Form Name | Effective Date | Download Form |
---|---|---|
New Group Submission |
||
CalChoice Medical Submission Checklist |
01/01/2020 | Download |
CalChoice Dental/Life Submission Checklist |
01/01/2020 | Download |
Employer Application 4.21 to 6.21 Effective Dates |
04/01/2021 | Download |
Employer Application 7.21 to 9.21 Effective Dates |
07/01/2021 | Download |
Initial Payment Form (One-time ACH) |
04/01/2020 | Download |
Owner Partner Statement Form |
01/01/2020 | Download |
Case Submission Acknowledgement (for groups submitted after the requested effective date) |
01/01/2020 | Download |
Common Ownership Statement |
01/01/2020 | Download |
Full FSA Election Form |
01/01/2020 | Download |
Group Size Attestation |
01/01/2020 | Download |
Prior Carrier Cancellation Letter Template |
01/01/2020 | Download |
In Force Group Forms |
||
Employee Termination Notification |
01/01/2019 | Download |
Employee Termination Notification 7.21 |
07/01/2021 | Download |
Employer Change Request Form 4.21 to 6.21 Effective Dates |
04/01/2021 | Download |
Employer Change Request Form 7.21 to 9.21 Effective Date |
07/01/2021 | Download |
Employer Group Contact Change |
01/01/2019 | Download |
Employer In Force Group Dental Application 4.21 |
04/01/2021 | Download |
Employer In Force Group Voluntary Vision Application 1.20 |
01/01/2020 | Download |
Employer Recertification Agreement 1.20 to 12.20 Effective Dates |
01/01/2020 | Download |
Exception Review Request Form |
01/01/2019 | Download |
Group COBRA Direct Billing Contract |
01/01/2020 | Download |
New Hire Enrollment Quote Request |
01/01/2020 | Download |
Administration |
||
Employer Administrative Guide 4.21 (updated 3.21) |
04/01/2021 | Download |
Employer Program Guide 4.21 to 6.21 Effective Dates |
04/01/2021 | Download |
Form Name | Effective Date | Download Form |
---|---|---|
Enrollment and Change Forms |
||
Employee Enrollment Form 4.21 to 6.21 Effective Dates |
04/01/2021 | Download |
Employee Enrollment Form 7.21 to 9.21 Effective Dates |
07/01/2021 | Download |
Employee Change Request Form 4.21 to 6.21 Effective Dates |
04/01/2021 | Download |
Employee Change Request Form 7.21 to 9.21 Effective Dates |
07/01/2021 | Download |
Disabled Dependent Certification Form |
01/01/2020 | Download |
Affidavit of Domestic Partnership |
01/01/2020 | Download |
COBRA Forms |
||
COBRA Enrollment Application |
01/01/2020 | Download |
Claim Forms |
||
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 - 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 | |
---|---|---|---|
2021 Medical Plan Benefit Summary Booklets |
|||
April - June 2021 Effective Dates |
|||
All Tiers Benefit Summaries 4.21 - 6.21 Effective Dates (updated 3.21) |
04/01/2021 | Summary | |
Platinum Benefit Summaries 4.21 - 6.21 Effective Dates |
04/01/2021 | Summary | |
Platinum/Gold Benefit Summaries 4.21 - 6.21 Effective Dates |
04/01/2021 | Summary | |
Platinum/Gold/Silver Benefit Summaries 4.21 - 6.21 Effective Dates |
04/01/2021 | Summary | |
Gold Benefit Summaries 4.21 - 6.21 Effective Dates |
04/01/2021 | Summary | |
Gold/Silver Benefit Summaries 4.21 - 6.21 Effective Dates |
04/01/2021 | Summary | |
Gold/Silver/Bronze Benefit Summaries 4.21 - 6.21 Effective Dates |
04/01/2021 | Summary | |
Silver Benefit Summaries 4.21 - 6.21 Effective Dates |
04/01/2021 | Summary | |
Silver/Bronze Benefit Summaries 4.21 - 6.21 Effective Dates |
04/01/2021 | Summary | |
Bronze Benefit Summaries 4.21 - 6.21 Effective Dates |
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 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 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 | |
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 | |
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 | |
2020 Medical Plan Benefit Summary Booklets |
|||
January - April 2020 Effective Dates |
|||
All Tiers Benefit Summaries 1.20 - 4.20 Effective Dates |
01/01/2020 | Summary | |
Platinum Benefit Summaries 1.20 - 4.20 Effective Dates |
01/01/2020 | Summary | |
Platinum/Gold Benefit Summaries 1.20 - 4.20 Effective Dates |
01/01/2020 | Summary | |
Platinum/Gold/Silver Benefit Summaries 1.20 - 4.20 Effective Dates |
01/01/2020 | Summary | |
Gold Benefit Summaries 1.20 - 4.20 Effective Dates |
01/01/2020 | Summary | |
Gold/Silver Benefit Summaries 1.20 - 4.20 Effective Dates |
01/01/2020 | Summary | |
Silver Benefit Summaries 1.20 - 4.20 Effective Dates |
01/01/2020 | Summary | |
Silver/Bronze Benefit Summaries 1.20 - 4.20 Effective Dates |
01/01/2020 | Summary | |
Bronze Benefit Summaries 1.20 - 4.20 Effective Dates |
01/01/2020 | Summary | |
May - June 2020 Effective Dates |
|||
All Tiers Benefit Summaries 5.20 - 6.20 Effective Dates |
05/01/2020 | Summary | |
Platinum Benefit Summaries 5.20 - 6.20 Effective Dates |
05/01/2020 | Summary | |
Platinum/Gold Benefit Summaries 5.20 - 6.20 Effective Dates |
05/01/2020 | Summary | |
Platinum/Gold/Silver Benefit Summaries 5.20 - 6.20 Effective Dates |
05/01/2020 | Summary | |
Gold Benefit Summaries 5.20 - 6.20 Effective Dates |
05/01/2020 | Summary | |
Gold/Silver Benefit Summaries 5.20 - 6.20 Effective Dates |
05/01/2020 | Summary | |
Silver Benefit Summaries 5.20 - 6.20 Effective Dates |
05/01/2020 | Summary | |
Silver/Bronze Benefit Summaries 5.20 - 6.20 Effective Dates |
05/01/2020 | Summary | |
Bronze Benefit Summaries 5.20 - 6.20 Effective Dates |
05/01/2020 | Summary | |
July - September 2020 Effective Dates |
|||
All Tiers Benefit Summaries 7.20 - 9.20 Effective Dates |
07/01/2020 | Summary | |
Platinum Benefit Summaries 7.20 - 9.20 Effective Dates |
07/01/2020 | Summary | |
Platinum/Gold Benefit Summaries 7.20 - 9.20 Effective Dates |
07/01/2020 | Summary | |
Platinum/Gold/Silver Benefit Summaries 7.20 - 9.20 Effective Dates |
07/01/2020 | Summary | |
Gold Benefit Summaries 7.20 - 9.20 Effective Dates |
07/01/2020 | Summary | |
Gold/Silver Benefit Summaries 7.20 - 9.20 Effective Dates |
07/01/2020 | Summary | |
Gold/Silver/Bronze Benefit Summaries 7.20 - 9.20 Effective Dates |
07/01/2020 | Summary | |
Silver Benefit Summaries 7.20 - 9.20 Effective Dates |
07/01/2020 | Summary | |
Silver/Bronze Benefit Summaries 7.20 - 9.20 Effective Dates |
07/01/2020 | Summary | |
Bronze Benefit Summaries 7.20 - 9.20 Effective Dates |
07/01/2020 | Summary | |
October - December 2020 Effective Dates |
|||
All Tiers Benefit Summaries 10.20 - 12.20 Effective Dates |
10/01/2020 | Summary | |
Platinum Benefit Summaries 10.20 - 12.20 Effective Dates |
10/01/2020 | Summary | |
Platinum/Gold Benefit Summaries 10.20 - 12.20 Effective Dates |
10/01/2020 | Summary | |
Platinum/Gold/Silver Benefit Summaries 10.20 - 12.20 Effective Dates |
10/01/2020 | Summary | |
Gold Benefit Summaries 10.20 - 12.20 Effective Dates |
10/01/2020 | Summary | |
Gold/Silver Benefit Summaries 10.20 - 12.20 Effective Dates |
10/01/2020 | Summary | |
Gold/Silver/Bronze Benefit Summaries 10.20 - 12.20 Effective Dates |
10/01/2020 | Summary | |
Silver Benefit Summaries 10.20 - 12.20 Effective Dates |
10/01/2020 | Summary | |
Silver/Bronze Benefit Summaries 10.20 - 12.20 Effective Dates |
10/01/2020 | Summary | |
Bronze Benefit Summaries 10.20 - 12.20 Effective Dates |
10/01/2020 | Summary | |
2020 Medical HMO SBCs |
|||
Anthem HMO |
|||
Anthem Blue Cross Platinum Select HMO A |
01/01/2020 | SBC | |
Anthem Blue Cross Gold Select HMO A |
01/01/2020 | SBC | |
Anthem Blue Cross Gold CaliforniaCare HMO B |
01/01/2020 | SBC | |
Anthem Blue Cross Silver Select HMO A |
01/01/2020 | SBC | |
Anthem Blue Cross Silver CaliforniaCare HMO B |
01/01/2020 | SBC | |
Health Net HMO |
|||
Health Net Platinum WholeCare HMO C |
01/01/2020 | SBC | |
Health Net Platinum Salud HMO D |
01/01/2020 | SBC | |
Health Net Platinum Full Network HMO E |
01/01/2020 | SBC | |
Health Net Gold WholeCare HMO A |
01/01/2020 | SBC | |
Health Net Gold WholeCare HMO B |
01/01/2020 | SBC | |
Health Net Gold WholeCare HMO C |
01/01/2020 | SBC | |
Health Net Gold Salud HMO D |
01/01/2020 | SBC | |
Health Net Gold Full Network HMO E |
01/01/2020 | SBC | |
Health Net Gold Full Network HMO F |
01/01/2020 | SBC | |
Health Net Silver WholeCare HMO A |
01/01/2020 | SBC | |
Health Net Silver CommunityCare HMO C |
01/01/2020 | SBC | |
Health Net Bronze CommunityCare HMO A |
01/01/2020 | SBC | |
Kaiser Permanente HMO |
|||
Kaiser Platinum HMO A |
01/01/2020 | SBC | |
Kaiser Platinum HMO B |
01/01/2020 | SBC | |
Kaiser Gold HMO A |
01/01/2020 | SBC | |
Kaiser Gold HMO B |
01/01/2020 | SBC | |
Kaiser Silver HMO A |
01/01/2020 | SBC | |
Kaiser Silver HMO B |
01/01/2020 | SBC | |
Kaiser Silver HMO C |
01/01/2020 | SBC | |
Kaiser Silver HMO D (HSA Eligible) |
01/01/2020 | SBC | |
Kaiser Bronze HMO A |
01/01/2020 | SBC | |
Kaiser Bronze HMO C (HSA Eligible) |
01/01/2020 | SBC | |
Sharp HMO |
|||
Sharp Platinum Premier HMO A |
01/01/2020 | SBC | |
Sharp Platinum Performance HMO B |
01/01/2020 | SBC | |
Sharp Platinum Premier HMO C |
01/01/2020 | SBC | |
Sharp Gold Performance HMO A |
01/01/2020 | SBC | |
Sharp Gold Premier HMO B |
01/01/2020 | SBC | |
Sharp Gold Performance HMO D |
01/01/2020 | SBC | |
Sharp Silver Premier HMO A |
01/01/2020 | SBC | |
Sharp Silver Performance HMO B |
01/01/2020 | SBC | |
Sharp Silver Premier HMO C |
01/01/2020 | SBC | |
Sharp Bronze Premier HMO A |
01/01/2020 | SBC | |
Sharp Bronze Performance HMO B (HSA Eligible) |
01/01/2020 | SBC | |
Sutter Health Plus HMO |
|||
Sutter Health Plus Platinum HMO A |
01/01/2020 | SBC | |
Sutter Health Plus Platinum HMO B |
01/01/2020 | SBC | |
Sutter Health Plus Gold HMO A |
01/01/2020 | SBC | |
Sutter Health Plus Gold HMO B |
01/01/2020 | SBC | |
Sutter Health Plus Silver HMO B |
01/01/2020 | SBC | |
Sutter Health Plus Silver HMO C (HSA Eligible) |
01/01/2020 | SBC | |
Sutter Health Plus Bronze HMO A |
01/01/2020 | SBC | |
Sutter Health Plus Bronze HMO B (HSA Eligible) |
01/01/2020 | SBC | |
UnitedHealthcare HMO |
|||
UHC Platinum SignatureValue HMO A |
01/01/2020 | SBC | |
UHC Platinum Focus HMO B |
01/01/2020 | SBC | |
UHC Platinum Alliance HMO C |
01/01/2020 | SBC | |
UHC Gold SignatureValue HMO A |
01/01/2020 | SBC | |
UHC Gold Alliance HMO B |
01/01/2020 | SBC | |
UHC Gold Focus HMO C |
01/01/2020 | SBC | |
UHC Gold Advantage HMO E [new effective 10/1/2020] |
10/01/2020 | SBC | |
UHC Silver SignatureValue HMO A |
01/01/2020 | SBC | |
UHC Silver Advantage HMO B |
01/01/2020 | SBC | |
UHC Silver Alliance HMO C |
01/01/2020 | SBC | |
UHC Silver Focus HMO D |
01/01/2020 | SBC | |
UHC Bronze Alliance HMO A |
01/01/2020 | SBC | |
UHC Bronze Alliance HMO B (HSA Eligible) |
01/01/2020 | SBC | |
Western Health Advantage HMO |
|||
Western Health Platinum HMO A |
01/01/2020 | SBC | |
Western Health Platinum HMO B |
01/01/2020 | SBC | |
Western Health Gold HMO A |
01/01/2020 | SBC | |
Western Health Gold HMO B |
01/01/2020 | SBC | |
Western Health Gold HMO C |
01/01/2020 | SBC | |
Western Health Gold HMO D (HSA Eligible) |
01/01/2020 | SBC | |
Western Health Silver HMO A |
01/01/2020 | SBC | |
Western Health Silver HMO B |
01/01/2020 | SBC | |
Western Health Silver HMO C (HSA Eligible) |
01/01/2020 | SBC | |
Western Health Bronze HMO B |
01/01/2020 | SBC | |
Western Health Bronze HMO C (HSA Eligible) |
01/01/2020 | SBC | |
2020 Medical PPO and EPO SBCs |
|||
Anthem Blue Cross PPO and EPO |
|||
Anthem Blue Cross Gold Advantage PPO A |
01/01/2020 | SBC | |
Anthem Blue Cross Gold Select PPO B |
01/01/2020 | SBC | |
Anthem Blue Cross Gold Select PPO C |
01/01/2020 | SBC | |
Anthem Blue Cross Gold Select PPO D |
01/01/2020 | SBC | |
Anthem Blue Cross Gold PPO E [new effective 7/1/2020] |
07/01/2020 | SBC | |
Anthem Blue Cross Silver Advantage PPO A |
01/01/2020 | SBC | |
Anthem Blue Cross Silver Select PPO B |
01/01/2020 | SBC | |
Anthem Blue Cross Silver PPO C [new effective 7/1/2020] |
07/01/2020 | SBC | |
Anthem Blue Cross Silver EPO A |
01/01/2020 | SBC | |
Anthem Blue Cross Silver EPO B (HSA Eligible) |
01/01/2020 | SBC | |
Anthem Blue Cross Bronze PPO A (HSA Eligible) [new effective 7/1/2020] |
07/01/2020 | SBC | |
Anthem Blue Cross Bronze Select PPO B (HSA Eligible) [new effective 7/1/2020] |
07/01/2020 | SBC | |
Anthem Blue Cross Bronze EPO A [plan discontinued 4/30/2020] |
01/01/2020 | SBC | |
Anthem Blue Cross Bronze EPO A [updated benefits for groups effective 5/1/2020 and later] |
05/01/2020 | SBC | |
Oscar EPO |
|||
Oscar Platinum EPO A |
01/01/2020 | SBC | |
Oscar Platinum EPO B |
01/01/2020 | SBC | |
Oscar Gold EPO A |
01/01/2020 | SBC | |
Oscar Gold EPO B |
01/01/2020 | SBC | |
Oscar Gold EPO C |
01/01/2020 | SBC | |
Oscar Gold EPO D |
01/01/2020 | SBC | |
Oscar Silver EPO A (HSA Eligible) |
01/01/2020 | SBC | |
Oscar Silver EPO B |
01/01/2020 | SBC | |
Oscar Silver EPO C |
01/01/2020 | SBC | |
Oscar Silver EPO D [new effective 10/1/2020] |
10/01/2020 | SBC | |
Oscar Bronze EPO A (HSA Eligible) |
01/01/2020 | SBC | |
Oscar Bronze EPO B |
01/01/2020 | SBC | |
Oscar Bronze EPO C [new effective 10/1/2020] |
10/01/2020 | SBC |
Form Name | Effective Date | Download Form |
---|---|---|
General Information |
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CaliforniaChoice Fast Facts Brochure 7.20 |
07/01/2020 | Download |
CaliforniaChoice Underwriting Guidelines 4.21 |
04/01/2021 | Download |
CaliforniaChoice Underwriting Guidelines 7.21 |
07/01/2021 | Download |
CaliforniaChoice Total Choice Option [new effective 12/1/2020] |
12/01/2020 | Download |
Cal Perks Flyer |
01/01/2020 | Download |
Mammoth HR Cheat Sheet Flyer |
08/01/2020 | Download |
Mobile App Flyer 1.20 |
01/01/2020 | Download |
Payroll & HRIS Solutions via CaliforniaChoice |
01/01/2020 | Download |
POP Flyer |
01/01/2020 | Download |
Smart Decision Technology Overview for Brokers |
01/01/2020 | Download |
Smart Decision Technology Overview for Employers |
01/01/2020 | Download |
Smart Decision Technology - Automated Choice Profiler |
01/01/2020 | Download |
Smart Decision Technology - Online Enrollment |
01/01/2020 | Download |
Smart Decision Technology - Online Provider Search |
01/01/2020 | Download |
Smart Decision Technology - Online Rx Search |
01/01/2020 | Download |
Value Plus Benefits Flyer |
01/01/2020 | Download |
Website Features Flyer |
01/01/2020 | Download |
Schedule Of Commissions |
01/01/2020 | Download |
Medical |
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Anthem Advantage PPO Tier Hospital Network |
01/01/2018 | Download |
CaliforniaChoice HSA Guide 1.21 |
01/01/2021 | Download |
CaliforniaChoice Member Enrollment Guide 1.21 Effective Dates |
01/01/2021 | Download |
CaliforniaChoice Renewal Plan Transition Guide1.21 Effective Dates |
01/01/2021 | Download |
CaliforniaChoice Summary of Changes for Groups Renewing 4.21 (updated 3.21) |
04/01/2021 | Download |
CaliforniaChoice Summary of Changes for Groups Renewing 7.21 |
07/01/2021 | Download |
Infertility Benefit Grid 1.21 Effective Dates |
01/01/2021 | Download |
Infertility Benefit Grid 7.21 Effective Dates |
07/01/2021 | Download |
Medicare Part D Credibility 1.21 Effective Dates |
01/01/2021 | Download |
Medicare Part D Credibility 7.21 Effective Dates |
07/01/2021 | Download |
Network Availability by Carrier & Plan 1.21 |
01/01/2021 | Download |
Online Provider Search Instructions |
01/01/2020 | Download |
Provider Network Definitions 1.21 |
01/01/2021 | Download |
SBC-EOC Flyer |
01/01/2020 | Download |
Ancillary |
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Employer Guide to Optional Benefits 4.21 to 6.21 Effective Dates (updated 3.21) |
04/01/2021 | Download |
Chiropractic Benefits Flyer 1.20 |
01/01/2020 | Download |
Chiropractic Benefits Flyer 7.21 |
07/01/2021 | Download |
Dental Benefits Flyer 4.21 |
04/01/2021 | Download |
Dental Benefits Flyer 7.21 |
07/01/2021 | Download |
Hearing Value Added Benefit Flyer 1.20 |
01/01/2020 | Download |
Hearing Value Added Benefit Flyer 7.21 |
07/01/2021 | Download |
Life Insurance Benefits Flyer 1.20 |
01/01/2020 | Download |
Life Insurance Benefits Flyer 7.21 |
07/01/2021 | Download |
Vision Benefits Flyer 1.21 |
01/01/2021 | Download |
Vision Benefits Flyer 7.21 |
07/01/2021 | Download |
Video Name | Watch Video |
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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
|