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 1.24 to 4.24 Effective Dates |
01/01/2024 | Download |
Employer Application 7.23 to 12.23 Effective Dates |
07/01/2023 | 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 1.24 |
01/01/2024 | Download |
Employer Change Request Form 1.22 |
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 4.23 |
04/01/2023 | Download |
Employer Program Guide 7.22 |
07/01/2022 | Download |
Form Name | Effective Date | Download Form |
---|---|---|
Enrollment and Change Forms |
||
Employee Enrollment Form 1.24 to 4.24 Effective Dates |
01/01/2024 | Download |
Employee Enrollment Form 7.23 to 12.23 Effective Dates |
07/01/2023 | Download |
Employee Change Request Form 1.24 to 3.24 Effective Dates |
01/01/2024 | Download |
Employee Change Request Form 7.23 to 12.23 Effective Dates |
07/01/2023 | 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 | |
---|---|---|---|
2024 Medical Plan Benefit Summary Booklets |
|||
All Tiers Benefit Summaries 1.24 - 12.23 Effective Dates |
01/01/2024 | Summary | |
2023 Medical Plan Benefit Summary Booklets |
|||
July - December 2023 Effective Dates |
|||
All Tiers Benefit Summaries 7.23 - 12.23 Effective Dates |
07/01/2023 | Summary | |
Platinum Benefit Summaries 7.23 - 12.23 Effective Dates |
07/01/2023 | Summary | |
Platinum/Gold Benefit Summaries 7.23 - 12.23 Effective Dates |
07/01/2023 | Summary | |
Platinum/Gold/Silver Benefit Summaries 7.23 - 12.23 Effective Dates |
07/01/2023 | Summary | |
Gold Benefit Summaries 7.23 - 12.23 Effective Dates |
07/01/2023 | Summary | |
Gold/Silver Benefit Summaries 7.23 - 12.23 Effective Dates |
07/01/2023 | Summary | |
Gold/Silver/Bronze Benefit Summaries 7.23 - 12.23 Effective Dates |
07/01/2023 | Summary | |
Silver Benefit Summaries 7.23 - 12.23 Effective Dates |
07/01/2023 | Summary | |
Silver/Bronze Benefit Summaries 7.23 - 12.23 Effective Dates |
07/01/2023 | Summary | |
Bronze Benefit Summaries 7.23 - 12.23 Effective Dates |
07/01/2023 | Summary | |
April - June 2023 Effective Dates |
|||
All Tiers Benefit Summaries 4.23 - 6.23 Effective Dates |
04/01/2023 | Summary | |
Platinum Benefit Summaries 4.23 - 6.23 Effective Dates |
04/01/2023 | Summary | |
Platinum/Gold Benefit Summaries 4.23 - 6.23 Effective Dates |
04/01/2023 | Summary | |
Platinum/Gold/Silver Benefit Summaries 4.23 - 6.23 Effective Dates |
04/01/2023 | Summary | |
Gold Benefit Summaries 4.23 - 6.23 Effective Dates |
04/01/2023 | Summary | |
Gold/Silver Benefit Summaries 4.23 - 6.23 Effective Dates |
04/01/2023 | Summary | |
Gold/Silver/Bronze Benefit Summaries 4.23 - 6.23 Effective Dates |
04/01/2023 | Summary | |
Silver Benefit Summaries 4.23 - 6.23 Effective Dates |
04/01/2023 | Summary | |
Silver/Bronze Benefit Summaries 4.23 - 6.23 Effective Dates |
04/01/2023 | Summary | |
Bronze Benefit Summaries 4.23 - 6.23 Effective Dates |
04/01/2023 | Summary | |
January - March 2023 Effective Dates |
|||
All Tiers Benefit Summaries 1.23 - 3.23 Effective Dates |
01/01/2023 | Summary | |
Platinum Benefit Summaries 1.23 - 3.23 Effective Dates |
01/01/2023 | Summary | |
Platinum/Gold Benefit Summaries 1.23 - 3.23 Effective Dates |
01/01/2023 | Summary | |
Platinum/Gold/Silver Benefit Summaries 1.23 - 3.23 Effective Dates |
01/01/2023 | Summary | |
Gold Benefit Summaries 1.23 - 3.23 Effective Dates |
01/01/2023 | Summary | |
Gold/Silver Benefit Summaries 1.23 - 3.23 Effective Dates |
01/01/2023 | Summary | |
Gold/Silver/Bronze Benefit Summaries 1.23 - 3.23 Effective Dates |
01/01/2023 | Summary | |
Silver Benefit Summaries 1.23 - 3.23 Effective Dates |
01/01/2023 | Summary | |
Silver/Bronze Benefit Summaries 1.23 - 3.23 Effective Dates |
01/01/2023 | Summary | |
Bronze Benefit Summaries 1.23 - 3.23 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 |
|||
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 Gold HMO C (HSA Eligible) |
04/01/2023 | 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 |
|||
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 Platinum PPO A [New 7/1/2023] |
07/01/2023 | SBC | |
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 Gold PPO F [New 7/1/2023] |
07/01/2023 | SBC | |
Anthem Blue Cross Gold Select PPO G [New 7/1/2023] |
07/01/2023 | 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 |
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) |
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 |
10/01/2023 | Download |
Choice Administrators Agent Agreement |
02/01/2023 | Download |
Choice Administrators Amendment Agent Agreement |
02/01/2023 | Download |
Choice Administrators Broker License Form |
02/01/2023 | Download |
Choice Administrators Direct Deposit Authorization |
02/01/2023 | Download |
IRS W-9 Request for Taxpayer Identification Number & Certification |
01/01/2022 | Download |
Mobile App Flyer |
04/01/2023 | 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 Member Enrollment Guide 7.23 - 12.23 Effective Dates |
07/01/2023 | Download |
CaliforniaChoice Member Enrollment Guide 4.23 - 6.23 Effective Dates |
04/01/2023 | Download |
CaliforniaChoice Member Enrollment Guide 1.23 - 3.23 Effective Dates |
01/01/2023 | Download |
CaliforniaChoice Member Enrollment Guide 7.22 - 12.22 Effective Dates |
07/01/2022 | Download |
CaliforniaChoice Summary of Changes for Groups Renewing 1.24 - 3.24 Effective Dates |
01/01/2024 | Download |
CaliforniaChoice Summary of Changes for Groups Renewing 7.23 - 12.23 Effective Dates |
07/01/2023 | Download |
CaliforniaChoice Summary of Changes for Groups Renewing 4.23 - 6.23 Effective Dates |
04/01/2023 | Download |
CaliforniaChoice Summary of Changes for Groups Renewing 3.23 - 3.23 Effective Dates |
03/01/2023 | Download |
CaliforniaChoice Summary of Changes for Groups Renewing 1.23 - 2.23 Effective Dates |
01/01/2023 | Download |
HSA Guide Brochure |
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 |
04/01/2023 | Download |
Provider Network Definitions 7.23 - 12.23 Effective Dates |
07/01/2023 | Download |
Provider Network Definitions 4.23 - 6.23 Effective Dates |
04/01/2023 | Download |
Provider Network Definitions 1.23 - 3.23 Effective Dates |
01/01/2023 | Download |
SBC-EOC Flyer |
01/01/2022 | Download |
Ancillary |
||
Employer Guide to Optional Benefits 7.22 - 12.23 Effective Dates |
01/01/2023 | Download |
Chiropractic & Acupuncture Benefits Flyer 4.23 - 12.23 Effective Dates |
04/01/2023 | Download |
Landmark Acupuncture Directory 4.23 |
04/01/2023 | Download |
Landmark Chiropractic Directory 4.23 |
04/01/2023 | Download |
Dental Benefits Flyer 4.23 - 12.23 Effective Dates |
04/01/2023 | Download |
Dentegra Smile Club Program Flyer 7.22 |
01/01/2023 | Download |
Hearing Value Added Benefit Flyer 4.23 - 12.23 Effective Dates |
04/01/2023 | Download |
Life Insurance Benefits Flyer 4.23 - 12.23 Effective Dates |
04/01/2023 | Download |
Vision Benefits Flyer 4.22 - 12.23 Effective Dates |
04/01/2023 | Download |
Vision One Eyecare Discount Program |
01/01/2023 | 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 1/1/2024 to 3/1/2024] |
01/01/2024 | Download |
Rate Guide Summary [effective 10/1/2023 to 12/1/2023] |
10/01/2023 | Download |
Rate Guide Summary [effective 7/1/2023 to 9/1/2023] |
07/01/2023 | Download |
Rate Guide Summary [effective 4/1/2023 to 6/1/2023] |
04/01/2023 | Download |
Rate Guide Summary [effective 1/1/2023 to 3/1/2023] |
01/01/2023 | Download |