CaliforniaChoice

At┬áCaliforniaChoice, we understand the unique needs of small businesses. As the only Small Group Private Exchange in California, our goal is to provide great benefits, simple administration, and the best customer service, year-round, to all our customers. We’ve worked with brokers, small business owners, and employees for more than 17 years and we love what we do.

Provider Finder

Form Name Effective Date Download Form
New Group Submission
CalChoice Medical Submission Checklist 7.22
07/01/2022 Download
CalChoice Dental/Life Submission Checklist
01/01/2022 Download
Employer Application 7.22 Effective Dates
07/01/2022 Download
Employer Application 1.23 Effective Dates
01/01/2023 Download
Initial Payment Form (ACH) 1.22
01/01/2022 Download
Owner Partner Statement Form
01/01/2022 Download
Case Submission Acknowledgement (for groups submitted after the requested effective date)
01/01/2022 Download
Common Ownership Statement
01/01/2022 Download
Full FSA Election Form
01/01/2022 Download
Group Size Attestation
01/01/2022 Download
Prior Carrier Cancellation Letter Template
01/01/2022 Download
In Force Group Forms
Employee Termination Notification 1.22
01/01/2022 Download
Employer Change Request Form 1.22 to 3.22 Effective Date
01/01/2022 Download
Employer Group Contact Change
01/01/2022 Download
Employer In Force Group Dental Application
01/01/2022 Download
Employer In Force Group Voluntary Vision Application
01/01/2022 Download
Employer Recertification Agreement 1.20 to 12.20 Effective Dates
01/01/2020 Download
Exception Review Request Form-Member Level
07/01/2022 Download
Group COBRA Direct Billing Contract
01/01/2022 Download
Administration
Employer Administrative Guide 7.22
07/01/2022 Download
Employer Program Guide 4.22
04/01/2022 Download
Employer Program Guide 7.22
07/01/2022 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Enrollment Form 3.22 to 12.22 Effective Dates
03/01/2022 Download
Employee Change Request Form 3.22 to 12.22 Effective Dates
03/01/2022 Download
Employee Enrollment Form 1.23 to 3.23 Effective Dates
01/01/2023 Download
Employee Change Request Form 1.23 to 3.23 Effective Dates
01/01/2023 Download
Disabled Dependent Certification Form
01/01/2022 Download
Affidavit of Domestic Partnership
01/01/2022 Download
COBRA Forms
COBRA Enrollment Application 1.22
01/01/2022 Download
Claim Forms
RX Claim Form - Anthem Express Scripts
Download
RX Claim Form - Health Net
07/01/2022 Download
RX Claim Form - Sharp
Download
RX Claim Form - UHC
Download
RX by Mail Claim Form - Anthem
Download
RX by Mail Claim Form - Health Net
Download
RX by Mail Claim Form - Kaiser
Download
RX by Mail Claim Form - Sharp
Download
RX by Mail Claim Form - UHC
Download
Form Name Effective Date Download Form
2023 Medical Plan Benefit Summary Booklets
January 2023 Effective Dates
All Tiers Benefit Summaries 1.23 Effective Dates
01/01/2023 Summary
2023 Medical HMO SBCs
Anthem HMO
Anthem Blue Cross Platinum Select HMO A
01/01/2023 SBC
Anthem Blue Cross Gold Select HMO A
01/01/2023 SBC
Anthem Blue Cross Gold CaliforniaCare HMO B
01/01/2023 SBC
Anthem Blue Cross Gold Priority Select HMO C
01/01/2023 SBC
Anthem Blue Cross Silver Select HMO A
01/01/2023 SBC
Anthem Blue Cross Silver CaliforniaCare HMO B
01/01/2023 SBC
Anthem Blue Cross Silver Priority Select HMO C
01/01/2023 SBC
Health Net HMO
Health Net Platinum WholeCare HMO C
01/01/2023 SBC
Health Net Platinum Salud HMO D
01/01/2023 SBC
Health Net Platinum Full Network HMO E
01/01/2023 SBC
Health Net Platinum Wholecare HMO F
01/01/2023 SBC
Health Net Platinum Salud HMO G
01/01/2023 SBC
Health Net Platinum Full Network HMO H
01/01/2023 SBC
Health Net Platinum SmartCare HMO I
01/01/2023 SBC
Health Net Platinum SmartCare HMO J
01/01/2023 SBC
Health Net Gold WholeCare HMO A
01/01/2023 SBC
Health Net Gold WholeCare HMO B
01/01/2023 SBC
Health Net Gold WholeCare HMO C
01/01/2023 SBC
Health Net Gold Salud HMO D
01/01/2023 SBC
Health Net Gold Full Network HMO E
01/01/2023 SBC
Health Net Gold Full Network HMO F
01/01/2023 SBC
Health Net Gold Full Network HMO G
01/01/2023 SBC
Health Net Gold SmartCare HMO H
01/01/2023 SBC
Health Net Gold SmartCare HMO I
01/01/2023 SBC
Health Net Silver WholeCare HMO A
01/01/2023 SBC
Health Net Silver CommunityCare HMO C
01/01/2023 SBC
Health Net Silver Full Network HMO D
01/01/2023 SBC
Health Net Bronze CommunityCare HMO A
01/01/2023 SBC
Kaiser Permanente HMO
Kaiser Platinum HMO A
01/01/2023 SBC
Kaiser Platinum HMO B
01/01/2023 SBC
Kaiser Gold HMO B
01/01/2023 SBC
Kaiser Gold HMO C
01/01/2023 SBC
Kaiser Gold HMO D
01/01/2023 SBC
Kaiser Gold HMO E (HSA Eligible)
01/01/2023 SBC
Kaiser Silver HMO A
01/01/2023 SBC
Kaiser Silver HMO B
01/01/2023 SBC
Kaiser Silver HMO C
01/01/2023 SBC
Kaiser Silver HMO D (HSA Eligible)
01/01/2023 SBC
Kaiser Silver HMO E
01/01/2023 SBC
Kaiser Bronze HMO A
01/01/2023 SBC
Kaiser Bronze HMO B
01/01/2023 SBC
Kaiser Bronze HMO C (HSA Eligible)
01/01/2023 SBC
Sharp HMO (plans below are sample documents pending release from carrier)
Sharp Platinum Premier HMO A
01/01/2023 SBC
Sharp Platinum Performance HMO B
01/01/2023 SBC
Sharp Platinum Premier HMO C
01/01/2023 SBC
Sharp Gold Performance HMO A
01/01/2023 SBC
Sharp Gold Premier HMO B
01/01/2023 SBC
Sharp Gold Performance HMO D
01/01/2023 SBC
Sharp Silver Premier HMO A
01/01/2023 SBC
Sharp Silver Performance HMO B
01/01/2023 SBC
Sharp Silver Premier HMO C
01/01/2023 SBC
Sharp Bronze Premier HMO A
01/01/2023 SBC
Sharp Bronze Performance HMO B (HSA Eligible)
01/01/2023 SBC
Sutter Health Plus HMO
Sutter Health Plus Platinum HMO A
01/01/2023 SBC
Sutter Health Plus Platinum HMO B
01/01/2023 SBC
Sutter Health Plus Gold HMO A
01/01/2023 SBC
Sutter Health Plus Gold HMO B
01/01/2023 SBC
Sutter Health Plus Silver HMO B
01/01/2023 SBC
Sutter Health Plus Silver HMO C (HSA Eligible)
01/01/2023 SBC
Sutter Health Plus Bronze HMO A
01/01/2023 SBC
Sutter Health Plus Bronze HMO B (HSA Eligible)
01/01/2023 SBC
UnitedHealthcare HMO (plans below are sample documents pending release from carrier)
UHC Platinum SignatureValue HMO A
01/01/2023 SBC
UHC Platinum SignatureValue HMO B
01/01/2023 SBC
UHC Platinum Alliance HMO C
01/01/2023 SBC
UHC Platinum SignatureValue HMO E
01/01/2023 SBC
UHC Platinum Alliance HMO G
01/01/2023 SBC
UHC Platinum Harmony HMO H
01/01/2023 SBC
UHC Platinum Harmony HMO I
01/01/2023 SBC
UHC Platinum Alliance HMO J
01/01/2023 SBC
UHC Platinum Harmony HMO K
01/01/2023 SBC
UHC Platinum SignatureValue HMO L
01/01/2023 SBC
UHC Platinum Harmony HMO M
01/01/2023 SBC
UHC Platinum Alliance HMO N
01/01/2023 SBC
UHC Gold SignatureValue HMO A
01/01/2023 SBC
UHC Gold Alliance HMO B
01/01/2023 SBC
UHC Gold SignatureValue HMO F
01/01/2023 SBC
UHC Gold Alliance HMO G
01/01/2023 SBC
UHC Gold SignatureValue HMO H
01/01/2023 SBC
UHC Gold Alliance HMO J
01/01/2023 SBC
UHC Gold Harmony HMO L
01/01/2023 SBC
UHC Gold Harmony HMO M
01/01/2023 SBC
UHC Gold Harmony HMO N
01/01/2023 SBC
UHC Gold Alliance HMO O
01/01/2023 SBC
UHC Gold Harmony HMO P
01/01/2023 SBC
UHC Gold SignatureValue HMO Q
01/01/2023 SBC
UHC Silver SignatureValue HMO A
01/01/2023 SBC
UHC Silver Alliance HMO E
01/01/2023 SBC
UHC Silver Harmony HMO F
01/01/2023 SBC
UHC Silver Harmony HMO G
01/01/2023 SBC
Western Health Advantage HMO
Western Health Platinum HMO A
01/01/2023 SBC
Western Health Platinum HMO B
01/01/2023 SBC
Western Health Platinum HMO C
01/01/2023 SBC
Western Health Gold HMO A
01/01/2023 SBC
Western Health Gold HMO B
01/01/2023 SBC
Western Health Gold HMO C
01/01/2023 SBC
Western Health Gold HMO D (HSA Eligible)
01/01/2023 SBC
Western Health Silver HMO A
01/01/2023 SBC
Western Health Silver HMO B
01/01/2023 SBC
Western Health Silver HMO C (HSA Eligible)
01/01/2023 SBC
Western Health Bronze HMO B
01/01/2023 SBC
Western Health Bronze HMO C (HSA Eligible)
01/01/2023 SBC
2023 Medical EPO SBCs
Cigna + Oscar EPO
Cigna+Oscar Platinum LocalPlus EPO C
01/01/2023 SBC
Cigna+Oscar Platinum LocalPlus EPO D
01/01/2023 SBC
Cigna+Oscar Platinum LocalPlus EPO E
01/01/2023 SBC
Cigna+Oscar Platinum Open Access Plus EPO F
01/01/2023 SBC
Cigna+Oscar Platinum Open Access Plus EPO G
01/01/2023 SBC
Cigna+Oscar Gold LocalPlus EPO C
01/01/2023 SBC
Cigna+Oscar Gold LocalPlus EPO D
01/01/2023 SBC
Cigna+Oscar Gold LocalPlus EPO E
01/01/2023 SBC
Cigna+Oscar Gold Open Access Plus EPO F
01/01/2023 SBC
Cigna+Oscar Gold Open Access Plus EPO G
01/01/2023 SBC
Cigna+Oscar Silver LocalPlus EPO C
01/01/2023 SBC
Cigna+Oscar Silver LocalPlus EPO D
01/01/2023 SBC
Cigna+Oscar Silver LocalPlus EPO E (HSA Eligible)
01/01/2023 SBC
Cigna+Oscar Silver Open Access Plus EPO F
01/01/2023 SBC
Cigna+Oscar Silver Open Access Plus EPO G (HSA Eligible)
01/01/2023 SBC
Cigna+Oscar Bronze LocalPlus EPO C (HSA Eligible)
01/01/2023 SBC
Cigna+Oscar Bronze LocalPlus EPO D
01/01/2023 SBC
Cigna+Oscar Bronze LocalPlus EPO F
01/01/2023 SBC
Cigna+Oscar Bronze Open Access Plus EPO E
01/01/2023 SBC
2023 Medical PPO SBCs
Anthem Blue Cross PPO
Anthem Blue Cross Gold Select PPO B
01/01/2023 SBC
Anthem Blue Cross Gold Select PPO C
01/01/2023 SBC
Anthem Blue Cross Gold Select PPO D
01/01/2023 SBC
Anthem Blue Cross Gold PPO E
01/01/2023 SBC
Anthem Blue Cross Silver Select PPO B
01/01/2023 SBC
Anthem Blue Cross Silver PPO C
01/01/2023 SBC
Anthem Blue Cross Silver PPO D (HSA Eligible)
01/01/2023 SBC
Anthem Blue Cross Silver Select PPO E (HSA Eligible)
01/01/2023 SBC
Anthem Blue Cross Bronze PPO A (HSA Eligible)
01/01/2023 SBC
Anthem Blue Cross Bronze Select PPO B (HSA Eligible)
01/01/2023 SBC
Anthem Blue Cross Bronze PPO C
01/01/2023 SBC
Anthem Blue Cross Bronze Select PPO D
01/01/2023 SBC
2022 Medical Plan Benefit Summary Booklets
July - December 2022 Effective Dates
All Tiers Benefit Summaries 7.22 - 12.22 Effective Dates
07/01/2022 Summary
Platinum Benefit Summaries 7.22 - 12.22 Effective Dates
07/01/2022 Summary
Platinum/Gold Benefit Summaries 7.22 - 12.22 Effective Dates
07/01/2022 Summary
Platinum/Gold/Silver Benefit Summaries 7.22 - 12.22 Effective Dates
07/01/2022 Summary
Gold Benefit Summaries 7.22 - 12.22 Effective Dates
07/01/2022 Summary
Gold/Silver Benefit Summaries 7.22 - 12.22 Effective Dates
07/01/2022 Summary
Gold/Silver/Bronze Benefit Summaries 7.22 - 12.22 Effective Dates
07/01/2022 Summary
Silver Benefit Summaries 7.22 - 12.22 Effective Dates
07/01/2022 Summary
Silver/Bronze Benefit Summaries 7.22 - 12.22 Effective Dates
07/01/2022 Summary
Bronze Benefit Summaries 7.22 - 12.22 Effective Dates
07/01/2022 Summary
April - June 2022 Effective Dates
All Tiers Benefit Summaries 4.22 - 6.22 Effective Dates
05/01/2022 Summary
Platinum Benefit Summaries 4.22 - 6.22 Effective Dates
05/01/2022 Summary
Platinum/Gold Benefit Summaries 4.22 - 6.22 Effective Dates
05/01/2022 Summary
Platinum/Gold/Silver Benefit Summaries 4.22 - 6.22 Effective Dates
05/01/2022 Summary
Gold Benefit Summaries 4.22 - 6.22 Effective Dates
05/01/2022 Summary
Gold/Silver Benefit Summaries 4.22 - 6.22 Effective Dates
05/01/2022 Summary
Gold/Silver/Bronze Benefit Summaries 4.22 - 6.22 Effective Dates
05/01/2022 Summary
Silver Benefit Summaries 4.22 - 6.22 Effective Dates
05/01/2022 Summary
Silver/Bronze Benefit Summaries 4.22 - 6.22 Effective Dates
05/01/2022 Summary
Bronze Benefit Summaries 4.22 - 6.22 Effective Dates
05/01/2022 Summary
March 2022 Effective Dates
All Tiers Benefit Summaries 3.22 Effective Dates
03/01/2022 Summary
Platinum Benefit Summaries 3.22 Effective Dates
03/01/2022 Summary
Platinum/Gold Benefit Summaries 3.22 Effective Dates
03/01/2022 Summary
Platinum/Gold/Silver Benefit Summaries 3.22 Effective Dates
03/01/2022 Summary
Gold Benefit Summaries 3.22 Effective Dates
03/01/2022 Summary
Gold/Silver Benefit Summaries 3.22 Effective Dates
03/01/2022 Summary
Gold/Silver/Bronze Benefit Summaries 3.22 Effective Dates
03/01/2022 Summary
Silver Benefit Summaries 3.22 Effective Dates
03/01/2022 Summary
Silver/Bronze Benefit Summaries 3.22 Effective Dates
03/01/2022 Summary
Bronze Benefit Summaries 3.22 Effective Dates
03/01/2022 Summary
January - February 2022 Effective Dates
All Tiers Benefit Summaries 1.22 - 2.22 Effective Dates
03/01/2022 Summary
Platinum Benefit Summaries 1.22 - 2.22 Effective Dates
03/01/2022 Summary
Platinum/Gold Benefit Summaries 1.22 - 2.22 Effective Dates
03/01/2022 Summary
Platinum/Gold/Silver Benefit Summaries 1.22 - 2.22 Effective Dates
03/01/2022 Summary
Gold Benefit Summaries 1.22 - 2.22 Effective Dates
03/01/2022 Summary
Gold/Silver Benefit Summaries 1.22 - 2.22 Effective Dates
03/01/2022 Summary
Gold/Silver/Bronze Benefit Summaries 1.22 - 2.22 Effective Dates
03/01/2022 Summary
Silver Benefit Summaries 1.22 - 2.22 Effective Dates
03/01/2022 Summary
Silver/Bronze Benefit Summaries 1.22 - 2.22 Effective Dates
03/01/2022 Summary
Bronze Benefit Summaries 1.22 - 2.22 Effective Dates
03/01/2022 Summary
2022 Medical HMO SBCs
Anthem HMO
Anthem Blue Cross Platinum Select HMO A
01/01/2022 SBC
Anthem Blue Cross Gold Select HMO A
01/01/2022 SBC
Anthem Blue Cross Gold CaliforniaCare HMO B
01/01/2022 SBC
Anthem Blue Cross Gold Priority Select HMO C
03/01/2022 SBC
Anthem Blue Cross Silver Select HMO A
01/01/2022 SBC
Anthem Blue Cross Silver CaliforniaCare HMO B
01/01/2022 SBC
Anthem Blue Cross Silver Priority Select HMO C
03/01/2022 SBC
Health Net HMO
Health Net Platinum WholeCare HMO C
01/01/2022 SBC
Health Net Platinum Salud HMO D
01/01/2022 SBC
Health Net Platinum Full Network HMO E
01/01/2022 SBC
Health Net Platinum Wholecare HMO F
01/01/2022 SBC
Health Net Platinum Salud HMO G
01/01/2022 SBC
Health Net Platinum Full Network HMO H
01/01/2022 SBC
Health Net Gold WholeCare HMO A
01/01/2022 SBC
Health Net Gold WholeCare HMO B
01/01/2022 SBC
Health Net Gold WholeCare HMO C
01/01/2022 SBC
Health Net Gold Salud HMO D
01/01/2022 SBC
Health Net Gold Full Network HMO E
01/01/2022 SBC
Health Net Gold Full Network HMO F
01/01/2022 SBC
Health Net Gold Full Network HMO G
01/01/2022 SBC
Health Net Silver WholeCare HMO A
01/01/2022 SBC
Health Net Silver CommunityCare HMO C
01/01/2022 SBC
Health Net Bronze CommunityCare HMO A
01/01/2022 SBC
Kaiser Permanente HMO
Kaiser Platinum HMO A
01/01/2022 SBC
Kaiser Platinum HMO B
01/01/2022 SBC
Kaiser Gold HMO B
01/01/2022 SBC
Kaiser Gold HMO C
01/01/2022 SBC
Kaiser Gold HMO D
01/01/2022 SBC
Kaiser Gold HMO E (HSA Eligible)
01/01/2022 SBC
Kaiser Silver HMO A
01/01/2022 SBC
Kaiser Silver HMO B
01/01/2022 SBC
Kaiser Silver HMO C
01/01/2022 SBC
Kaiser Silver HMO D (HSA Eligible)
01/01/2022 SBC
Kaiser Silver HMO E
01/01/2022 SBC
Kaiser Bronze HMO A
01/01/2022 SBC
Kaiser Bronze HMO B
01/01/2022 SBC
Kaiser Bronze HMO C (HSA Eligible)
01/01/2022 SBC
Sharp HMO
Sharp Platinum Premier HMO A
01/01/2022 SBC
Sharp Platinum Performance HMO B
01/01/2022 SBC
Sharp Platinum Premier HMO C
01/01/2022 SBC
Sharp Gold Performance HMO A
01/01/2022 SBC
Sharp Gold Premier HMO B
01/01/2022 SBC
Sharp Gold Performance HMO D
01/01/2022 SBC
Sharp Silver Premier HMO A
01/01/2022 SBC
Sharp Silver Performance HMO B
01/01/2022 SBC
Sharp Silver Premier HMO C
01/01/2022 SBC
Sharp Bronze Premier HMO A
01/01/2022 SBC
Sharp Bronze Performance HMO B (HSA Eligible)
01/01/2022 SBC
Sutter Health Plus HMO
Sutter Health Plus Platinum HMO A
01/01/2022 SBC
Sutter Health Plus Platinum HMO B
01/01/2022 SBC
Sutter Health Plus Gold HMO A
01/01/2022 SBC
Sutter Health Plus Gold HMO B
01/01/2022 SBC
Sutter Health Plus Silver HMO B
01/01/2022 SBC
Sutter Health Plus Silver HMO C (HSA Eligible)
01/01/2022 SBC
Sutter Health Plus Bronze HMO A
01/01/2022 SBC
Sutter Health Plus Bronze HMO B (HSA Eligible)
01/01/2022 SBC
UnitedHealthcare HMO
UHC Platinum SignatureValue HMO A
01/01/2022 SBC
UHC Platinum Alliance HMO C
01/01/2022 SBC
UHC Platinum SignatureValue HMO E
01/01/2022 SBC
UHC Platinum Alliance HMO G
01/01/2022 SBC
UHC Platinum Harmony HMO H
01/01/2022 SBC
UHC Platinum Harmony HMO I
01/01/2022 SBC
UHC Platinum Alliance HMO J
01/01/2022 SBC
UHC Platinum Harmony HMO K
01/01/2022 SBC
UHC Platinum SignatureValue HMO L
01/01/2022 SBC
UHC Gold SignatureValue HMO A
01/01/2022 SBC
UHC Gold Alliance HMO B
01/01/2022 SBC
UHC Gold SignatureValue HMO F
01/01/2022 SBC
UHC Gold Alliance HMO G
01/01/2022 SBC
UHC Gold SignatureValue HMO H
01/01/2022 SBC
UHC Gold Alliance HMO J
01/01/2022 SBC
UHC Gold Harmony HMO L
01/01/2022 SBC
UHC Gold Harmony HMO M
01/01/2022 SBC
UHC Gold Harmony HMO N
01/01/2022 SBC
UHC Gold Alliance HMO O
01/01/2022 SBC
UHC Gold Harmony HMO P
01/01/2022 SBC
UHC Gold SignatureValue HMO Q
01/01/2022 SBC
UHC Silver SignatureValue HMO A
01/01/2022 SBC
UHC Silver Alliance HMO E
01/01/2022 SBC
UHC Silver Harmony HMO F
01/01/2022 SBC
UHC Silver Harmony HMO G
01/01/2022 SBC
Western Health Advantage HMO
Western Health Platinum HMO A
01/01/2022 SBC
Western Health Platinum HMO B
01/01/2022 SBC
Western Health Platinum HMO C
01/01/2022 SBC
Western Health Gold HMO A
01/01/2022 SBC
Western Health Gold HMO B
01/01/2022 SBC
Western Health Gold HMO C
01/01/2022 SBC
Western Health Gold HMO D (HSA Eligible)
01/01/2022 SBC
Western Health Silver HMO A
01/01/2022 SBC
Western Health Silver HMO B
01/01/2022 SBC
Western Health Silver HMO C (HSA Eligible)
01/01/2022 SBC
Western Health Bronze HMO B
01/01/2022 SBC
Western Health Bronze HMO C (HSA Eligible)
01/01/2022 SBC
2022 Medical EPO SBCs
Anthem Blue Cross EPO
Anthem Blue Cross Silver EPO A
01/01/2022 SBC
Anthem Blue Cross Silver EPO B (HSA Eligible)
01/01/2022 SBC
Anthem Blue Cross Bronze EPO A
01/01/2022 SBC
Cigna + Oscar EPO
Cigna+Oscar Platinum LocalPlus EPO C
01/01/2022 SBC
Cigna+Oscar Platinum LocalPlus EPO D
01/01/2022 SBC
Cigna+Oscar Platinum LocalPlus EPO E
01/01/2022 SBC
Cigna+Oscar Gold LocalPlus EPO C
01/01/2022 SBC
Cigna+Oscar Gold LocalPlus EPO D
01/01/2022 SBC
Cigna+Oscar Gold LocalPlus EPO E
01/01/2022 SBC
Cigna+Oscar Silver LocalPlus EPO C
01/01/2022 SBC
Cigna+Oscar Silver LocalPlus EPO D
01/01/2022 SBC
Cigna+Oscar Silver LocalPlus EPO E (HSA Eligible)
01/01/2022 SBC
Cigna+Oscar Bronze LocalPlus EPO D
01/01/2022 SBC
Cigna+Oscar Bronze LocalPlus EPO C (HSA Eligible)
01/01/2022 SBC
Anthem Blue Cross PPO
Anthem Blue Cross Gold Advantage PPO A
01/01/2022 SBC
Anthem Blue Cross Gold Select PPO B
01/01/2022 SBC
Anthem Blue Cross Gold Select PPO C
01/01/2022 SBC
Anthem Blue Cross Gold Select PPO D
01/01/2022 SBC
Anthem Blue Cross Gold PPO E
01/01/2022 SBC
Anthem Blue Cross Silver Advantage PPO A
01/01/2022 SBC
Anthem Blue Cross Silver Select PPO B
01/01/2022 SBC
Anthem Blue Cross Silver PPO C
01/01/2022 SBC
Anthem Blue Cross Bronze PPO A (HSA Eligible)
01/01/2022 SBC
Anthem Blue Cross Bronze Select PPO B (HSA Eligible)
01/01/2022 SBC
2021 Medical Plan Benefit Summary Booklets
July - December 2021 Effective Dates
All Tiers Benefit Summaries 7.21 - 12.21 Effective Dates (updated 7.21)
08/01/2021 Summary
Platinum Benefit Summaries 7.21 - 12.21 Effective Dates (updated 7.21)
08/01/2021 Summary
Platinum/Gold Benefit Summaries 7.21 - 12.21 Effective Dates (updated 7.21)
08/01/2021 Summary
Platinum/Gold/Silver Benefit Summaries 7.21 - 12.21 Effective Dates (updated 7.21)
08/01/2021 Summary
Gold Benefit Summaries 7.21 - 12.21 Effective Dates (updated 7.21)
08/01/2021 Summary
Gold/Silver Benefit Summaries 7.21 - 12.21 Effective Dates (updated 7.21)
08/01/2021 Summary
Gold/Silver/Bronze Benefit Summaries 7.21 - 12.21 Effective Dates (updated 7.21)
08/01/2021 Summary
Silver Benefit Summaries 7.21 - 12.21 Effective Dates (updated 7.21)
08/01/2021 Summary
Silver/Bronze Benefit Summaries 7.21 - 12.21 Effective Dates (updated 7.21)
08/01/2021 Summary
Bronze Benefit Summaries 7.21 - 12.21 Effective Dates (updated 7.21)
04/01/2021 Summary
January - March 2021 Effective Dates
All Tiers Benefit Summaries 1.21 - 3.21 Effective Dates (updated 3.21)
03/01/2021 Summary
Platinum Benefit Summaries 1.21 - 3.21 Effective Dates (updated 3.21)
03/01/2021 Summary
Platinum/Gold Benefit Summaries 1.21 - 3.21 Effective Dates (updated 3.21)
03/01/2021 Summary
Platinum/Gold/Silver Benefit Summaries 1.21 - 3.21 Effective Dates (updated 3.21)
03/01/2021 Summary
Gold Benefit Summaries 1.21 - 3.21 Effective Dates (updated 3.21)
03/01/2021 Summary
Gold/Silver Benefit Summaries 1.21 - 3.21 Effective Dates (updated 3.21)
03/01/2021 Summary
Gold/Silver/Bronze Benefit Summaries 1.21 - 3.21 Effective Dates (updated 3.21)
03/01/2021 Summary
Silver Benefit Summaries 1.21 - 3.21 Effective Dates (updated 3.21)
03/01/2021 Summary
Silver/Bronze Benefit Summaries 1.21 - 3.21 Effective Dates (updated 3.21)
03/01/2021 Summary
Bronze Benefit Summaries 1.21 - 3.21 Effective Dates (updated 3.21)
03/01/2021 Summary
2021 Medical HMO SBCs
Anthem HMO
Anthem Blue Cross Platinum Select HMO A
01/01/2021 SBC
Anthem Blue Cross Gold Select HMO A
01/01/2021 SBC
Anthem Blue Cross Gold CaliforniaCare HMO B
01/01/2021 SBC
Anthem Blue Cross Silver Select HMO A
01/01/2021 SBC
Anthem Blue Cross Silver CaliforniaCare HMO B
01/01/2021 SBC
Health Net HMO
Health Net Platinum WholeCare HMO C
01/01/2021 SBC
Health Net Platinum Salud HMO D
01/01/2021 SBC
Health Net Platinum Full Network HMO E
01/01/2021 SBC
Health Net Platinum Wholecare HMO F
01/01/2021 SBC
Health Net Platinum Salud HMO G
01/01/2021 SBC
Health Net Platinum Full Network HMO H
01/01/2021 SBC
Health Net Gold WholeCare HMO A
01/01/2021 SBC
Health Net Gold WholeCare HMO B
01/01/2021 SBC
Health Net Gold WholeCare HMO C
01/01/2021 SBC
Health Net Gold Salud HMO D
01/01/2021 SBC
Health Net Gold Full Network HMO E
01/01/2021 SBC
Health Net Gold Full Network HMO F
01/01/2021 SBC
Health Net Silver WholeCare HMO A
01/01/2021 SBC
Health Net Silver CommunityCare HMO C
01/01/2021 SBC
Health Net Bronze CommunityCare HMO A
01/01/2021 SBC
Kaiser Permanente HMO
Kaiser Platinum HMO A
01/01/2021 SBC
Kaiser Platinum HMO B
01/01/2021 SBC
Kaiser Gold HMO B
01/01/2021 SBC
Kaiser Gold HMO C
01/01/2021 SBC
Kaiser Gold HMO D
01/01/2021 SBC
Kaiser Silver HMO A
01/01/2021 SBC
Kaiser Silver HMO B
01/01/2021 SBC
Kaiser Silver HMO C
01/01/2021 SBC
Kaiser Silver HMO D (HSA Eligible)
01/01/2021 SBC
Kaiser Silver HMO E
01/01/2021 SBC
Kaiser Bronze HMO A
01/01/2021 SBC
Kaiser Bronze HMO B
01/01/2021 SBC
Kaiser Bronze HMO C (HSA Eligible)
01/01/2021 SBC
Sharp HMO
Sharp Platinum Premier HMO A
01/01/2021 SBC
Sharp Platinum Performance HMO B
01/01/2021 SBC
Sharp Platinum Premier HMO C
01/01/2021 SBC
Sharp Gold Performance HMO A
01/01/2021 SBC
Sharp Gold Premier HMO B
01/01/2021 SBC
Sharp Gold Performance HMO D
01/01/2021 SBC
Sharp Silver Premier HMO A
01/01/2021 SBC
Sharp Silver Performance HMO B
01/01/2021 SBC
Sharp Silver Premier HMO C
01/01/2021 SBC
Sharp Bronze Premier HMO A
01/01/2021 SBC
Sharp Bronze Performance HMO B (HSA Eligible)
01/01/2021 SBC
Sutter Health Plus HMO
Sutter Health Plus Platinum HMO A
01/01/2021 SBC
Sutter Health Plus Platinum HMO B
01/01/2021 SBC
Sutter Health Plus Gold HMO A
01/01/2021 SBC
Sutter Health Plus Gold HMO B
01/01/2021 SBC
Sutter Health Plus Silver HMO B
01/01/2021 SBC
Sutter Health Plus Silver HMO C (HSA Eligible)
01/01/2021 SBC
Sutter Health Plus Bronze HMO A
01/01/2021 SBC
Sutter Health Plus Bronze HMO B (HSA Eligible)
01/01/2021 SBC
UnitedHealthcare HMO
UHC Platinum SignatureValue HMO A
01/01/2021 SBC
UHC Platinum Alliance HMO C
01/01/2021 SBC
UHC Platinum Advantage HMO D
01/01/2021 SBC
UHC Platinum SignatureValue HMO E
01/01/2021 SBC
UHC Platinum Advantage HMO F
01/01/2021 SBC
UHC Platinum Alliance HMO G
01/01/2021 SBC
UHC Platinum Harmony HMO H (New for 7/1/2021)
07/01/2021 SBC
UHC Platinum Harmony HMO I (New for 7/1/2021)
07/01/2021 SBC
UHC Gold SignatureValue HMO A
01/01/2021 SBC
UHC Gold Alliance HMO B
01/01/2021 SBC
UHC Gold Advantage HMO E
01/01/2021 SBC
UHC Gold SignatureValue HMO F
01/01/2021 SBC
UHC Gold Alliance HMO G
01/01/2021 SBC
UHC Gold SignatureValue HMO H
01/01/2021 SBC
UHC Gold Advantage HMO I
01/01/2021 SBC
UHC Gold Alliance HMO J
01/01/2021 SBC
UHC Gold Advantage HMO K
01/01/2021 SBC
UHC Gold Harmony HMO L (New for 7/1/2021)
07/01/2021 SBC
UHC Gold Harmony HMO M (New for 7/1/2021)
07/01/2021 SBC
UHC Gold Harmony HMO N (New for 7/1/2021)
07/01/2021 SBC
UHC Silver SignatureValue HMO A
01/01/2021 SBC
UHC Silver Advantage HMO B
01/01/2021 SBC
UHC Silver Alliance HMO E
01/01/2021 SBC
UHC Silver Harmony HMO F (New for 7/1/2021)
07/01/2021 SBC
UHC Silver Harmony HMO G (New for 7/1/2021)
08/01/2021 SBC
Western Health Advantage HMO
Western Health Platinum HMO A
01/01/2021 SBC
Western Health Platinum HMO B
01/01/2021 SBC
Western Health Platinum HMO C
01/01/2021 SBC
Western Health Gold HMO A
01/01/2021 SBC
Western Health Gold HMO B
03/01/2021 SBC
Western Health Gold HMO C
01/01/2021 SBC
Western Health Gold HMO D (HSA Eligible)
01/01/2021 SBC
Western Health Silver HMO A
01/01/2021 SBC
Western Health Silver HMO B
01/01/2021 SBC
Western Health Silver HMO C (HSA Eligible)
01/01/2021 SBC
Western Health Bronze HMO B
01/01/2021 SBC
Western Health Bronze HMO C (HSA Eligible)
01/01/2021 SBC
2021 Medical EPO SBCs
Anthem Blue Cross EPO
Anthem Blue Cross Silver EPO A
01/01/2021 SBC
Anthem Blue Cross Silver EPO B (HSA Eligible)
01/01/2021 SBC
Anthem Blue Cross Bronze EPO A
01/01/2021 SBC
Cigna + Oscar EPO
Cigna+Oscar Platinum LocalPlus EPO A (New for 7/1/2021)
07/01/2021 SBC
Cigna+Oscar Platinum LocalPlus EPO B (New for 7/1/2021)
07/01/2021 SBC
Cigna+Oscar Gold LocalPlus EPO A (New for 7/1/2021)
07/01/2021 SBC
Western Health Bronze HMO B
01/01/2021 SBC
Western Health Bronze HMO C (HSA Eligible)
01/01/2021 SBC
2021 Medical EPO SBCs
Anthem Blue Cross EPO
Anthem Blue Cross Silver EPO A
01/01/2021 SBC
Anthem Blue Cross Silver EPO B (HSA Eligible)
01/01/2021 SBC
Anthem Blue Cross Bronze EPO A
01/01/2021 SBC
Cigna + Oscar EPO
Cigna+Oscar Platinum LocalPlus EPO A (New for 7/1/2021)
07/01/2021 SBC
Cigna+Oscar Platinum LocalPlus EPO B (New for 7/1/2021)
07/01/2021 SBC
Cigna+Oscar Gold LocalPlus EPO A (New for 7/1/2021)
07/01/2021 SBC
Cigna+Oscar Gold LocalPlus EPO B (New for 7/1/2021)
07/01/2021 SBC
Cigna+Oscar Silver LocalPlus EPO A (New for 7/1/2021)
07/01/2021 SBC
Cigna+Oscar Silver LocalPlus EPO B (New for 7/1/2021)
07/01/2021 SBC
Cigna+Oscar Bronze LocalPlus EPO A (HSA Eligible) (New for 7/1/2021)
07/01/2021 SBC
Cigna+Oscar Bronze LocalPlus EPO B (HSA Eligible) (New for 7/1/2021)
07/01/2021 SBC
Oscar EPO
Oscar Platinum EPO A
01/01/2021 SBC
Oscar Platinum EPO B
01/01/2021 SBC
Oscar Gold EPO A
01/01/2021 SBC
Oscar Gold EPO B
01/01/2021 SBC
Oscar Gold EPO C
01/01/2021 SBC
Oscar Gold EPO D
01/01/2021 SBC
Oscar Silver EPO A (HSA Eligible)
01/01/2021 SBC
Oscar Silver EPO B
01/01/2021 SBC
Oscar Silver EPO C
01/01/2021 SBC
Oscar Silver EPO D
01/01/2021 SBC
Oscar Bronze EPO A (HSA Eligible)
01/01/2021 SBC
Oscar Bronze EPO B
01/01/2021 SBC
Oscar Bronze EPO C
01/01/2021 SBC
2021 Medical PPO SBCs
Anthem Blue Cross PPO
Anthem Blue Cross Gold Advantage PPO A
01/01/2021 SBC
Anthem Blue Cross Gold Select PPO B
01/01/2021 SBC
Anthem Blue Cross Gold Select PPO C
01/01/2021 SBC
Anthem Blue Cross Gold Select PPO D
01/01/2021 SBC
Anthem Blue Cross Gold PPO E
01/01/2021 SBC
Anthem Blue Cross Silver Advantage PPO A
01/01/2021 SBC
Anthem Blue Cross Silver Select PPO B
01/01/2021 SBC
Anthem Blue Cross Silver PPO C
01/01/2021 SBC
Anthem Blue Cross Bronze PPO A (HSA Eligible)
01/01/2021 SBC
Anthem Blue Cross Bronze Select PPO B (HSA Eligible)
01/01/2021 SBC
Form Name Effective Date Download Form
General Information
CaliforniaChoice Fast Facts Brochure 1.22
01/01/2022 Download
CaliforniaChoice Underwriting Guidelines 3.22
03/01/2022 Download
Cal Perks Flyer
01/01/2022 Download
Choice Administrators Agent Agreement
01/01/2022 Download
Choice Administrators Amendment Agent Agreement
01/01/2022 Download
Choice Administrators Broker License Form
01/01/2022 Download
Choice Administrators Direct Deposit Authorization
01/01/2022 Download
IRS W-9 Request for Taxpayer Identification Number & Certification
01/01/2022 Download
Mobile App Flyer
01/01/2022 Download
Payroll & HRIS Solutions via CaliforniaChoice
01/01/2022 Download
Premium Only Plan Flyer
01/01/2022 Download
Program Highlights Flyer
01/01/2022 Download
Smart Decision Technology Overview for Brokers
01/01/2022 Download
Smart Decision Technology Overview for Employers
01/01/2022 Download
Smart Decision Technology - Automated Choice Profiler
01/01/2022 Download
Smart Decision Technology - Online Enrollment
01/01/2022 Download
Smart Decision Technology - Online Rx Search
01/01/2022 Download
Website Features Flyer - Brokers
01/01/2022 Download
Website Features Flyer - Employers
01/01/2022 Download
Website Features Flyer - Employees
01/01/2022 Download
Medical
CaliforniaChoice HSA Guide 1.22
01/01/2022 Download
CaliforniaCare Member Enrollment Guide 7.22 to 12.22 Effective Dates
07/01/2022 Download
CaliforniaChoice Renewal Plan Transition Guide 7.22 Effective Dates
07/01/2022 Download
CaliforniaChoice Summary of Changes for Groups Renewing 7.22 to 12.22 Effective Dates
07/01/2022 Download
CaliforniaChoice Summary of Changes for Groups Renewing 1.23 to 2.23 Effective Dates
01/01/2023 Download
Infertility Benefit Grid 3.22 Effective Dates
03/01/2022 Download
Medicare Part D Credibility 1.22 Effective Dates
01/01/2022 Download
Network Availability by Carrier & Plan Summary 3.22
03/01/2022 Download
Online Provider Search Instructions
01/01/2022 Download
Provider Network Definitions 3.22
03/01/2022 Download
SBC-EOC Flyer
01/01/2022 Download
Ancillary
Employer Guide to Optional Benefits 7.22 Effective Dates
07/01/2022 Download
Chiropractic & Acupuncture Benefits Flyer 1.22
01/01/2022 Download
Landmark Acupuncture Directory 4.22
04/01/2022 Download
Landmark Chiropractor Directory 4.22
04/01/2022 Download
Dental Benefits Flyer 1.22
07/01/2022 Download
Dentegra Smile Club Program Flyer
07/01/2022 Download
Hearing Value Added Benefit Flyer 1.22
01/01/2022 Download
Life Insurance Benefits Flyer 1.22
01/01/2022 Download
Vision Benefits Flyer 1.22
01/01/2022 Download
Vision One Eyecare Discount Program
01/01/2022 Download
Video Name Watch Video
Intro to CaliforniaChoice Watch Video
CaliforniaChoice What is Defined Contribution? Watch Video
CaliforniaChoice Health Insurance Plans Watch Video
CaliforniaChoice Ease of Administration Watch Video
CaliforniaChoice Additional Plans and Perks Watch Video
CaliforniaChoice Working with Health Insurance Brokers Watch Video
Form Name Effective Date Download Form
Rate Guide Summary [effective 10/1/2022 to 12/1/2022]
10/01/2022 Download
Rate Guide Summary [effective 1/1/2023 to 3/1/2023]
01/01/2023 Download