Covered California for Small Business

Covered California for Small Business offers four levels of coverage — Bronze, Silver, Gold and Platinum — each with multiple plan options. We make it easy for you to choose not just one level, but two, three or four adjoining or contiguous levels of coverage.

 

Form Name Effective Date Download Form
New Group Submission
Enrollment Checklist
01/01/2020 Download
Employer Application 3.23
01/01/2024 Download
New Business Late Submission Acknowledgement Form
01/01/2024 Download
New Business Documentation Guide
07/01/2022 Download
In Force Group Forms
Employer Change Request Form 1.23
01/01/2023 Download
COBRA Participant Cancellation Form
07/01/2022 Download
Administration
Small Business Employer Guide
01/01/2023 Download
CCSB Carrier Contacts
03/01/2022 Download
Employer Portal - Renewal Guide
01/01/2020 Download
Invoice Tutorial
01/01/2020 Download
Open Enrollment Checklist
04/01/2020 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Combined Enrollment & Change Form 1.24
01/01/2024 Download
Employee Change Request Form 7.23
07/01/2023 Download
COBRA Forms
COBRA Election Form
07/01/2022 Download
Form Name Effective Date Download Form
2024 Medical HMO
Blue Shield Access+ HMO Network
Blue Shield Access+ Platinum 90 HMO 0/20 + Child Dental
01/01/2024 Summary SBC
Blue Shield Access+ Platinum 90 HMO 0/20 + Child Dental INF
01/01/2024 SBC
Blue Shield Access+ Gold 80 HMO 250/35 + Child Dental
01/01/2024 Summary SBC
Blue Shield Access+ Gold 80 HMO 250/35 + Child Dental INF
01/01/2024 SBC
Blue Shield Access+ Silver 70 HMO 2500/55 + Child Dental
01/01/2024 Summary SBC
Blue Shield Access+ Silver 70 HMO 2500/55 + Child Dental INF
01/01/2024 SBC
Blue Shield Trio HMO Network
Blue Shield Trio Platinum 90 HMO 0/20 + Child Dental
01/01/2024 Summary SBC
Blue Shield Trio Platinum 90 HMO 0/20 + Child Dental INF
01/01/2024 SBC
Blue Shield Trio Gold 80 HMO 250/35 + Child Dental
01/01/2024 Summary SBC
Blue Shield Trio Gold 80 HMO 250/35 + Child Dental INF
01/01/2024 SBC
Blue Shield Trio Silver 70 HMO 2500/55 + Child Dental
01/01/2024 Summary SBC
Blue Shield Trio Silver 70 HMO 2500/55 + Child Dental INF
01/01/2024 SBC
Blue Shield Trio Bronze 60 HMO 7000/70 + Child Dental Alt
01/01/2024 Summary SBC
Blue Shield Trio Bronze 60 HMO 7000/70 + Child Dental Alt INF
01/01/2024 SBC
Kaiser Permanente HMO
Kaiser Platinum 90 HMO 0/10 + Child Dental Alt
01/01/2024 Summary SBC
Kaiser Platinum 90 HMO 0/10 + Child Dental Alt INF
01/01/2024 SBC
Kaiser Platinum 90 HMO 0/20 + Child Dental
01/01/2024 Summary SBC
Kaiser Platinum 90 HMO 0/20 + Child Dental INF
01/01/2024 SBC
Kaiser Platinum 90 HMO 250/30 + Child Dental Alt
01/01/2024 Summary SBC
Kaiser Platinum 90 HMO 250/30 + Child Dental Alt INF
01/01/2024 SBC
Kaiser Gold 80 HMO 0/35 + Child Dental Alt
01/01/2024 Summary SBC
Kaiser Gold 80 HMO 0/35 + Child Dental Alt INF
01/01/2024 SBC
Kaiser Gold 80 HMO 250/35 + Child Dental
01/01/2024 Summary SBC
Kaiser Gold 80 HMO 250/35 + Child Dental INF
01/01/2024 SBC
Kaiser Gold 80 HMO 1000/40 + Child Dental Alt
01/01/2024 Summary SBC
Kaiser Gold 80 HMO 1000/40 + Child Dental Alt INF
01/01/2024 SBC
Kaiser Gold 80 HDHP HMO 1750/15% + Child Dental Alt
01/01/2024 Summary SBC
Kaiser Gold 80 HDHP HMO 1750/15% + Child Dental Alt INF
01/01/2024 SBC
Kaiser Silver 70 HMO 1900/65 + Child Dental Alt
01/01/2024 Summary SBC
Kaiser Silver 70 HMO 1900/65 + Child Dental Alt INF
01/01/2024 SBC
Kaiser Silver 70 HMO 2300/65 + Child Dental Alt
01/01/2024 Summary SBC
Kaiser Silver 70 HMO 2300/65 + Child Dental Alt INF
01/01/2024 SBC
Kaiser Silver 70 HMO 2500/55 + Child Dental
01/01/2024 Summary SBC
Kaiser Silver 70 HMO 2500/55 + Child Dental INF
01/01/2024 SBC
Kaiser Silver 70 HMO 2950/65 + Child Dental Alt
01/01/2024 Summary SBC
Kaiser Silver 70 HMO 2950/65 + Child Dental Alt INF
01/01/2024 SBC
Kaiser Silver 70 HDHP HMO 2850/25% + Child Dental
01/01/2024 Summary SBC
Kaiser Silver 70 HDHP HMO 2850/25% + Child Dental INF
01/01/2024 SBC
Kaiser Bronze 60 HMO 5400/60 + Child Dental Alt
01/01/2024 Summary SBC
Kaiser Bronze 60 HMO 5400/60 + Child Dental Alt INF
01/01/2024 SBC
Kaiser Bronze 60 HMO 6300/60 + Child Dental
01/01/2024 Summary SBC
Kaiser Bronze 60 HMO 6300/60 + Child Dental INF
01/01/2024 SBC
Kaiser Bronze 60 HDHP HMO 7050/0% + Child Dental
01/01/2024 Summary SBC
Kaiser Bronze 60 HDHP HMO 7050/0% + Child Dental INF
01/01/2024 SBC
Sharp HMO
Sharp Performance Platinum 90 HMO 0/15 + Child Dental
01/01/2024 Summary SBC
Sharp Performance Platinum 90 HMO 0/15 + Child Dental INF
01/01/2024 SBC
Sharp Premier Platinum 90 HMO 0/20 + Child Dental
01/01/2024 Summary SBC
Sharp Premier Platinum 90 HMO 0/20 + Child Dental INF
01/01/2024 SBC
Sharp Performance Gold 80 HMO 350/25 + Child Dental
01/01/2024 Summary SBC
Sharp Performance Gold 80 HMO 350/25 + Child Dental INF
01/01/2024 SBC
Sharp Premier Gold 80 HMO 250/35 + Child Dental
01/01/2024 Summary SBC
Sharp Premier Gold 80 HMO 250/35 + Child Dental INF
01/01/2024 SBC
Sharp Performance Silver 70 HMO 2500/55 + Child Dental
01/01/2024 Summary SBC
Sharp Performance Silver 70 HMO 2500/55 + Child Dental INF
01/01/2024 SBC
Sharp Premier Silver 70 HMO 2500/55 + Child Dental
01/01/2024 Summary SBC
Sharp Premier Silver 70 HMO 2500/55 + Child Dental INF
01/01/2024 SBC
Sharp Premier Silver 70 HDHP HMO 2850/25% + Child Dental
01/01/2024 Summary SBC
Sharp Premier Silver 70 HDHP HMO 2850/25% + Child Dental INF
01/01/2024 SBC
Sharp Performance Bronze 60 HMO 6300/60 + Child Dental
01/01/2024 Summary SBC
Sharp Performance Bronze 60 HMO 6300/60 + Child Dental INF
01/01/2024 SBC
Sharp Premier Bronze 60 HDHP HMO 7050/0% + Child Dental
01/01/2024 Summary SBC
Sharp Premier Bronze 60 HDHP HMO 7050/0% + Child Dental INF
01/01/2024 SBC
2024 Medical PPO
Blue Shield PPO
Blue Shield Platinum 90 PPO 0/15 + Child Dental
01/01/2024 Summary SBC
Blue Shield Platinum 90 PPO 0/15 + Child Dental INF
01/01/2024 SBC
Blue Shield Gold 80 PPO 350/25 + Child Dental
01/01/2024 Summary SBC
Blue Shield Gold 80 PPO 350/25 + Child Dental INF
01/01/2024 SBC
Blue Shield Silver 70 PPO 2500/55 + Child Dental
01/01/2024 Summary SBC
Blue Shield Silver 70 PPO 2500/55 + Child Dental INF
01/01/2024 SBC
Blue Shield Silver 70 HDHP PPO 2300/30% + Child Dental Alt
01/01/2024 Summary SBC
Blue Shield Silver 70 HDHP PPO 2300/30% + Child Dental Alt INF
01/01/2024 SBC
Blue Shield Bronze 60 PPO 6300/60 + Child Dental
01/01/2024 Summary SBC
Blue Shield Bronze 60 PPO 6300/60 + Child Dental INF
01/01/2024 SBC
Blue Shield Bronze 60 HDHP PPO 7500/0% + Child Dental Alt
01/01/2024 Summary SBC
Blue Shield Bronze 60 HDHP PPO 7500/0% + Child Dental Alt INF
01/01/2024 SBC
2023 Medical HMO
Blue Shield Access+ HMO Network
Blue Shield Access+ Platinum 90 HMO 0/20 + Child Dental [New 7/1/2023]
07/01/2023 Summary SBC
Blue Shield Access+ Platinum 90 HMO 0/20 + Child Dental INF [New 7/1/2023]
07/01/2023 SBC
Blue Shield Access+ Gold 80 HMO 250/35 + Child Dental [New 7/1/2023]
07/01/2023 Summary SBC
Blue Shield Access+ Gold 80 HMO 250/35 + Child Dental INF [New 7/1/2023]
07/01/2023 SBC
Blue Shield Access+ Silver 70 HMO 2500/55 + Child Dental [New 7/1/2023]
07/01/2023 Summary SBC
Blue Shield Access+ Silver 70 HMO 2500/55 + Child Dental INF [New 7/1/2023]
07/01/2023 SBC
Blue Shield Trio HMO Network
Blue Shield Trio Platinum 90 HMO 0/20 + Child Dental
01/01/2023 Summary SBC
Blue Shield Trio Platinum 90 HMO 0/20 + Child Dental INF
01/01/2023 SBC
Blue Shield Trio Gold 80 HMO 250/35 + Child Dental
01/01/2023 Summary SBC
Blue Shield Trio Gold 80 HMO 250/35 + Child Dental INF
01/01/2023 SBC
Blue Shield Trio Silver 70 HMO 2500/55 + Child Dental
01/01/2023 Summary SBC
Blue Shield Trio Silver 70 HMO 2500/55 + Child Dental INF
01/01/2023 SBC
Blue Shield Bronze Trio HMO 7000/70 + Child Dental [New 7/1/2023]
07/01/2023 Summary SBC
Blue Shield Bronze Trio HMO 7000/70 + Child Dental INF [New 7/1/2023]
07/01/2023 SBC
Kaiser Permanente HMO
Kaiser Platinum 90 HMO 0/10 + Child Dental Alt
01/01/2023 Summary SBC
Kaiser Platinum 90 HMO 0/10 + Child Dental Alt INF
01/01/2023 SBC
Kaiser Platinum 90 HMO 0/20 + Child Dental
01/01/2023 Summary SBC
Kaiser Platinum 90 HMO 0/20 + Child Dental INF
01/01/2023 SBC
Kaiser Gold 80 HMO 0/30 + Child Dental Alt
01/01/2023 Summary SBC
Kaiser Gold 80 HMO 0/30 + Child Dental Alt INF
01/01/2023 SBC
Kaiser Gold 80 HMO 25/35 + Child Dental
01/01/2023 Summary SBC
Kaiser Gold 80 HMO 250/35 + Child Dental INF
01/01/2023 SBC
Kaiser Gold 80 HMO 1000/40 + Child Dental Alt
01/01/2023 Summary SBC
Kaiser Gold 80 HMO 1000/40 + Child Dental Alt INF
01/01/2023 SBC
Kaiser Gold 80 HDHP HMO 1600/15% + Child Dental Alt
01/01/2023 Summary SBC
Kaiser Gold 80 HDHP HMO 1600/15% + Child Dental Alt INF
01/01/2023 SBC
Kaiser Silver 70 HMO 1900/65 + Child Dental Alt
01/01/2023 Summary SBC
Kaiser Silver 70 HMO 1900/65 + Child Dental Alt INF
01/01/2023 SBC
Kaiser Silver 70 HMO 2300/65 + Child Dental Alt
01/01/2023 Summary SBC
Kaiser Silver 70 HMO 2300/65 + Child Dental Alt INF
01/01/2023 SBC
Kaiser Silver 70 HMO 2500/55 + Child Dental
01/01/2023 Summary SBC
Kaiser Silver 70 HMO 2500/55 + Child Dental INF
01/01/2023 SBC
Kaiser Silver 70 HMO 2800/65 + Child Dental Alt
01/01/2023 Summary SBC
Kaiser Silver 70 HMO 2800/65 + Child Dental Alt INF
01/01/2023 SBC
Kaiser Silver 70 HDHP HMO 2700/25% + Child Dental
01/01/2023 Summary SBC
Kaiser Silver 70 HDHP HMO 2700/25% + Child Dental INF
01/01/2023 SBC
Kaiser Bronze 60 HMO 5400/60 + Child Dental Alt
01/01/2023 Summary SBC
Kaiser Bronze 60 HMO 5400/60 + Child Dental Alt INF
01/01/2023 SBC
Kaiser Bronze 60 HMO 6300/65 + Child Dental
01/01/2023 Summary SBC
Kaiser Bronze 60 HMO 6300/65 + Child Dental INF
01/01/2023 SBC
Kaiser Bronze 60 HDHP HMO 7000/0% + Child Dental
01/01/2023 Summary SBC
Kaiser Bronze 60 HDHP HMO 7000/0% + Child Dental INF
01/01/2023 SBC
Sharp HMO
Sharp Performance Platinum 90 HMO 0/15 + Child Dental
01/01/2023 Summary SBC
Sharp Performance Platinum 90 HMO 0/15 + Child Dental INF
01/01/2023 SBC
Sharp Premier Platinum 90 HMO 0/20 + Child Dental
01/01/2023 Summary SBC
Sharp Premier Platinum 90 HMO 0/20 + Child Dental INF
01/01/2023 SBC
Sharp Performance Gold 80 HMO 350/25 + Child Dental
01/01/2023 Summary SBC
Sharp Performance Gold 80 HMO 350/25 + Child Dental INF
01/01/2023 SBC
Sharp Premier Gold 80 HMO 250/35 + Child Dental
01/01/2023 Summary SBC
Sharp Premier Gold 80 HMO 250/35 + Child Dental INF
01/01/2023 SBC
Sharp Performance Silver 70 HMO 2500/55 + Child Dental
01/01/2023 Summary SBC
Sharp Performance Silver 70 HMO 2500/55 + Child Dental INF
01/01/2023 SBC
Sharp Premier Silver 70 HMO 2500/55 + Child Dental
01/01/2023 Summary SBC
Sharp Premier Silver 70 HMO 2500/55 + Child Dental INF
01/01/2023 SBC
Sharp Premier Silver 70 HDHP HMO 2700/25% + Child Dental
01/01/2023 Summary SBC
Sharp Premier Silver 70 HDHP HMO 2700/25% + Child Dental INF
01/01/2023 SBC
Sharp Performance Bronze 60 HMO 6300/65 + Child Dental
01/01/2023 Summary SBC
Sharp Performance Bronze 60 HMO 6300/65 + Child Dental INF
01/01/2023 SBC
Sharp Premier Bronze 60 HDHP HMO 7000/0% + Child Dental
01/01/2023 Summary SBC
Sharp Premier Bronze 60 HDHP HMO 7000/0% + Child Dental INF
01/01/2023 SBC
2023 Medical PPO
Blue Shield PPO
Blue Shield Platinum 90 PPO 0/15 + Child Dental
01/01/2023 Summary SBC
Blue Shield Platinum 90 PPO 0/15 + Child Dental INF
01/01/2023 SBC
Blue Shield Gold 80 PPO 350/25 + Child Dental
01/01/2023 Summary SBC
Blue Shield Gold 80 PPO 350/25 + Child Dental INF
01/01/2023 SBC
Blue Shield Silver 70 PPO 2500/55 + Child Dental
01/01/2023 Summary SBC
Blue Shield Silver 70 PPO 2500/55 + Child Dental INF
01/01/2023 SBC
Blue Shield Silver Full PPO Savings 2300/25% + Child Dental [New 7/1/2023]
07/01/2023 Summary SBC
Blue Shield Silver Full PPO Savings 2300/25% + Child Dental INF [New 7/1/2023]
07/01/2023 SBC
Blue Shield Bronze 60 PPO 6300/65 + Child Dental
01/01/2023 Summary SBC
Blue Shield Bronze 60 PPO 6300/65 + Child Dental INF
01/01/2023 SBC
Blue Shield Bronze Full PPO Savings 7000 + Child Dental [New 7/1/2023]
07/01/2023 Summary SBC
Blue Shield Bronze Full PPO Savings 7000 + Child Dental INF [New 7/1/2023]
07/01/2023 SBC
Form Name Effective Date Download Form
General Information
Standard Plan Summary Platinum 2024
01/01/2024 Download
Standard Plan Summary Gold 2024
01/01/2024 Download
Standard Plan Summary Silver 2024
01/01/2024 Download
Standard Plan Summary Bronze 2024
01/01/2024 Download
Standard Plan Summary Platinum 2023
01/01/2023 Download
Standard Plan Summary Gold 2023
01/01/2023 Download
Standard Plan Summary Silver 2023
01/01/2023 Download
Standard Plan Summary Bronze 2023
01/01/2023 Download
Underwriting Guidelines 1.24
01/01/2024 Download
Employer Guide 2024
01/01/2024 Download
Flexible Plan Options with More Metal Tiers Flyer
10/01/2021 Download
Health Insurance Made Simple Employer Brochure
07/01/2022 Download
Health & Dental Plan Offerings and Network Summary
07/01/2022 Download
How to Access or Order A Member ID Card
01/01/2022 Download
Broker How to Get Certified to Sell Flyer
08/01/2022 Download
MyCCSB Broker Portal Registration Flyer
01/01/2020 Download
MyCCSB Enrollment Online Portal Agent Guide
01/01/2023 Download
MyCCSB Enrollment Online Portal Employer Guide
07/01/2022 Download
Network Summary Health Plan Offerings
10/01/2023 Download
Small Business Tax Credit Fact Sheet
08/01/2022 Download
Small Business Tax Credit Instructions Flyer
02/01/2021 Download
Small Business Trifold Brochure
07/01/2022 Download
Top 10 Reasons to Consider Covered California
10/01/2023 Download
Value Added Benefit Grid
01/01/2022 Download
Why Sell CCSB - Think Differently
07/01/2022 Download
Form Name Effective Date Download Form
Contact Sheet
Download