Platinum CA $20/30 0 Ded
01/01/2023 Summary SBC
AWH Northern CA HMO Platinum CA $20/30 0 Ded wINF
01/01/2023 Summary SBC
AWH Northern CA HMO Platinum CA $20/40 0 Ded
01/01/2023 Summary SBC
AWH Northern CA HMO Platinum CA $20/40 0 Ded wINF
01/01/2023 Summary SBC
AWH Northern CA HMO Gold CA $30/60 0 Ded
01/01/2023 Summary SBC
AWH Northern CA HMO Gold CA $30/60 0 Ded wINF
01/01/2023 Summary SBC
AWH Northern CA HMO Gold CA $35/55 250 Ded
01/01/2023 Summary SBC
AWH Northern CA HMO Gold CA $35/55 250 Ded wINF
01/01/2023 Summary SBC
AWH Northern CA HMO Gold CA $35/65 250 Ded
01/01/2023 Summary SBC
AWH Northern CA HMO Gold CA $35/65 250 Ded wINF
01/01/2023 Summary SBC
AWH Northern CA HMO Gold CA $25/50 500 Ded
01/01/2023 Summary SBC
AWH Northern CA HMO Gold CA $25/50 500 Ded wINF
01/01/2023 Summary SBC
AWH Northern CA HMO Gold CA $30/70 1250 Ded
01/01/2023 Summary SBC
AWH Northern CA HMO Gold CA $30/70 1250 Ded wINF
01/01/2023 Summary SBC
AWH Northern CA HMO Silver CA $50/70 0 Ded
01/01/2023 Summary SBC
AWH Northern CA HMO Silver CA $50/70 0 Ded wINF
01/01/2023 Summary SBC
AWH Northern CA HMO Silver CA $55/90 2500 Ded
01/01/2023 Summary SBC
AWH Northern CA HMO Silver CA $55/90 2500 Ded wINF
01/01/2023 Summary SBC
AWH Northern CA HMO Silver CA $60/100 2500 Ded
01/01/2023 Summary SBC
AWH Northern CA HMO Silver CA $60/100 2500 Ded wINF
01/01/2023 Summary SBC
AWH Northern CA HMO Bronze CA $75/125 7900 Ded
01/01/2023 Summary SBC
AWH Northern CA HMO Bronze CA $75/125 7900 Ded wINF
01/01/2023 Summary SBC
2023 Medical PPO
Managed Choice POS Network
OA Managed Choice POS Platinum CA 90/50 0 Ded
01/01/2023 Summary SBC
OA Managed Choice POS Platinum CA 90/50 0 Ded wINF
01/01/2023 Summary SBC
OA Managed Choice POS Platinum CA 80/50 250 Ded
01/01/2023 Summary SBC
OA Managed Choice POS Platinum CA 80/50 250 Ded wINF
01/01/2023 Summary SBC
OA Managed Choice POS Gold CA 80/50 350 Ded
01/01/2023 Summary SBC
OA Managed Choice POS Gold CA 80/50 350 Ded wINF
01/01/2023 Summary SBC
OA Managed Choice POS Gold CA 75/50 500 Ded
01/01/2023 Summary SBC
OA Managed Choice POS Gold CA 75/50 500 Ded wINF
01/01/2023 Summary SBC
OA Managed Choice POS Gold CA 70/50 1250 Ded
01/01/2023 Summary SBC
OA Managed Choice POS Gold CA 70/50 1250 Ded wINF
01/01/2023 Summary SBC
OA Managed Choice POS Gold CA 80/50 1500 Ded
01/01/2023 Summary SBC
OA Managed Choice POS Gold CA 80/50 1500 Ded wINF
01/01/2023 Summary SBC
OA Managed Choice POS Gold HDHP CA 90/50 3000 Ded HSA
01/01/2023 Summary SBC
OA Managed Choice POS Gold HDHP CA 90/50 3000 Ded HSA wINF
01/01/2023 Summary SBC
OA Managed Choice POS Silver CA 60/50 2100 Ded
01/01/2023 Summary SBC
OA Managed Choice POS Silver CA 60/50 2100 Ded wINF
01/01/2023 Summary SBC
OA Managed Choice POS Silver CA Copay Plan 65/50 2500 Ded
01/01/2023 Summary SBC
OA Managed Choice POS Silver CA Copay Plan 65/50 2500 Ded wINF
01/01/2023 Summary SBC
OA Managed Choice POS Silver CA 65/50 2600 Ded
01/01/2023 Summary SBC
OA Managed Choice POS Silver CA 65/50 2600 Ded wINF
01/01/2023 Summary SBC
OA Managed Choice POS Bronze CA 55/50 4600 Ded
01/01/2023 Summary SBC
OA Managed Choice POS Bronze CA 55/50 4600 Ded wINF
01/01/2023 Summary SBC
OA Managed Choice POS Bronze CA 100/50 7350 Ded
01/01/2023 Summary SBC
OA Managed Choice POS Bronze CA 100/50 7350 Ded wINF
01/01/2023 Summary SBC
OA Managed Choice POS Bronze CA 50/50 8300 Ded
01/01/2023 Summary SBC
OA Managed Choice POS Bronze CA 50/50 8300 Ded wINF
01/01/2023 Summary SBC
OA Managed Choice POS Bronze HDHP CA 100 7000 Ded HSA
01/01/2023 Summary SBC
OA Managed Choice POS Bronze HDHP CA 100 7000 Ded HSA wINF
01/01/2023 Summary SBC
Savings Plus Managed Choice POS Network
Savings Plus OA Managed Choice POS Platinum CA 90/50 0 Ded
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Platinum CA 90/50 0 Ded wINF
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Platinum CA 80/50 250 Ded
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Platinum CA 80/50 250 Ded wINF
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 350 Ded
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 350 Ded wINF
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 75/50 500 Ded
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 75/50 500 Ded wINF
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 70/50 1250 Ded
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 70/50 1250 Ded wINF
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 1500 Ded
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 1500 Ded wINF
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Gold HDHP CA 90/50 3000 Ded HSA
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Gold HDHP CA 90/50 3000 Ded HSA wINF
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Silver CA 60/50 2100 Ded
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Silver CA 60/50 2100 Ded wINF
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Silver CA 65/50 2600 Ded
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Silver CA 65/50 2600 Ded wINF
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Silver CA Copay Plan 65/50 2500 Ded
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Silver CA Copay Plan 65/50 2500 Ded wINF
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 55/50 4600 Ded
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 55/50 4600 Ded wINF
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 100/50 7350 Ded
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 100/50 7350 Ded wINF
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 50/50 8300 Ded
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 50/50 8300 Ded wINF
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Bronze HDHP CA 100 7000 Ded HSA
01/01/2023 Summary SBC
Savings Plus OA Managed Choice POS Bronze HDHP CA 100 7000 Ded HSA wINF
01/01/2023 Summary SBC
Aetna Whole Health Network Southern CA Managed Choice POS Network
AWH Southern CA OA Managed Choice POS Platinum CA 80/50 250 Ded
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Platinum CA 80/50 250 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 75/50 500 Ded
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 75/50 500 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 70/50 1250 Ded
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 70/50 1250 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 80/50 1500 Ded
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 80/50 1500 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Gold HDHP CA 90/50 3000 Ded HSA
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Gold HDHP CA 90/50 3000 Ded HSA wINF
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA 60/50 2100 Ded
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA 60/50 2100 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA 65/50 2600 Ded
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA 65/50 2600 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze CA 55/50 4600 Ded
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze CA 55/50 4600 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze CA 100/50 7350 Ded
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze CA 100/50 7350 Ded wINF
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze CA 50/50 8300 Ded
01/01/2023 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze CA 50/50 8300 Ded wINF
01/01/2023 Summary SBC
PPO Network (available to out-of-state employees only)
Open Choice PPO Gold CA 80/50 1000 Ded
01/01/2023 Summary SBC
Open Choice PPO Gold CA 80/50 1000 Ded wINF
01/01/2023 Summary SBC
Open Choice PPO Silver CA 60/50 2100 Ded
01/01/2023 Summary SBC
Open Choice PPO Silver CA 60/50 2100 Ded wINF
01/01/2023 Summary SBC
Open Choice PPO Bronze CA 55/50 4600 Ded
01/01/2023 Summary SBC
Open Choice PPO Bronze CA 55/50 4600 Ded wINF
01/01/2023 Summary SBC
Open Choice PPO Bronze CA 50/50 8300 Ded
01/01/2023 Summary SBC
Open Choice PPO Bronze CA 50/50 8300 Ded wINF
01/01/2023 Summary SBC
2022 Medical HMO
Full HMO Network
HMO Platinum CA $20/40 0 Ded
01/01/2022 Summary SBC
HMO Platinum CA $20/40 0 Ded wINF
01/01/2022 Summary SBC
HMO Gold CA $30/60 0 Ded
01/01/2022 Summary SBC
HMO Gold CA $30/60 0 Ded wINF
01/01/2022 Summary SBC
HMO Gold CA $35/65 250 Ded
01/01/2022 Summary SBC
HMO Gold CA $35/65 250 Ded wINF
01/01/2022 Summary SBC
HMO Gold CA $25/50 500 Ded
01/01/2022 Summary SBC
HMO Gold CA $25/50 500 Ded wINF
01/01/2022 Summary SBC
HMO Gold CA $30/70 1250 Ded
01/01/2022 Summary SBC
HMO Gold CA $30/70 1250 Ded wINF
01/01/2022 Summary SBC
HMO Silver CA $50/70 0 Ded
01/01/2022 Summary SBC
HMO Silver CA $50/70 0 Ded wINF
01/01/2022 Summary SBC
HMO Silver CA $55/90 2500 Ded
01/01/2022 Summary SBC
HMO Silver CA $55/90 2500 Ded wINF
01/01/2022 Summary SBC
HMO Bronze CA $75/125 7900 Ded
01/01/2022 Summary SBC
HMO Bronze CA $75/125 7900 Ded wINF
01/01/2022 Summary SBC
Aetna Value Network
Aetna Value Network HMO Platinum CA $20/30 0 Ded
01/01/2022 Summary SBC
Aetna Value Network HMO Platinum CA $20/30 0 Ded wINF
01/01/2022 Summary SBC
Aetna Value Network HMO Platinum CA $20/40 0 Ded
01/01/2022 Summary SBC
Aetna Value Network HMO Platinum CA $20/40 0 Ded wINF
01/01/2022 Summary SBC
Aetna Value Network HMO Gold CA $30/60 0 Ded
01/01/2022 Summary SBC
Aetna Value Network HMO Gold CA $30/60 0 Ded wINF
01/01/2022 Summary SBC
Aetna Value Network HMO Gold CA $35/55 250 Ded
01/01/2022 Summary SBC
Aetna Value Network HMO Gold CA $35/55 250 Ded wINF
01/01/2022 Summary SBC
Aetna Value Network HMO Gold CA $35/65 250 Ded
01/01/2022 Summary SBC
Aetna Value Network HMO Gold CA $35/65 250 Ded wINF
01/01/2022 Summary SBC
Aetna Value Network HMO Gold CA $25/50 500 Ded
01/01/2022 Summary SBC
Aetna Value Network HMO Gold CA $25/50 500 Ded wINF
01/01/2022 Summary SBC
Aetna Value Network HMO Gold CA $30/70 1250 Ded
01/01/2022 Summary SBC
Aetna Value Network HMO Gold CA $30/70 1250 Ded wINF
01/01/2022 Summary SBC
Aetna Value Network HMO Silver CA $50/70 0 Ded
01/01/2022 Summary SBC
Aetna Value Network HMO Silver CA $50/70 0 Ded wINF
01/01/2022 Summary SBC
Aetna Value Network HMO Silver CA $55/90 2250 Ded
01/01/2022 Summary SBC
Aetna Value Network HMO Silver CA $55/90 2250 Ded wINF
01/01/2022 Summary SBC
Aetna Value Network HMO Silver CA $55/90 2500 Ded
01/01/2022 Summary SBC
Aetna Value Network HMO Silver CA $55/90 2500 Ded wINF
01/01/2022 Summary SBC
Aetna Value Network HMO Bronze CA $75/125 7900 Ded
01/01/2022 Summary SBC
Aetna Value Network HMO Bronze CA $75/125 7900 Ded wINF
01/01/2022 Summary SBC
Basic Network
HMO Basic Platinum CA $20/40 0 Ded
01/01/2022 Summary SBC
HMO Basic Platinum CA $20/40 0 Ded wINF
01/01/2022 Summary SBC
HMO Basic Gold CA $30/60 0 Ded
01/01/2022 Summary SBC
HMO Basic Gold CA $30/60 0 Ded wINF
01/01/2022 Summary SBC
HMO Basic Gold CA $35/65 250 Ded
01/01/2022 Summary SBC
HMO Basic Gold CA $35/65 250 Ded wINF
01/01/2022 Summary SBC
HMO Basic Gold CA $25/50 500 Ded
01/01/2022 Summary SBC
HMO Basic Gold CA $25/50 500 Ded wINF
01/01/2022 Summary SBC
HMO Basic Gold CA $30/70 1250 Ded
01/01/2022 Summary SBC
HMO Basic Gold CA $30/70 1250 Ded wINF
01/01/2022 Summary SBC
HMO Basic Silver CA $50/70 0 Ded
01/01/2022 Summary SBC
HMO Basic Silver CA $50/70 0 Ded wINF
01/01/2022 Summary SBC
HMO Basic Silver CA $55/90 2500 Ded
01/01/2022 Summary SBC
HMO Basic Silver CA $55/90 2500 Ded wINF
01/01/2022 Summary SBC
HMO Basic Bronze CA $75/125 7900 Ded
01/01/2022 Summary SBC
HMO Basic Bronze CA $75/125 7900 Ded wINF
01/01/2022 Summary SBC
HMO Basic Bronze CA $65/95 6300 Ded - Mandated coverage CA exchange plan (contact RBG for plan availability and rates)
01/01/2022 Summary SBC
HMO Basic Bronze CA $65/95 6300 Ded wINF - Mandated coverage CA exchange plan (contact RBG for plan availability and rates)
01/01/2022 Summary SBC
Aetna Whole Health Network Southern CA
AWH Southern CA HMO Platinum CA $20/30 0 Ded
01/01/2022 Summary SBC
AWH Southern CA HMO Platinum CA $20/30 0 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA HMO Platinum CA $20/40 0 Ded
01/01/2022 Summary SBC
AWH Southern CA HMO Platinum CA $20/40 0 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA HMO Gold CA $30/60 0 Ded
01/01/2022 Summary SBC
AWH Southern CA HMO Gold CA $30/60 0 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA HMO Gold CA $35/55 250 Ded
01/01/2022 Summary SBC
AWH Southern CA HMO Gold CA $35/55 250 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA HMO Gold CA $35/65 250 Ded
01/01/2022 Summary SBC
AWH Southern CA HMO Gold CA $35/65 250 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA HMO Gold CA $25/50 500 Ded
01/01/2022 Summary SBC
AWH Southern CA HMO Gold CA $25/50 500 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA HMO Gold CA $30/70 1250 Ded
01/01/2022 Summary SBC
AWH Southern CA HMO Gold CA $30/70 1250 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA HMO Silver CA $50/70 0 Ded
01/01/2022 Summary SBC
AWH Southern CA HMO Silver CA $50/70 0 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA HMO Silver CA $55/90 2250 Ded
01/01/2022 Summary SBC
AWH Southern CA HMO Silver CA $55/90 2250 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA HMO Silver CA $55/90 2500 Ded
01/01/2022 Summary SBC
AWH Southern CA HMO Silver CA $55/90 2500 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA HMO Bronze CA $75/125 7900 Ded
01/01/2022 Summary SBC
AWH Southern CA HMO Bronze CA $75/125 7900 Ded wINF
01/01/2022 Summary SBC
2022 Medical PPO
Managed Choice POS Network
OA Managed Choice POS Platinum CA 90/50 0 Ded
01/01/2022 Summary SBC
OA Managed Choice POS Platinum CA 90/50 0 Ded wINF
01/01/2022 Summary SBC
OA Managed Choice POS Platinum CA 80/50 250 Ded
01/01/2022 Summary SBC
OA Managed Choice POS Platinum CA 80/50 250 Ded wINF
01/01/2022 Summary SBC
OA Managed Choice POS Gold CA 80/50 350 Ded
01/01/2022 Summary SBC
OA Managed Choice POS Gold CA 80/50 350 Ded wINF
01/01/2022 Summary SBC
OA Managed Choice POS Gold CA 75/50 500 Ded
01/01/2022 Summary SBC
OA Managed Choice POS Gold CA 75/50 500 Ded wINF
01/01/2022 Summary SBC
OA Managed Choice POS Gold CA 70/50 1250 Ded
01/01/2022 Summary SBC
OA Managed Choice POS Gold CA 70/50 1250 Ded wINF
01/01/2022 Summary SBC
OA Managed Choice POS Gold CA 80/50 1500 Ded
01/01/2022 Summary SBC
OA Managed Choice POS Gold CA 80/50 1500 Ded wINF
01/01/2022 Summary SBC
OA Managed Choice POS Gold HDHP CA 90/50 2800 Ded HSA
01/01/2022 Summary SBC
OA Managed Choice POS Gold HDHP CA 90/50 2800 Ded HSA wINF
01/01/2022 Summary SBC
OA Managed Choice POS Silver CA 60/50 1700 Ded
01/01/2022 Summary SBC
OA Managed Choice POS Silver CA 60/50 1700 Ded wINF
01/01/2022 Summary SBC
OA Managed Choice POS Silver CA 60/50 2000 Ded
01/01/2022 Summary SBC
OA Managed Choice POS Silver CA 60/50 2000 Ded wINF
01/01/2022 Summary SBC
OA Managed Choice POS Silver CA Copay Plan 70/50 2250 Ded
01/01/2022 Summary SBC
OA Managed Choice POS Silver CA Copay Plan 70/50 2250 Ded wINF
01/01/2022 Summary SBC
OA Managed Choice POS Silver CA 70/50 2500 Ded
01/01/2022 Summary SBC
OA Managed Choice POS Silver CA 70/50 2500 Ded wINF
01/01/2022 Summary SBC
OA Managed Choice POS Bronze CA 55/50 4600 Ded
01/01/2022 Summary SBC
OA Managed Choice POS Bronze CA 55/50 4600 Ded wINF
01/01/2022 Summary SBC
OA Managed Choice POS Bronze CA 100/50 7350 Ded
01/01/2022 Summary SBC
OA Managed Choice POS Bronze CA 100/50 7350 Ded wINF
01/01/2022 Summary SBC
OA Managed Choice POS Bronze CA 50/50 8300 Ded
01/01/2022 Summary SBC
OA Managed Choice POS Bronze CA 50/50 8300 Ded wINF
01/01/2022 Summary SBC
OA Managed Choice POS Bronze HDHP CA 100 7000 Ded HSA
01/01/2022 Summary SBC
OA Managed Choice POS Bronze HDHP CA 100 7000 Ded HSA wINF
01/01/2022 Summary SBC
Savings Plus Managed Choice POS Network
Savings Plus OA Managed Choice POS Platinum CA 90/50 0 Ded
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Platinum CA 90/50 0 Ded wINF
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Platinum CA 80/50 250 Ded
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Platinum CA 80/50 250 Ded wINF
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 350 Ded
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 350 Ded wINF
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 75/50 500 Ded
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 75/50 500 Ded wINF
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 70/50 1250 Ded
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 70/50 1250 Ded wINF
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 1500 Ded
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 1500 Ded wINF
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Gold HDHP CA 90/50 2800 Ded HSA
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Gold HDHP CA 90/50 2800 Ded HSA wINF
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Silver CA 60/50 1700 Ded
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Silver CA 60/50 1700 Ded wINF
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Silver CA 60/50 2000 Ded
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Silver CA 60/50 2000 Ded wINF
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Silver CA Copay Plan 70/50 2250 Ded
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Silver CA Copay Plan 70/50 2250 Ded wINF
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Silver CA 70/50 2500 Ded
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Silver CA 70/50 2500 Ded wINF
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 55/50 4600 Ded
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 55/50 4600 Ded wINF
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 100/50 7350 Ded
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 100/50 7350 Ded wINF
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 50/50 8300 Ded
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 50/50 8300 Ded wINF
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Bronze HDHP CA 100 7000 Ded HSA
01/01/2022 Summary SBC
Savings Plus OA Managed Choice POS Bronze HDHP CA 100 7000 Ded HSA wINF
01/01/2022 Summary SBC
Aetna Whole Health Network Southern CA Managed Choice POS Network
AWH Southern CA OA Managed Choice POS Platinum CA 80/50 250 Ded
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Platinum CA 80/50 250 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 75/50 500 Ded
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 75/50 500 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 70/50 1250 Ded
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 70/50 1250 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 80/50 1500 Ded
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 80/50 1500 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Gold HDHP CA 90/50 2800 Ded HSA
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Gold HDHP CA 90/50 2800 Ded HSA wINF
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA 60/50 1700 Ded
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA 60/50 1700 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA 60/50 2000 Ded
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA 60/50 2000 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA 70/50 2500 Ded
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA 70/50 2500 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze CA 55/50 4600 Ded
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze CA 55/50 4600 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze CA 100/50 7350 Ded
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze CA 100/50 7350 Ded wINF
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze CA 50/50 8300 Ded
01/01/2022 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze CA 50/50 8300 Ded wINF
01/01/2022 Summary SBC
Sutter Health Network
Sutter OA Managed Choice POS Platinum CA 90/50 0 Ded
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Platinum CA 90/50 0 Ded wINF
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Platinum CA 80/50 250 Ded
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Platinum CA 80/50 250 Ded wINF
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Gold CA 80/50 350 Ded
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Gold CA 80/50 350 Ded wINF
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Gold CA 75/50 500 Ded
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Gold CA 75/50 500 Ded wINF
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Gold CA 70/50 1250 Ded
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Gold CA 70/50 1250 Ded wINF
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Gold CA 80/50 1500 Ded
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Gold CA 80/50 1500 Ded wINF
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Gold HDHP CA 90/50 2800 Ded HSA
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Gold HDHP CA 90/50 2800 Ded HSA wINF
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Silver CA 60/50 1700 Ded
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Silver CA 60/50 1700 Ded wINF
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Silver CA 60/50 2000 Ded
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Silver CA 60/50 2000 Ded wINF
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Silver CA Copay Plan 70/50 2250 Ded
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Silver CA Copay Plan 70/50 2250 Ded wINF
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Silver CA 70/50 2500 Ded
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Silver CA 70/50 2500 Ded wINF
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Bronze CA 55/50 4600 Ded
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Bronze CA 55/50 4600 Ded wINF
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Bronze CA 100/50 7350 Ded
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Bronze CA 100/50 7350 Ded wINF
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Bronze CA 50/50 8300 Ded
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Bronze CA 50/50 8300 Ded wINF
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Bronze HDHP CA 100 7000 Ded HSA
01/01/2022 Summary SBC
Sutter OA Managed Choice POS Bronze HDHP CA 100 7000 Ded HSA wINF
01/01/2022 Summary SBC
PPO Network (available to out-of-state employees only)
Open Choice PPO Gold CA 80/50 1000 Ded
01/01/2022 Summary SBC
Open Choice PPO Gold CA 80/50 1000 Ded wINF
01/01/2022 Summary SBC
2021 Medical HMO
Full HMO Network
HMO Platinum CA $20/30 0 Ded
01/01/2021 Summary SBC
HMO Platinum CA $20/30 0 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Gold CA $30/60 0 Ded
01/01/2021 Summary SBC
HMO Gold CA $35/55 250 Ded
01/01/2021 Summary SBC
HMO Gold CA $35/55 250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Gold CA $25/50 500 Ded
01/01/2021 Summary SBC
HMO Silver CA $55/90 2250 Ded
01/01/2021 Summary SBC
HMO Silver CA $55/90 2250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Silver CA $50/75 2550 Ded
01/01/2021 Summary SBC
HMO Bronze CA $75/125 7900 Ded
01/01/2021 Summary SBC
HMO Deductible Network
HMO Deductible Platinum CA $20/30 0 Ded
01/01/2021 Summary SBC
HMO Deductible Platinum CA $20/30 0 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Deductible Gold CA $30/60 0 Ded
01/01/2021 Summary SBC
HMO Deductible Gold CA $35/55 250 Ded
01/01/2021 Summary SBC
HMO Deductible Gold CA $35/55 250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Deductible Gold CA $25/50 500 Ded
01/01/2021 Summary SBC
HMO Deductible Silver CA $55/90 2250 Ded
01/01/2021 Summary SBC
HMO Deductible Silver CA $55/90 2250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Deductible Silver CA $50/75 2550 Ded
01/01/2021 Summary SBC
HMO Deductible Bronze CA $75/125 7900 Ded
01/01/2021 Summary SBC
Aetna Value Network
Aetna Value Network HMO Platinum CA $20/30 0 Ded
01/01/2021 Summary SBC
Aetna Value Network HMO Platinum CA $20/30 0 Ded noINF (without Infertility)
02/01/2021 Summary SBC
Aetna Value Network HMO Gold CA $30/60 0 Ded
01/01/2021 Summary SBC
Aetna Value Network HMO Gold CA $35/55 250 Ded
01/01/2021 Summary SBC
Aetna Value Network HMO Gold CA $35/55 250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
Aetna Value Network HMO Gold CA $25/50 500 Ded
01/01/2021 Summary SBC
Aetna Value Network HMO Silver CA $55/90 2250 Ded
01/01/2021 Summary SBC
Aetna Value Network HMO Silver CA $55/90 2250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
Aetna Value Network HMO Silver CA $50/75 2550 Ded
01/01/2021 Summary SBC
Aetna Value Network HMO Bronze CA $75/125 7900 Ded
01/01/2021 Summary SBC
Basic Network
HMO Basic Platinum CA $20/30 0 Ded
01/01/2021 Summary SBC
HMO Basic Platinum CA $20/30 0 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Basic Gold CA $30/60 0 Ded
01/01/2021 Summary SBC
HMO Basic Gold CA $35/55 250 Ded
01/01/2021 Summary SBC
HMO Basic Gold CA $35/55 250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Basic Gold CA $25/50 500 Ded
01/01/2021 Summary SBC
HMO Basic Silver CA $55/90 2250 Ded
01/01/2021 Summary SBC
HMO Basic Silver CA $55/90 2250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
HMO Basic Silver CA $50/75 2550 Ded
01/01/2021 Summary SBC
HMO Basic Bronze CA $75/125 7900 Ded
01/01/2021 Summary SBC
HMO Basic Bronze CA $65/95 6300 Ded - Mandated coverage CA exchange plan (contact RBG for plan availability and rates)
01/01/2021 Summary SBC
HMO Basic Bronze CA $65/95 6300 Ded noINF (without Infertility) - Mandated coverage CA exchange plan (contact RBG for plan availability and rates)
02/01/2021 Summary SBC
Aetna Whole Health Network Southern CA
AWH Southern CA HMO Platinum CA $20/30 0 Ded
01/01/2021 Summary SBC
AWH Southern CA HMO Platinum CA $20/30 0 Ded noINF (without Infertility)
02/01/2021 Summary SBC
AWH Southern CA HMO Gold CA $30/60 0 Ded
01/01/2021 Summary SBC
AWH Southern CA HMO Gold CA $35/55 250 Ded
01/01/2021 Summary SBC
AWH Southern CA HMO Gold CA $35/55 250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
AWH Southern CA HMO Gold CA $25/50 500 Ded
01/01/2021 Summary SBC
AWH Southern CA HMO Silver CA $55/90 2250 Ded
01/01/2021 Summary SBC
AWH Southern CA HMO Silver CA $55/90 2250 Ded noINF (without Infertility)
02/01/2021 Summary SBC
AWH Southern CA HMO Silver CA $50/75 2550 Ded
01/01/2021 Summary SBC
AWH Southern CA HMO Bronze CA $75/125 7900 Ded
01/01/2021 Summary SBC
2021 Medical EPO
Elect Choice EPO Network
OA Elect Choice EPO Silver CA 60 2000 Ded
01/01/2021 Summary SBC
Aetna Whole Health Network Southern CA Elect Choice EPO
AWH Southern CA OA Elect Choice EPO Silver CA 60 2000 Ded
01/01/2021 Summary SBC
2021 Medical PPO
Managed Choice POS Network
OA Managed Choice POS Platinum CA 90/50 0 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Gold CA 80/50 350 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Gold CA 80/50 750 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Gold CA 80/50 1250 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Gold CA 80/50 1500 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Silver CA 60/50 2000 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Silver CA Copay Plan 70/50 2250 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Silver CA 60/50 2550 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Bronze CA 60/50 6300 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Bronze CA 50/50 8300 Ded
01/01/2021 Summary SBC
OA Managed Choice POS Bronze HDHP CA 100 7000 Ded HSA
01/01/2021 Summary SBC
Savings Plus Managed Choice POS Network
Savings Plus OA Managed Choice POS Platinum CA 90/50 0 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 350 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 750 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 1250 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Gold CA 80/50 1500 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Silver CA 60/50 2000 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Silver CA Copay Plan 70/50 2250 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Silver CA 60/50 2550 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 60/50 6300 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Bronze CA 50/50 8300 Ded
01/01/2021 Summary SBC
Savings Plus OA Managed Choice POS Bronze HDHP CA 100 7000 Ded HSA
01/01/2021 Summary SBC
Aetna Whole Health Network Southern CA Managed Choice POS Network
AWH Southern CA OA Managed Choice POS Platinum CA 90/50 0 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 80/50 350 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 80/50 750 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 80/50 1250 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Gold CA 80/50 1500 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA 60/50 2000 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA Copay Plan 70/50 2250 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Silver CA 60/50 2550 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze CA 60/50 6300 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze CA 50/50 8300 Ded
01/01/2021 Summary SBC
AWH Southern CA OA Managed Choice POS Bronze HDHP CA 100 7000 Ded HSA
01/01/2021 Summary SBC
PPO Network (available to out-of-state employees only)
Open Choice PPO Gold CA 80/50 1000 Ded
01/01/2021 Summary SBC
Form Name Effective Date Download Form
General Information
CA Small Group Plan Guide - Benefits Toolkit 5.22
05/01/2022 Download
CA Small Group Plan Guide - Benefits Toolkit 1.23
01/01/2023 Download
Underwriting Guidelines 1.22
01/01/2022 Download
Underwriting Guidelines 1.23
01/01/2023 Download
Attain by Aetna Member Flyer
03/01/2022 Download
Attain by Aetna FAQ
05/01/2022 Download
Bundle Up Dental & Vision Flyer
06/01/2022 Download
COVID-19 OTC Test POS Plan Sponsor Letter
02/01/2022 Download
California CVS MinuteClinic Flyer
01/01/2022 Download
Discount Program Brochure
01/01/2022 Download
Discount Program Brochure (Post Enrollment)
01/01/2022 Download
Helpful Information & Resources Flyer
01/01/2022 Download
HMO Network Guide - Southern California
01/01/2022 Download
HMO Network Guide - Northern California
01/01/2022 Download
California Network Map
01/01/2022 Download
Member Mobile App & Website Flyer
01/01/2022 Download
Online Provider Search Instructions-Full Network HMO
07/01/2022 Download
Online Provider Search Instructions-Aetna Value Network HMO
07/01/2022 Download
Online Provider Search Instructions-Basic Network HMO
07/01/2022 Download
Online Provider Search Instructions-AWH So Cal Network HMO
07/01/2022 Download
Online Provider Search Instructions-OA Managed Choice Network POS
07/01/2022 Download
Online Provider Search Instructions-Savings Plus OA Managed Choice Network POS
07/01/2022 Download
Online Provider Search Instructions-AWH So Cal OA Managed Choice Network POS
07/01/2022 Download
Small Group Prescription Drug Formulary Guide 2022
03/01/2022 Download
Teladoc Pricing Flyer
01/01/2022 Download
Vision Preferred Flyer 1.22 Effective Dates
01/01/2022 Download
Form Name Effective Date Download Form
Contact Information
01/01/2022 Download