| Form Name | Effective Date | Download Form |
|---|---|---|
|
New Group Submission |
||
|
New Group Submission Checklist 1.21 |
01/01/2021 | Download |
|
Employer Application 1.24 |
01/01/2024 | Download |
|
Employer Application 1.23 |
01/01/2023 | Download |
|
ACH Authorization Form |
01/01/2024 | Download |
|
Corporate Officer/Proprietor/Partner Verification Statement |
01/01/2024 | Download |
|
Administration |
||
|
Business Administrative Guide |
01/01/2021 | Download |
|
Renewal Guide |
04/01/2024 | Download |
| Form Name | Effective Date | Download Form |
|---|---|---|
|
Enrollment and Change Forms |
||
|
Employee Enrollment & Change Form 1.24 |
01/01/2024 | Download |
|
Employee Enrollment & Change Form 1.23 |
01/01/2023 | Download |
|
Employee Waiver Form |
01/01/2024 | Download |
|
Deductible Credit Form |
01/01/2024 | Download |
|
Deductible Credit Carryover Guidelines |
02/01/2024 | Download |
|
Disabled Dependent Form |
01/01/2024 | Download |
|
Express Scripts Home Delivery Order Form |
02/01/2024 | Download |
|
Claim Forms |
||
|
HIPAA Authorization to Disclose PHI Form |
01/01/2024 | Download |
|
Member Medical Claim Form |
01/01/2024 | Download |
|
Prescription Reimbursement Direct Claim Form |
02/01/2024 | Download |
| Form Name | Effective Date | Download Form | |
|---|---|---|---|
|
2024 Medical PPO |
|||
|
LocalPlus Network |
|||
|
LocalPlus Platinum $0/$10 |
01/01/2024 | Summary | SBC |
|
LocalPlus Platinum $0/$10 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Platinum $0/$20 |
01/01/2024 | Summary | SBC |
|
LocalPlus Platinum $0/$20 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Platinum $250 |
01/01/2024 | Summary | SBC |
|
LocalPlus Platinum $250 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Platinum $500 |
01/01/2024 | Summary | SBC |
|
LocalPlus Platinum $500 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Gold $0 |
01/01/2024 | Summary | SBC |
|
LocalPlus Gold $0 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Gold $250 |
01/01/2024 | Summary | SBC |
|
LocalPlus Gold $250 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Gold $500 |
01/01/2024 | Summary | SBC |
|
LocalPlus Gold $500 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Gold $750 |
01/01/2024 | Summary | SBC |
|
LocalPlus Gold $750 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Gold $1350 |
01/01/2024 | Summary | SBC |
|
LocalPlus Gold $1350 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Gold $3500 HSA |
01/01/2024 | Summary | SBC |
|
LocalPlus Gold $3500 HSA INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Silver $0 |
01/01/2024 | Summary | SBC |
|
LocalPlus Silver $0 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Silver $1950 |
01/01/2024 | Summary | SBC |
|
LocalPlus Silver $1950 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Silver $2500 |
01/01/2024 | Summary | SBC |
|
LocalPlus Silver $2500 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Silver $2600 |
01/01/2024 | Summary | SBC |
|
LocalPlus Silver $2600 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Silver $3200 HSA |
01/01/2024 | Summary | SBC |
|
LocalPlus Silver $3200 HSA INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Bronze $1000 |
01/01/2024 | Summary | SBC |
|
LocalPlus Bronze $1000 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Bronze $3000 |
01/01/2024 | Summary | SBC |
|
LocalPlus Bronze $3000 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Bronze $6000 |
01/01/2024 | Summary | SBC |
|
LocalPlus Bronze $6000 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Bronze $6300 |
01/01/2024 | Summary | SBC |
|
LocalPlus Bronze $6300 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Bronze $7250 |
01/01/2024 | Summary | SBC |
|
LocalPlus Bronze $7250 INF |
01/01/2024 | Summary | SBC |
|
LocalPlus Bronze $5750 HSA |
01/01/2024 | Summary | SBC |
|
LocalPlus Bronze $5750 HSA INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Network |
|||
|
Open Access Plus Platinum $0/$10 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Platinum $0/$10 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Platinum $0/$20 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Platinum $0/$20 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Platinum $250 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Platinum $250 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Platinum $500 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Platinum $500 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Gold $0 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Gold $0 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Gold $250 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Gold $250 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Gold $500 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Gold $500 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Gold $750 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Gold $750 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Gold $1350 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Gold $1350 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Gold $3500 HSA |
01/01/2024 | Summary | SBC |
|
Open Access Plus Gold $3500 HSA INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Silver $0 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Silver $0 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Silver $1950 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Silver $1950 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Silver $2500 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Silver $2500 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Silver $2600 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Silver $2600 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Silver $3200 HSA |
01/01/2024 | Summary | SBC |
|
Open Access Plus Silver $3200 HSA INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Bronze $1000 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Bronze $1000 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Bronze $3000 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Bronze $3000 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Bronze $6000 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Bronze $6000 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Bronze $6300 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Bronze $6300 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Bronze $7250 |
01/01/2024 | Summary | SBC |
|
Open Access Plus Bronze $7250 INF |
01/01/2024 | Summary | SBC |
|
Open Access Plus Bronze $5750 HSA |
01/01/2024 | Summary | SBC |
|
Open Access Plus Bronze $5750 HSA INF |
01/01/2024 | Summary | SBC |
|
2023 Medical PPO |
|||
|
LocalPlus Network |
|||
|
LocalPlus Platinum $0/$10 |
01/01/2023 | Summary | SBC |
|
LocalPlus Platinum $0/$10 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Platinum $0/$20 |
01/01/2023 | Summary | SBC |
|
LocalPlus Platinum $0/$20 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Platinum $250 |
01/01/2023 | Summary | SBC |
|
LocalPlus Platinum $250 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Platinum $500 |
01/01/2023 | Summary | SBC |
|
LocalPlus Platinum $500 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Gold $0 |
01/01/2023 | Summary | SBC |
|
LocalPlus Gold $0 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Gold $250 |
01/01/2023 | Summary | SBC |
|
LocalPlus Gold $250 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Gold $500 |
01/01/2023 | Summary | SBC |
|
LocalPlus Gold $500 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Gold $750 |
01/01/2023 | Summary | SBC |
|
LocalPlus Gold $750 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Gold $1350 |
01/01/2023 | Summary | SBC |
|
LocalPlus Gold $1350 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Silver $0 |
01/01/2023 | Summary | SBC |
|
LocalPlus Silver $0 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Silver $1950 |
01/01/2023 | Summary | SBC |
|
LocalPlus Silver $1950 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Silver $2500 |
01/01/2023 | Summary | SBC |
|
LocalPlus Silver $2500 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Silver $2600 |
01/01/2023 | Summary | SBC |
|
LocalPlus Silver $2600 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Silver $3000 HSA |
01/01/2023 | Summary | SBC |
|
LocalPlus Silver $3000 HSA INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Bronze $1000 |
01/01/2023 | Summary | SBC |
|
LocalPlus Bronze $1000 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Bronze $3000 |
01/01/2023 | Summary | SBC |
|
LocalPlus Bronze $3000 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Bronze $6000 |
01/01/2023 | Summary | SBC |
|
LocalPlus Bronze $6000 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Bronze $6300 |
01/01/2023 | Summary | SBC |
|
LocalPlus Bronze $6300 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Bronze $7250 |
01/01/2023 | Summary | SBC |
|
LocalPlus Bronze $7250 INF |
01/01/2023 | Summary | SBC |
|
LocalPlus Bronze $5750 HSA |
01/01/2023 | Summary | SBC |
|
LocalPlus Bronze $5750 HSA INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Network |
|||
|
Open Access Plus Platinum $0/$10 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Platinum $0/$10 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Platinum $0/$20 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Platinum $0/$20 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Platinum $250 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Platinum $250 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Platinum $500 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Platinum $500 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Gold $0 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Gold $0 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Gold $250 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Gold $250 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Gold $500 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Gold $500 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Gold $750 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Gold $750 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Gold $1350 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Gold $1350 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Silver $0 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Silver $0 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Silver $1950 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Silver $1950 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Silver $2500 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Silver $2500 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Silver $2600 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Silver $2600 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Silver $3000 HSA |
01/01/2023 | Summary | SBC |
|
Open Access Plus Silver $3000 HSA INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Bronze $1000 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Bronze $1000 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Bronze $3000 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Bronze $3000 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Bronze $6000 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Bronze $6000 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Bronze $6300 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Bronze $6300 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Bronze $7250 |
01/01/2023 | Summary | SBC |
|
Open Access Plus Bronze $7250 INF |
01/01/2023 | Summary | SBC |
|
Open Access Plus Bronze $5750 HSA |
01/01/2023 | Summary | SBC |
|
Open Access Plus Bronze $5750 HSA INF |
01/01/2023 | Summary | SBC |
| Form Name | Effective Date | Download Form |
|---|---|---|
|
General Information |
||
|
Broker Sales Kit |
02/01/2024 | Download |
|
Broker Appointment Guide |
02/01/2024 | Download |
|
Broker Client Onboarding Guide |
01/01/2021 | Download |
|
Care Team Customer Service Flyer |
02/01/2024 | Download |
|
Cigna + Oscar Partnership |
02/01/2024 | Download |
|
Dual Network Overview - Bay Area 1.24 |
01/01/2024 | Download |
|
Dual Network Overview - Central Coast 1.24 |
01/01/2024 | Download |
|
Dual Network Overview - Los Angeles & Orange County 1.24 |
01/01/2024 | Download |
|
Dual Network Overview - San Diego County 1.24 |
01/01/2024 | Download |
|
Dual Network Overview - Inland Empire 1.24 |
01/01/2024 | Download |
|
Helpful Information & Resources Flyer |
02/01/2024 | Download |
|
Hi, we're Oscar Flyer |
01/01/2021 | Download |
|
Introducing Cigna + Oscar Flyer |
02/01/2024 | Download |
|
Online and Mobile Tools |
02/01/2024 | Download |
|
Online Provider Search Instructions |
02/01/2024 | Download |
|
Pharmacy Benefit Overview |
02/01/2024 | Download |
|
Pharmacy Network Flyer |
02/01/2024 | Download |
|
Plan Feature Overview |
02/01/2024 | Download |
|
Post-enrollment Timeline |
01/01/2021 | Download |
|
Provider Education FAQ |
12/01/2022 | Download |
|
Step Tracking Flyer |
02/01/2024 | Download |
|
Talkspace Member Overview |
02/01/2024 | Download |
|
Understanding Infertility Benefits |
02/01/2024 | Download |
|
Underwriting Guide 10.23 |
01/01/2024 | Download |
|
Virtual Primary Care Flyer |
01/01/2024 | Download |
|
Virtual Urgent Care |
02/01/2024 | Download |
|
Medical |
||
|
Small Group Plan Grid 1.24 |
01/01/2024 | Download |
|
Express Scripts Prescription Drug Formulary List 1.24 |
01/01/2024 | Download |
|
Express Scripts Prescription Drug Formulary List (with Infertility) 1.24 |
01/01/2024 | Download |
|
Consumer Directed Healthcare Preventive Medication List 1.24 |
01/01/2024 | Download |
|
Preventive Care Guide |
02/01/2024 | Download |
| Form Name | Effective Date | Download Form |
|---|---|---|
|
Southern California Small Group Rate Guide [effective 4/1/2024] |
04/01/2024 | Download |
|
Southern California Small Group Rate Guide w/ Infertility [effective 4/1/2024] |
04/01/2024 | Download |
|
Northern California Small Group Rate Guide [effective 4/1/2024] |
04/01/2024 | Download |
|
Northern California Small Group Rate Guide w/ Infertility [effective 4/1/2024] |
04/01/2024 | Download |
|
Southern California Small Group Rate Guide [effective 1/1/2024] |
01/01/2024 | Download |
|
Southern California Small Group Rate Guide w/ Infertility [effective 1/1/2024] |
01/01/2024 | Download |
|
Northern California Small Group Rate Guide [effective 1/1/2024] |
01/01/2024 | Download |
|
Northern California Small Group Rate Guide w/ Infertility [effective 1/1/2024] |
01/01/2024 | Download |
