CalCPA Health

CalCPA Health is an exclusive healthcare and benefit program endorsed by the California Society of Certified Public Accountants. For 60 years CalCPA Health has provided CalCPA member firms quality healthcare and benefit plans alongside unparalleled customer service. Participation in CalCPA Health is available to California-based accounting firms in public practice or those offering general financial or related business services. Offering medical, dental and vision plans as well as other member benefits, CalCPA Health is visible and accountable to their members every step of the way.

Form Name Effective Date Download Form
New Group Submission
Submission Checklist
01/01/2020 Download
Employer Subscription Agreement 1.21
01/01/2021 Download
Medicare Secondary Payer Exception Form (for groups <20 employees)
01/01/2020 Download
COBRA Administration Authorization
01/01/2020 Download
CalCPA Society Membership Application 5.21
05/01/2021 Download
HealthEquity HSA Employer Implementation Guide
01/01/2020 Download
HealthEquity HSA Administration Employer Enrollment
01/01/2020 Download
In Force Group Forms
Direct Deposit Payment Authorization Form
01/01/2020 Download
Electronic Billing Registration Form
01/01/2020 Download
Administration
Firm Administrator Guide 2.20
02/01/2020 Download
Online Benefits Management Contract Addendum
01/01/2020 Download
Online Benefits Management User Registration Form
01/01/2020 Download
Open Enrollment FAQ
01/01/2020 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Enrollment and Change Form
10/01/2020 Download
Continuity of Care | Transition of Care Request Form
01/01/2020 Download
HealthEquity HSA Administration Member Enrollment
01/01/2020 Download
HealthEquity HSA Beneficiary Designation Form
01/01/2020 Download
Health Equity HSA Transfer Information
01/01/2020 Download
Health Equity HSA Transfer Form
01/01/2020 Download
Claim Forms
Anthem HIPAA Authorization
01/01/2020 Download
Anthem Medical Claim Form
01/01/2020 Download
International Medical Claim Form
01/01/2020 Download
Delta Dental Claim Form
01/01/2020 Download
Express Scripts Claim Form [for PPO and PPO-HSA plans]
01/01/2020 Download
Express Scripts Mail Order Form [for PPO and PPO-HSA plans]
01/01/2020 Download
IngenioRx Claim Form [for HMO plans]
01/01/2020 Download
IngenioRx Mail Order Form [for HMO plans]
01/01/2020 Download
Lincoln LTD Claim Form
01/01/2020 Download
Form Name Effective Date Download Form
2022 Medical Plan Benefits Comparison
Medical Plan Benefits Comparison Grid
01/01/2022 Summary
2022 Medical HMO
CaliforniaCare Full HMO Network
Platinum HMO 10/0
01/01/2022 SBC
Gold HMO 35/0
01/01/2022 SBC
Silver HMO 25/1500
01/01/2022 SBC
Silver HMO 30/3000
01/01/2022 SBC
Select HMO Network
Platinum Select HMO 10/0
01/01/2022 SBC
Gold Select HMO 35/0
01/01/2022 SBC
Silver Select HMO 25/1500
01/01/2022 SBC
Silver Select HMO 30/3000
01/01/2022 SBC
2022 Medical PPO
PPO Pediatric Dental & Vision Rider
PPO Pediatric Dental & Vision Benefit Summary
01/01/2022 Summary
Prudent Buyer Full PPO Network (BlueCard Network Out-of-State)
Platinum PPO 10/0
01/01/2022 SBC
Gold PPO 25/750
01/01/2022 SBC
Gold PPO 25/1000
01/01/2022 SBC
Gold PPO 30/650
01/01/2022 SBC
Gold PPO 35/1250
01/01/2022 SBC
Silver PPO 40/2000
01/01/2022 SBC
Silver PPO 45/1650/OV-1
01/01/2022 SBC
Silver PPO 45/2750/OV-1
01/01/2022 SBC
Silver PPO 50/2250
01/01/2022 SBC
Silver PPO HSA 1450
01/01/2022 SBC
Silver PPO HSA 1950
01/01/2022 SBC
Silver PPO HSA 2950
01/01/2022 SBC
Silver PPO HSA 3750
01/01/2022 SBC
Bronze PPO 50/6000/OV-3
01/01/2022 SBC
Bronze PPO 65/3950
01/01/2022 SBC
Bronze PPO 75/7000
01/01/2022 SBC
Bronze PPO HSA 4950
01/01/2022 SBC
Bronze PPO HSA 6250
01/01/2022 SBC
Select PPO Network (BlueCard Network Out of State)
Platinum Select PPO 10/0
01/01/2022 SBC
Gold Select PPO 25/750
01/01/2022 SBC
Gold Select PPO 25/1000
01/01/2022 SBC
Gold Select PPO 30/650
01/01/2022 SBC
Gold Select PPO 35/1250
01/01/2022 SBC
Silver Select PPO 40/2000
01/01/2022 SBC
Silver Select PPO 45/1650/OV-1
01/01/2022 SBC
Silver Select PPO 45/2750/OV-1
01/01/2022 SBC
Silver Select PPO 50/2250
01/01/2022 SBC
Silver Select PPO HSA 1450
01/01/2022 SBC
Silver Select PPO HSA 1950
01/01/2022 SBC
Silver Select PPO HSA 2950
01/01/2022 SBC
Silver Select PPO HSA 3750
01/01/2022 SBC
Bronze Select PPO 50/6000/OV-3
01/01/2022 SBC
Bronze Select PPO 65/3950
01/01/2022 SBC
Bronze Select PPO 75/7000
01/01/2022 SBC
Bronze Select PPO HSA 4950
01/01/2022 SBC
Bronze Select PPO HSA 6250
01/01/2022 SBC
2021 Medical Plan Benefits Comparison
Medical Plan Benefits Comparison Grid
01/01/2021 Summary
2021 Medical HMO
CaliforniaCare Full HMO Network
Platinum HMO 10/0
01/01/2021 SBC
Gold HMO 35/0
01/01/2021 SBC
Silver HMO 25/1500
01/01/2021 SBC
Silver HMO 30/3000
01/01/2021 SBC
Select HMO Network
Platinum Select HMO 10/0
01/01/2021 SBC
Gold Select HMO 35/0
01/01/2021 SBC
Silver Select HMO 25/1500
01/01/2021 SBC
Silver Select HMO 30/3000
01/01/2021 SBC
2021 Medical PPO
PPO Pediatric Dental & Vision Rider
PPO Pediatric Dental & Vision Benefit Summary
01/01/2021 Summary
Prudent Buyer Full PPO Network (BlueCard Network Out-of-State)
Platinum PPO 10/0
01/01/2021 SBC
Gold PPO 20/600
01/01/2021 SBC
Gold PPO 30/600
01/01/2021 SBC
Gold PPO 20/1000
01/01/2021 SBC
Gold PPO 35/1200
01/01/2021 SBC
Silver PPO 45/1500
01/01/2021 SBC
Silver PPO 40/2000
01/01/2021 SBC
Silver PPO 45/2500
01/01/2021 SBC
Silver PPO HSA 1450
01/01/2021 SBC
Silver PPO HSA 1900
01/01/2021 SBC
Silver PPO HSA 2900
01/01/2021 SBC
Silver PPO HSA 3700
01/01/2021 SBC
Bronze PPO 65/3900
01/01/2021 SBC
Bronze PPO 50/6000 Saver
01/01/2021 SBC
Bronze PPO HSA 4900
01/01/2021 SBC
Bronze PPO HSA 6000
01/01/2021 SBC
Select PPO Network (BlueCard Network Out-of-State)
Platinum Select PPO 10/0
01/01/2021 SBC
Gold Select PPO 20/600
01/01/2021 SBC
Gold Select PPO 30/600
01/01/2021 SBC
Gold Select PPO 20/1000
01/01/2021 SBC
Gold Select PPO 35/1200
01/01/2021 SBC
Silver Select PPO 45/1500
01/01/2021 SBC
Silver Select PPO 40/2000
01/01/2021 SBC
Silver Select PPO 45/2500
01/01/2021 SBC
Silver Select PPO HSA 1450
01/01/2021 SBC
Silver Select PPO HSA 1900
01/01/2021 SBC
Silver Select PPO HSA 2900
01/01/2021 SBC
Silver Select PPO HSA 3700
01/01/2021 SBC
Bronze Select PPO 65/3900
01/01/2021 SBC
Bronze Select PPO 50/6000 Saver
01/01/2021 SBC
Bronze Select PPO HSA 4900
01/01/2021 SBC
Bronze Select PPO HSA 6000
01/01/2021 SBC
2020 Medical Plan Benefits Comparison
Medical Plan Benefits Comparison Grid
01/01/2020
2020 Medical HMO
CaliforniaCare Full HMO Network
Platinum HMO 10/0
01/01/2020 SBC
Gold HMO 35/0
01/01/2020 SBC
Silver HMO 1500
01/01/2020 SBC
Silver HMO 3000
01/01/2020 SBC
Select HMO Network
Platinum Select HMO 10/0
01/01/2020 SBC
Gold Select HMO 35/0
01/01/2020 SBC
Silver Select HMO 1500
01/01/2020 SBC
Silver Select HMO 3000
01/01/2020 SBC
2020 Medical PPO
PPO Pediatric Dental & Vision Rider
PPO Pediatric Dental & Vision Benefit Summary
01/01/2020 Summary
Prudent Buyer Full PPO Network (BlueCard Network Out-of-State)
Platinum PPO 10/0
01/01/2020 SBC
Gold PPO 20/500
01/01/2020 SBC
Gold PPO 30/550
01/01/2020 SBC
Gold PPO 30/550/RxV
01/01/2020 SBC
Gold PPO 20/1000
01/01/2020 SBC
Silver PPO 35/1200
01/01/2020 SBC
Silver PPO 45/1500
01/01/2020 SBC
Silver PPO 40/2000
01/01/2020 SBC
Silver PPO 40/2000/RxV
01/01/2020 SBC
Silver PPO 45/2500
01/01/2020 SBC
Silver PPO HSA 1400
01/01/2020 SBC
Silver PPO HSA 1850
01/01/2020 SBC
Silver PPO HSA 2800
01/01/2020 SBC
Silver PPO HSA 3600
01/01/2020 SBC
Bronze PPO 65/3750
01/01/2020 SBC
Bronze PPO 45/6000 Saver
01/01/2020 SBC
Bronze PPO HSA 4800
01/01/2020 SBC
Bronze PPO HSA 5800
01/01/2020 SBC
Select PPO Network (BlueCard Network Out-of-State)
Platinum Select PPO 10/0
01/01/2020 SBC
Gold Select PPO 20/500
01/01/2020 SBC
Gold Select PPO 30/550
01/01/2020 SBC
Gold Select PPO 30/550/RxV
01/01/2020 SBC
Gold Select PPO 20/1000
01/01/2020 SBC
Silver Select PPO 35/1200
01/01/2020 SBC
Silver Select PPO 45/1500
01/01/2020 SBC
Silver Select PPO 40/2000
01/01/2020 SBC
Silver Select PPO 40/2000/RxV
01/01/2020 SBC
Silver Select PPO 45/2500
01/01/2020 SBC
Silver Select PPO HSA 1400
01/01/2020 SBC
Silver Select PPO HSA 1850
01/01/2020 SBC
Silver Select PPO HSA 2800
01/01/2020 SBC
Silver Select PPO HSA 3600
01/01/2020 SBC
Bronze Select PPO 65/3750
01/01/2020 SBC
Bronze Select PPO 45/6000 Saver
01/01/2020 SBC
Bronze Select PPO HSA 4800
01/01/2020 SBC
Bronze Select PPO HSA 5800
01/01/2020 SBC
Form Name Effective Date Download Form
General Information
CalCPA Health 2022 Health Plan Brochure
01/01/2022 Download
CalCPA Health 2022 Medical Plan Changes
01/01/2022 Download
CalCPA Health Broker Flyer
01/01/2020 Download
CalCPA Health Broker PowerPoint Presentation
01/01/2020 Download
CalCPA Health Producer Agreement
06/01/2020 Download
Underwriting Guidelines
01/01/2020 Download
Welcome to CalCPA Health
01/01/2020 Download
Anthem Discounts & Special Offers
01/01/2020 Download
Anthem Mobile App - Meet Sydney
01/01/2020 Download
HealthEquity HSA Employee Brochure
01/01/2020 Download
HealthEquity HSA Employer Brochure
01/01/2020 Download
Understanding an HSA Flyer
01/01/2020 Download
Live Health Online Flyer
01/01/2020 Download
Medical
CalCPA Health 2022 Medical Plan Benefits Comparison Grid
01/01/2022 Download
BlueCard PPO & Global Core Program Flyer
01/01/2020 Download
Credit Monitoring Flyer for Medical Members
01/01/2020 Download
Estimate Your Costs Tool
01/01/2020 Download
Express Scripts Locate a Pharmacy Flyer
01/01/2020 Download
Express Scripts Online Access
01/01/2020 Download
Online Provider Search Instructions
01/01/2020 Download
Rx Formulary - 2019 Anthem Essential 4 Tier [Silver HMO Plans]
01/01/2020 Download
Rx Formulary - 2019 Anthem National 4 Tier [Platinum & Gold HMO Plans]
01/01/2020 Download
Rx Formulary - 2019 Express Scripts National Preferred [PPO Plans]
01/01/2020 Download
Dental
Delta Dental Online Access
01/01/2020 Download
Delta Dental SmileWay Challenge
01/01/2020 Download
Delta Dental Value Add - Amplifon Hearing Health Care
01/01/2020 Download
Delta Dental Value Add - QualSight LASIK
01/01/2020 Download
Delta Dental Value Added Benefits Employer Flyer
01/01/2020 Download
Delta Dental Wellness Resources Calendar
01/01/2020 Download
Vision
VSP Member Extras - TruHearing Discount
01/01/2020 Download
VSP Provider Flyer
01/01/2020 Download
VSP Savings Pass
01/01/2020 Download
VSP WellVision Exam Flyer
01/01/2020 Download
Form Name Effective Date Download Form
Small Group Medical Rate Sheets [effective 1/1/2022]
01/01/2022 Download
Ancillary Rate Guides
Dental Rate Sheet - Group Size 2 - 4 [effective 1/1/2022]
01/01/2022 Download
Dental Rate Sheet - Group Size 5 + [effective 1/1/2022]
01/01/2022 Download
Vision Rate Sheet [effective 1/1/2022]
01/01/2022 Download