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 Submission Checklist
01/01/2018 Download
Employer Application 10.18 to 11.18 Effective Dates
10/01/2018 Download
Employer Application 12.18 Effective Dates
12/01/2018 Download
ACH Payment Form 4.18 and Later Effective Dates
04/01/2018 Download
Owner Partner Statement Form
01/01/2018 Download
Case Submission Acknowledgement (for groups submitted after the requested effective date)
01/01/2018 Download
Common Ownership Statement
01/01/2018 Download
Group Size Attestation
01/01/2018 Download
Self Funding Declaration
01/01/2018 Download
Prior Carrier Cancellation Letter Template
01/01/2018 Download
In Force Group Forms
Changes to Group Policy Guidelines
01/01/2018 Download
Employee Termination Notification 4.18 and Later Effective Dates
04/01/2018 Download
Employer Change Request Form 10.18 - 11.18 Effective Dates
10/01/2018 Download
Employer Change Request Form 12.18 Effective Dates
12/01/2018 Download
Employer Group Contact Change
01/01/2018 Download
Employer In Force Group Dental Application 4.18 and later effective dates
04/01/2018 Download
Employer Inforce Group Voluntary Vision Application 10.17 and later effective dates
01/01/2018 Download
Employer Recertification Agreement
01/01/2018 Download
Exception Request Form
01/01/2018 Download
Group COBRA Billing Contract
01/01/2018 Download
Administration
Employer Administrative Guide 7.18
07/01/2018 Download
Employer Administrative Guide 12.18
12/01/2018 Download
Employer Program Guide 1.18 to 3.18 Effective Dates
01/01/2018 Download
Employer Program Guide 4.18 to 6.18 Effective Dates
04/01/2018 Download
Employer Program Guide 7.18 to 9.18 Effective Dates
07/01/2018 Download
Employer Program Guide 10.18 to 11.18 Effective Dates
10/01/2018 Download
Employer Program Guide 12.18 Effective Dates
12/01/2018 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Application 10.18 to 11.18 Effective Dates
10/01/2018 Download
Employee Application 12.18 Effective Dates
12/01/2018 Download
Employee Change Request Form 10.18 to 11.18 Effective Dates
10/01/2018 Download
Employee Change Request Form 12.18 Effective Dates
12/01/2018 Download
Domestic Partner Affidavit Form
10/01/2018 Download
Claim Forms
RX Claim Form - Aetna
Download
RX Claim Form - Anthem Express Scripts
Download
RX Claim Form - Health Net
Download
RX Claim Form - Sharp
Download
RX Claim Form - UHC
Download
RX by Mail Claim Form - Aetna
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
2018 Medical Plan Summary Booklets
Q1
All Tiers Benefit Summaries 1/1/18 - 3/1/18 Effective Dates
01/01/2018 Summary
Platinum Benefit Summaries 1/1/18 - 3/1/18 Effective Dates
01/01/2018 Summary
Platinum/Gold Benefit Summaries 1/1/18 - 3/1/18 Effective Dates
01/01/2018 Summary
Gold Benefit Summaries 1/1/18 - 3/1/18 Effective Dates
01/01/2018 Summary
Gold/Silver Benefit Summaries 1/1/18 - 3/1/18 Effective Dates
01/01/2018 Summary
Silver Benefit Summaries 1/1/18 - 3/1/18 Effective Dates
01/01/2018 Summary
Silver/Bronze Benefit Summaries 1/1/18 - 3/1/18 Effective Dates
01/01/2018 Summary
Bronze Benefit Summaries 1/1/18 - 3/1/18 Effective Dates
01/01/2018 Summary
Q2
All Tiers Benefit Summaries 4/1/18 - 6/1/18 Effective Dates
04/01/2018 Summary
Platinum Benefit Summaries 4/1/18 - 6/1/18 Effective Dates
04/01/2018 Summary
Platinum/Gold Benefit Summaries 4/1/18 - 6/1/18 Effective Dates
04/01/2018 Summary
Gold Benefit Summaries 4/1/18 - 6/1/18 Effective Dates
04/01/2018 Summary
Gold/Silver Benefit Summaries 4/1/18 - 6/1/18 Effective Dates
04/01/2018 Summary
Silver Benefit Summaries 4/1/18 - 6/1/18 Effective Dates
04/01/2018 Summary
Silver/Bronze Benefit Summaries 4/1/18 - 6/1/18 Effective Dates
04/01/2018 Summary
Bronze Benefit Summaries 4/1/18 - 6/1/18 Effective Dates
04/01/2018 Summary
Q3
All Tiers Benefit Summaries 7/1/18 - 9/1/18 Effective Dates
07/01/2018 Summary
Platinum Benefit Summaries 7/1/18 - 9/1/18 Effective Dates
07/01/2018 Summary
Platinum/Gold Benefit Summaries 7/1/18 - 9/1/18 Effective Dates
07/01/2018 Summary
Gold Benefit Summaries 7/1/18 - 9/1/18 Effective Dates
07/01/2018 Summary
Gold/Silver Benefit Summaries 7/1/18 - 9/1/18 Effective Dates
07/01/2018 Summary
Silver Benefit Summaries 7/1/18 - 9/1/18 Effective Dates
07/01/2018 Summary
Silver/Bronze Benefit Summaries 7/1/18 - 9/1/18 Effective Dates
07/01/2018 Summary
Bronze Benefit Summaries 7/1/18 - 9/1/18 Effective Dates
07/01/2018 Summary
Q4
All Tiers Benefit Summaries 10/1/18 - 11/1/18 Effective Dates
10/01/2018 Summary
All Tiers Benefit Summaries 12/1/18 Effective Dates
12/01/2018 Summary
Platinum Benefit Summaries 10/1/18 - 11/1/18 Effective Dates
10/01/2018 Summary
Platinum Benefit Summaries 12/1/18 Effective Dates
12/01/2018 Summary
Platinum/Gold Benefit Summaries 10/1/18 - 11/1/18 Effective Dates
10/01/2018 Summary
Platinum/Gold Benefit Summaries 12/1/18 Effective Dates
12/01/2018 Summary
Gold Benefit Summaries 10/1/18 - 11/1/18 Effective Dates
10/01/2018 Summary
Gold Benefit Summaries 12/1/18 Effective Dates
12/01/2018 Summary
Gold/Silver Benefit Summaries 10/1/18 - 11/1/18 Effective Dates
10/01/2018 Summary
Gold/Silver Benefit Summaries 12/1/18 Effective Dates
12/01/2018 Summary
Silver Benefit Summaries 10/1/18 - 11/1/18 Effective Dates
10/01/2018 Summary
Silver Benefit Summaries 12/1/18 Effective Dates
12/01/2018 Summary
Silver/Bronze Benefit Summaries 10/1/18 - 11/1/18 Effective Dates
10/01/2018 Summary
Silver/Bronze Benefit Summaries 12/1/18 Effective Dates
12/01/2018 Summary
Bronze Benefit Summaries 10/1/18 - 11/1/18 Effective Dates
10/01/2018 Summary
Bronze Benefit Summaries 12/1/18 Effective Dates
12/01/2018 Summary
2018 Medical HMO and HSP SBCs
Anthem HMO
Anthem Blue Cross Select A Platinum HMO
01/01/2018 SBC
Anthem Blue Cross Select A Gold HMO
01/01/2018 SBC
Anthem Blue Cross Select A Silver HMO
01/01/2018 SBC
Health Net HMO and HSP
Health Net Salud A Platinum HMO (Discontinued 10.1.18)
01/01/2018 SBC
Health Net WholeCare B Platinum HMO (Discontinued 10.1.18)
01/01/2018 SBC
Health Net WholeCare C Platinum HMO (10.1.18 and Later Effective Dates)
10/01/2018 SBC
Health Net Salud D Platinum HMO (10.1.18 and Later Effective Dates)
10/01/2018 SBC
Health Net SmartCare E Platinum HMO (10.1.18 and Later Effective Dates)
10/01/2018 SBC
Health Net WholeCare A Gold HMO
01/01/2018 SBC
Health Net WholeCare B Gold HMO
01/01/2018 SBC
Health Net WholeCare C Gold HMO (10.1.18 and Later Effective Dates)
10/01/2018 SBC
Health Net Salud D Gold HMO (10.1.18 and Later Effective Dates)
10/01/2018 SBC
Health Net SmartCare E Gold HMO (10.1.18 and Later Effective Dates)
10/01/2018 SBC
Health Net WholeCare A Silver HMO
01/01/2018 SBC
Health Net CommunityCare B Silver HMO
01/01/2018 SBC
Health Net PureCare A Gold HSP (Discontinued 10.1.18)
01/01/2018 SBC
Health Net PureCare A Silver HSP
01/01/2018 SBC
Health Net PureCare A Bronze HSP
01/01/2018 SBC
Kaiser Permanente HMO
Kaiser A Platinum HMO
01/01/2018 SBC
Kaiser B Platinum HMO
01/01/2018 SBC
Kaiser A Gold HMO
01/01/2018 SBC
Kaiser B Gold HMO
01/01/2018 SBC
Kaiser B Silver HMO
01/01/2018 SBC
Kaiser C Silver HMO
01/01/2018 SBC
Kaiser D Silver HMO (HSA Eligible)
01/01/2018 SBC
Kaiser A Bronze HMO
01/01/2018 SBC
Kaiser C Bronze HMO (HSA Eligible)
01/01/2018 SBC
Sharp HMO
Sharp Premier A Platinum HMO
01/01/2018 SBC
Sharp Performance B Platinum HMO
01/01/2018 SBC
Sharp Premier C Platinum HMO
01/01/2018 SBC
Sharp Performance A Gold HMO
01/01/2018 SBC
Sharp Premier B Gold HMO
01/01/2018 SBC
Sharp Premier C Gold HMO (Discontinued 7.1.18)
01/01/2018 SBC
Sharp Performance D Gold HMO (7.1.18 and Later Effective Dates)
07/01/2018 SBC
Sharp Premier A Silver HMO
01/01/2018 SBC
Sharp Performance B Silver HMO
01/01/2018 SBC
Sharp Premier C Silver HMO
01/01/2018 SBC
Sharp Premier A Bronze HMO
01/01/2018 SBC
Sharp Performance B Bronze HMO (HSA Eligible)
01/01/2018 SBC
Sharp Premier D Bronze HMO (HSA Eligible)
01/01/2018 SBC
Sutter Health Plus HMO
Sutter Health Plus A Platinum HMO
01/01/2018 SBC
Sutter Health Plus B Platinum HMO
01/01/2018 SBC
Sutter Health Plus A Gold HMO
01/01/2018 SBC
Sutter Health Plus B Gold HMO
01/01/2018 SBC
Sutter Health Plus B Silver HMO
01/01/2018 SBC
Sutter Health Plus C Silver HMO (HSA Eligible)
01/01/2018 SBC
Sutter Health Plus A Bronze HMO
01/01/2018 SBC
Sutter Health Plus B Bronze HMO (HSA Eligible)
01/01/2018 SBC
UnitedHealthcare HMO
UHC SignatureValue A Platinum HMO
01/01/2018 SBC
UHC Focus B Platinum HMO
01/01/2018 SBC
UHC Alliance C Platinum HMO
01/01/2018 SBC
UHC SignatureValue A Gold HMO
01/01/2018 SBC
UHC Alliance B Gold HMO
01/01/2018 SBC
UHC Focus C Gold HMO
01/01/2018 SBC
UHC SignatureValue A Silver HMO
01/01/2018 SBC
UHC Alliance B Silver HMO
01/01/2018 SBC
UHC Alliance C Silver HMO
01/01/2018 SBC
UHC Focus D Silver HMO
01/01/2018 SBC
UHC Alliance B Bronze HMO (HSA Eligible)
01/01/2018 SBC
UHC Alliance C Bronze HMO
01/01/2018 SBC
Western Health Advantage HMO
Western Health A Platinum HMO
01/01/2018 SBC
Western Health B Platinum HMO
01/01/2018 SBC
Western Health A Gold HMO
01/01/2018 SBC
Western Health B Gold HMO
01/01/2018 SBC
Western Health C Gold HMO
01/01/2018 SBC
Western Health D Gold HMO (HSA Eligible)
01/01/2018 SBC
Western Health A Silver HMO
01/01/2018 SBC
Western Health B Silver HMO
01/01/2018 SBC
Western Health C Silver HMO (HSA Eligible)
01/01/2018 SBC
Western Health B Bronze HMO
01/01/2018 SBC
Western Health C Bronze HMO (HSA Eligible)
01/01/2018 SBC
Western Health D Bronze HMO (HSA Eligible)
01/01/2018 SBC
2018 Medical PPO and EPO SBCs
Anthem Blue Cross PPO and EPO
Anthem Blue Cross Advantage A Gold PPO
01/01/2018 SBC
Anthem Blue Cross Select B Gold PPO
01/01/2018 SBC
Anthem Blue Cross Select C Gold PPO
01/01/2018 SBC
Anthem Blue Cross Select D Gold PPO
01/01/2018 SBC
Anthem Blue Cross Advantage A Silver PPO
01/01/2018 SBC
Anthem Blue Cross Select B Silver PPO
01/01/2018 SBC
Anthem Blue Cross A Silver EPO
01/01/2018 SBC
Anthem Blue Cross B Silver EPO (HSA Eligible)
01/01/2018 SBC
Anthem Blue Cross A Bronze EPO
01/01/2018 SBC
Oscar EPO (released for 12.1.18 in rating areas 15,16 and 18)
Oscar Platinum EPO A (available for 12/1/18 effective dates)
12/01/2018 SBC
Oscar Platinum EPO B (available for 12/1/18 effective dates)
12/01/2018 SBC
Oscar Gold EPO A (available for 12/1/18 effective dates)
12/01/2018 SBC
Oscar Gold EPO B (available for 12/1/18 effective dates)
12/01/2018 SBC
Oscar Gold EPO C (available for 12/1/18 effective dates)
12/01/2018 SBC
Oscar Silver EPO A (available for 12/1/18 effective dates)
12/01/2018 SBC
Oscar Silver EPO B (available for 12/1/18 effective dates)
12/01/2018 SBC
Oscar Bronze EPO A (available for 12/1/18 effective dates)
12/01/2018 SBC
Oscar Bronze EPO B (available for 12/1/18 effective dates)
12/01/2018 SBC
2017 Medical Plan Summary Booklets
All Tiers Benefit Summaries
10/01/2017 Summary
Platinum Benefit Summaries
10/01/2017 Summary
Platinum/Gold Benefit Summaries
10/01/2017 Summary
Gold Benefit Summaries
10/01/2017 Summary
Gold/Silver Benefit Summaries
10/01/2017 Summary
Silver Benefit Summaries
10/01/2017 Summary
Silver/Bronze Benefit Summaries
10/01/2017 Summary
Bronze Benefit Summaries
10/01/2017 Summary
2017 Medical HMO and HSP SBCs
Anthem HMO
Anthem Blue Cross Select A Platinum HMO
10/01/2017 SBC
Anthem Blue Cross Select A Gold HMO
10/01/2017 SBC
Anthem Blue Cross Select A Silver HMO
10/01/2017 SBC
Health Net HMO and HSP
Health Net Salud A Platinum HMO
10/01/2017 SBC
Health Net WholeCare A Gold HMO
10/01/2017 SBC
Health Net WholeCare B Gold HMO
10/01/2017 SBC
Health Net PureCare A Gold HSP
10/01/2017 SBC
Health Net PureCare A Silver HSP
10/01/2017 SBC
Health Net PureCare A Bronze HSP
10/01/2017 SBC
Kaiser Permanente HMO
Kaiser A Platinum HMO
10/01/2017 SBC
Kaiser A Gold HMO
10/01/2017 SBC
Kaiser B Gold HMO
10/01/2017 SBC
Kaiser B Silver HMO
10/01/2017 SBC
Kaiser C Silver HMO
10/01/2017 SBC
Kaiser D Silver HMO (HSA Eligible)
10/01/2017 SBC
Kaiser B Bronze HMO
10/01/2017 SBC
Kaiser C Bronze HMO (HSA Eligible)
10/01/2017 SBC
Sharp HMO
Sharp Premier A Platinum HMO
10/01/2017 SBC
Sharp Performance B Platinum HMO
10/01/2017 SBC
Sharp Premier C Platinum HMO
10/01/2017 SBC
Sharp Performance A Gold HMO
10/01/2017 SBC
Sharp Premier B Gold HMO
10/01/2017 SBC
Sharp Premier C Gold HMO
10/01/2017 SBC
Sharp Premier A Silver HMO
10/01/2017 SBC
Sharp Performance B Silver HMO
10/01/2017 SBC
Sharp Premier C Silver HMO
10/01/2017 SBC
Sharp Premier A Bronze HMO
10/01/2017 SBC
Sharp Performance B Bronze HMO (HSA Eligible)
10/01/2017 SBC
Sharp Premier D Bronze HMO (HSA Eligible)
10/01/2017 SBC
Sutter Health Plus HMO
Sutter Health Plus A Platinum HMO
10/01/2017 SBC
Sutter Health Plus B Platinum HMO
10/01/2017 SBC
Sutter Health Plus A Gold HMO
10/01/2017 SBC
Sutter Health Plus B Gold HMO
10/01/2017 SBC
Sutter Health Plus B Silver HMO
10/01/2017 SBC
Sutter Health Plus C Silver HMO (HSA Eligible)
10/01/2017 SBC
Sutter Health Plus A Bronze HMO
10/01/2017 SBC
Sutter Health Plus B Bronze HMO (HSA Eligible)
10/01/2017 SBC
UnitedHealthcare HMO
UHC SignatureValue A Platinum HMO
10/01/2017 SBC
UHC Focus B Platinum HMO
10/01/2017 SBC
UHC Alliance C Platinum HMO
10/01/2017 SBC
UHC SignatureValue A Gold HMO
10/01/2017 SBC
UHC Alliance B Gold HMO
10/01/2017 SBC
UHC Focus C Gold HMO
10/01/2017 SBC
UHC SignatureValue A Silver HMO
10/01/2017 SBC
UHC Alliance B Silver HMO
10/01/2017 SBC
UHC Alliance C Silver HMO
10/01/2017 SBC
UHC Focus D Silver HMO
10/01/2017 SBC
UHC Alliance B Bronze HMO (HSA Eligible)
10/01/2017 SBC
UHC Alliance C Bronze HMO
10/01/2017 SBC
Western Health Advantage HMO
Western Health A Platinum HMO
10/01/2017 SBC
Western Health B Platinum HMO
10/01/2017 SBC
Western Health A Gold HMO
10/01/2017 SBC
Western Health B Gold HMO
10/01/2017 SBC
Western Health C Gold HMO
10/01/2017 SBC
Western Health D Gold HMO (HSA Eligible)
10/01/2017 SBC
Western Health A Silver HMO
10/01/2017 SBC
Western Health B Silver HMO
10/01/2017 SBC
Western Health C Silver HMO (HSA Eligible)
10/01/2017 SBC
Western Health B Bronze HMO
10/01/2017 SBC
Western Health C Bronze HMO (HSA Eligible)
10/01/2017 SBC
Western Health D Bronze HMO (HSA Eligible)
10/01/2017 SBC
2017 Medical PPO and EPO SBCs
Anthem Blue Cross Advantage A Gold PPO
10/01/2017 SBC
Anthem Blue Cross Select B Gold PPO
10/01/2017 SBC
Anthem Blue Cross Select C Gold PPO
10/01/2017 SBC
Anthem Blue Cross Select D Gold PPO
10/01/2017 SBC
Anthem Blue Cross Advantage A Silver PPO
10/01/2017 SBC
Anthem Blue Cross Select B Silver PPO
10/01/2017 SBC
Anthem Blue Cross A Silver EPO
10/01/2017 SBC
Anthem Blue Cross B Silver EPO (HSA Eligible)
10/01/2017 SBC
Anthem Blue Cross A Bronze EPO
10/01/2017 SBC
Anthem Blue Cross B Bronze EPO (HSA Eligible)
10/01/2017 SBC
Form Name Effective Date Download Form
New CaliforniaChoice Triple Tier Flyer
01/01/2019 Download
Anthem Advantage PPO Tier Hospital Network
01/01/2018 Download
CalChoice Program Highlights Effective 1/1/18
01/01/2018 Download
CalChoice Program Highlights Effective 12/1/18
12/01/2018 Download
CalChoice vs Wrap Comparison Flyer
01/01/2018 Download
CalChoice 2018 Deductible and Out-of-Pocket Max Credit Reference Sheet
01/01/2018 Download
Cal Perks Flyer
01/01/2018 Download
Infertility Services Chart 1.18 to 6.18 Effective Dates
01/01/2018 Download
Infertility Services Chart 7.18 to 9.18 Effective Dates
07/01/2018 Download
Infertility Services Chart 10.18 to 11.18 Effective Dates
10/01/2018 Download
Member Enrollment Guide 1.18 to 3.18 Effective Dates
01/01/2018 Download
Member Enrollment Guide 4.18 to 6.18 Effective Dates
04/01/2018 Download
Member Enrollment Guide 7.18 to 9.18 Effective Dates
07/01/2018 Download
Member Value Program Flyer
01/01/2018 Download
Network Availability by Carrier & Plan Summary 1.18 to 6.18 Effective Dates
01/01/2018 Download
Network Availability by Carrier & Plan Summary 7.18 to 9.18 Effective Dates
07/01/2018 Download
Network Availability by Carrier & Plan Summary 10.18 to 12.18 Effective Dates
10/01/2018 Download
Provider Network Definitions 1.18 to 6.18 Effective Dates
01/01/2018 Download
Provider Network Definitions 7.18 to 9.18 Effective Dates
07/01/2018 Download
Provider Network Definitions 10.18 to 11.18 Effective Dates
10/01/2018 Download
Provider Search Instructions
04/01/2018 Download
Provider Search Instructions - 12.1.18 Effective Dates
12/01/2018 Download
Renewal Plan Transition Guide 7.18 to 9.18 Effective Dates
07/01/2018 Download
Renewal Plan Transition Guide 10.18 to 12.18 Effective Dates
10/01/2018 Download
Schedule Of Commissions
01/01/2018 Download
Summary of Changes for Groups Renewing 7.18 to 9.18
07/01/2018 Download
Summary of Changes for Groups Renewing 10.18 to 11.18
10/01/2018 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
Carrier Contacts
Download