Form Name | Effective Date | Download Form |
---|---|---|
New Group Submission |
||
New Business Submission Checklist 1.23 |
01/01/2023 | Download |
Employer Application 1.23 |
01/01/2023 | Download |
Employer Application 1.22 |
06/01/2022 | 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 |
02/01/2023 | Download |
New Customer Quick Start Guide |
01/01/2022 | Download |
Form Name | Effective Date | Download Form |
---|---|---|
Enrollment and Change Forms |
||
Employee Enrollment Change Form 1.23 |
01/01/2023 | Download |
Employee Enrollment Change Form 1.22 |
01/01/2022 | 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 M |
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 M |
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 M |
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 M |
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 M |
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 M |
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 M |
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 M |
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 M |
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 M |
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 M |
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 M |
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 M |
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 M |
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 M |
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 M |
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 M |
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 M |
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 1.23 |
01/01/2023 | Download |
CA Small Group Plan Guide - Benefits Toolkit 5.22 |
05/01/2022 | Download |
Underwriting Guidelines 5.23 |
05/01/2023 | 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 1.23 |
01/01/2023 | 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 |