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Small Business Group Plans – California

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2020 – Summary of Benefits – PPO

Summary of Benefits
Plans for new and renewing groups effective 1/1/20.

EnhancedCare PPO

EnhancedCare PPO Bronze HDHP 20% Alt

English 2.1MB   01/15/20


EnhancedCare PPO Bronze HDHP 20% Alt + INF

English 2.1MB   01/15/20


EnhancedCare PPO Gold $20 Alt

English 2MB   01/15/20


EnhancedCare PPO Gold $20 Alt + INF

English 2MB   01/15/20


EnhancedCare PPO Gold $30 Alt

English 2MB   01/15/20


EnhancedCare PPO Gold $30 Alt + INF

English 2MB   01/15/20


EnhancedCare PPO Gold 1000 -$30 Alt

English 2MB   01/15/20


EnhancedCare PPO Gold 1000 -$30 Alt + INF

English 2MB   01/15/20


EnhancedCare PPO Gold Value $15 Alt

English 2MB   01/15/20


EnhancedCare PPO Gold Value $15 Alt +INF

English 2MB   01/15/20


EnhancedCare PPO Platinum $15 Alt

English 2MB   01/15/20


EnhancedCare PPO Platinum $15 Alt + INF

English 2MB   01/15/20


EnhancedCare PPO Silver $50 Alt

English 2.1MB   01/15/20


EnhancedCare PPO Silver $50 Alt + INF

English 2MB   01/15/20


EnhancedCare PPO Silver $55 Alt

English 2.1MB   01/15/20


EnhancedCare PPO Silver $55 Alt + INF

English 2.1MB   01/15/20


EnhancedCare PPO Silver HDHP 40% Alt

English 2MB   01/15/20


EnhancedCare PPO Silver HDHP 40% Alt + INF

English 2MB   01/15/20


Full Network PPO

Full Network PPO Bronze $65

English 2MB   02/27/20


Full Network PPO Bronze $65 + INF

English 2MB   02/27/20


Full Network PPO Bronze HDHP 20% Alt

English 2MB   02/27/20


Full Network PPO Bronze HDHP 20% Alt + INF

English 2MB   02/27/20


Full Network PPO Gold $20 Alt

English 2MB   02/27/20


Full Network PPO Gold $20 Alt + INF

English 2MB   02/27/20


Full Network PPO Gold $25

English 2.1MB   02/27/20


Full Network PPO Gold $25 + INF

English 2MB   02/27/20


Full Network PPO Gold $30 Alt

English 2MB   02/27/20


Full Network PPO Gold $30 Alt + INF

English 2MB   02/27/20


Full Network PPO Gold 1000 -$30 Alt

English 2MB   02/27/20


Full Network PPO Gold 1000 - $30 Alt + INF

English 2MB   02/27/20


Full Network PPO Gold Value $15 Alt

English 2MB   02/27/20


Full Network PPO Gold Value $15 Alt + INF

English 2MB   02/27/20


Full Network PPO Platinum $15

English 2MB   02/27/20


Full Network PPO Platinum $15 + INF

English 2MB   02/27/20


Full Network PPO Platinum 250 - $15 Alt

English 2MB   02/27/20


Full Network PPO Platinum 250 - $15 Alt + INF

English 2MB   02/27/20


Full Network PPO Silver $50

English 2MB   02/27/20


Full Network PPO Silver$50 +INF

English 2MB   02/27/20


Full Network PPO Silver $55 Alt

English 2.1MB   02/27/20


Full Network PPO Silver $55 Alt + INF

English 2.1MB   02/27/20


Full Network PPO Silver HDHP 40% Alt

English 2MB   02/27/20


Full Network PPO Silver HDHP 40% Alt + INF

English 2MB   02/27/20


Full Network PPO Silver Value $50 Alt

English 2MB   02/27/20


Full Network PPO Silver Value $50 Alt + INF

English 2MB   02/27/20


2020 – Summary of Benefits – HMO

Full Network HMO

Full Network HMO Platinum $10

English 2.6MB   03/19/20


Full Network HMO Platinum $10 + NF

English 2.6MB   03/19/20


Full Network HMO Platinum $20

English 2.6MB   03/19/20


Full Network HMO Platinum $20 + INF

English 2.6MB   03/19/20


Full Network HMO Platinum $30

English 2.6MB   03/19/20


Full Network HMO Platinum $30 + INF

English 2.6MB   03/19/20


Full Network HMO Gold $30

English 2.6MB   03/19/20


Full Network HMO Gold $30 + INF

English 2.6MB   03/19/20


Full Network HMO Gold $35

English 2.6MB   03/19/20


Full Network HMO Gold $35+INF

English 2.6MB   03/19/20


Full Network HMO Gold $40

English 2.6MB   03/19/20


Full Network HMO Gold $40 + INF

English 2.6MB   03/19/20


Full Network HMO Gold $50

English 2.6MB   03/19/20


Full Network HMO Gold $50 + INF

English 2.6MB   03/19/20


Full Network HMO Silver $50

English 2.6MB   03/19/20


Full Network HMO Silver $50 + INF

English 2.6MB   03/19/20


Salud HMO y Mas

Salud HMO y Mas Gold $30

English 2.1MB   03/19/20


Salud HMO y Mas Gold $30 + INF

English 2.1MB   03/19/20


Salud HMO y Mas Gold $35

English 2.1MB   03/19/20


Salud HMO y Mas Gold $35 + INF

English 2.1MB   03/19/20


Salud HMO y Mas Gold $40

English 2.1MB   03/19/20


Salud HMO y Mas Gold $40+ INF

English 2.1MB   03/19/20


Salud HMO y Mas Gold $50

English 2.1MB   03/19/20


Salud HMO y Mas Gold $50 + INF

English 2.1MB   03/19/20


Salud HMO y Mas Platinum $10

English 2.1MB   03/19/20


Salud HMO y Mas Platinum $10 + INF

English 2.1MB   03/19/20


Salud HMO y Mas Platinum $20

English 2.1MB   03/19/20


Salud HMO y Mas Platinum $20 + INF

English 2.1MB   03/19/20


Salud HMO y Mas Platinum $30

English 2.1MB   03/19/20


Salud HMO y Mas Platinum $30 + INF

English 2.1MB   03/19/20


Salud HMO y Mas Silver $50

English 2.1MB   03/19/20


Salud HMO y Mas Silver $50 + INF

English 2.1MB   03/19/20


SmartCare HMO

SmartCare HMO Platinum $10

English 2.6MB   03/19/20


SmartCare HMO Platinum $10 + INF

English 2.6MB   03/19/20


SmartCare HMO Platinum $20

English 2.6MB   03/19/20


SmartCare HMO Platinum $20 + INF

English 2.6MB   03/19/20


SmartCare HMO Platinum $30

English 2.6MB   03/19/20


SmartCare HMO Platinum $30 +INF

English 2.6MB   03/19/20


SmartCare HMO Gold $30

English 2.6MB   03/19/20


SmartCare HMO Gold $30 + INF

English 2.6MB   03/19/20


SmartCare HMO Gold $35

English 2.6MB   03/19/20


SmartCare HMO Gold $35 + INF

English 2.6MB   03/19/20


SmartCare HMO Gold $40

English 2.6MB   03/19/20


SmartCare HMO Gold $40 + INF

English 2.6MB   03/19/20


SmartCare HMO Gold $50

English 2.6MB   03/19/20


SmartCare HMO Gold $50 + INF

English 2.6MB   03/19/20


SmartCare HMO Silver $50

English 2.6MB   03/19/20


SmartCare HMO Silver $50 + INF

English 2.6MB   03/19/20


WholeCare HMO

WholeCare HMO Platinum $10

English 2.6MB   03/19/20


WholeCare HMO Platinum $10 + INF

English 2.6MB   03/19/20


WholeCare HMO Platinum $20

English 2.6MB   03/19/20


WholeCare HMO Platinum $20 + INF

English 2.6MB   03/19/20


WholeCare HMO Platinum $30

English 2.6MB   03/19/20


WholeCare HMO Platinum $30 + INF

English 2.6MB   03/19/20


WholeCare HMO Gold $30

English 2.6MB   03/19/20


WholeCare HMO Gold $30 + INF

English 2.6MB   03/19/20


WholeCare HMO Gold $35

English 2.6MB   03/19/20


WholeCare HMO Gold $35 + INF

English 2.6MB   03/19/20


WholeCare HMO Gold $40

English 2.6MB   03/19/20


WholeCare HMO Gold $40 + INF

English 2.6MB   03/19/20


WholeCare HMO Gold $50

English 2.7MB   03/19/20


WholeCare HMO Gold $50 + INF

English 2.7MB   03/19/20


WholeCare HMO Silver $50

English 2.6MB   03/19/20


WholeCare HMO Silver $50 + INF

English 2.7MB   03/19/20


2019 – Plan Overviews / Summary of Benefits

Plan Overviews
Plans for new and renewing groups effective 1/1/19.

EnhancedCare PPO

Platinum 90 250/15 + Child Dental Alt (ENG) 2.2MB   12/09/19

Gold 80 1000/30 + Child Dental Alt (ENG) 2.2MB   12/09/19

Gold Value (ENG) 2.3MB   12/09/19

Silver 70 2000/55 + Child Dental Alt (ENG) 2.2MB   12/09/19

Silver Value (ENG) 2.2MB   12/09/19

Silver 70 HDHP 1350/40 + Child Dental Alt (ENG) 2.2MB   12/09/19

Bronze 60 HDHP 5600/15 + Child Dental Alt (ENG) 2.2MB   12/09/19


PPO

Platinum 90 0/15 + Child Dental (ENG) 2.2MB   12/09/19

Platinum 90 0/15 + Child Dental (SPN) 2.2MB   12/08/19

Platinum 250/15 + Child Dental Alt (ENG) 2.2MB   12/09/19

Platinum 250/15 + Child Dental Alt (SPN) 2.6MB   12/08/19

Gold 80 0/30 + Child Dental (ENG) 2.2MB   12/09/19

Gold 80 0/30 + Child Dental (SPN) 2.3MB   01/14/19

Gold 80 Value 750/10 + Child Dental Alt (ENG) 2.2MB   12/09/19

Gold 80 Value 750/10 + Child Dental Alt (SPN) 2.6MB   12/08/19

Gold 80 1000/30 + Child Dental Alt (ENG) 2.2MB   12/09/19

Gold 80 1000/30 + Child Dental Alt (SPN) 2.6MB   12/08/19

Silver 70 2000/45 + Child Dental (ENG) 2.2MB   12/09/19

Silver 70 2000/45 + Child Dental (SPN) 2.2MB   12/08/19

Silver 70 2000/55 + Child Dental Alt (ENG) 2.2MB   12/09/19

Silver 70 2000/55 + Child Dental Alt (SPN) 2.2MB   12/08/19

Silver 70 Value 1700/30 + Child Dental Alt (ENG) 2.2MB   12/09/19

Silver 70 Value 1700/30 + Child Dental Alt (SPN) 2.2MB   12/08/19

Silver 70 HDHP 1350/40 + Child Dental Alt (ENG) 2.2MB   12/09/19

Silver 70 HDHP 1350/40 + Child Dental Alt (SPN) 2.2MB   12/08/19

Bronze 60 6300/75 + Child Dental (ENG) 2.2MB   12/09/19

Bronze 60 6300/75 + Child Dental (SPN) 2.3MB   01/14/19

Bronze 60 HDHP 5600/15 + Child Dental Alt (ENG) 2.3MB   12/09/19

Bronze 60 HDHP 5600/15 + Child Dental Alt (SPN) 2.3MB   01/14/19


PureCare HSP

Platinum 90 0/15 + Child Dental (ENG) 525kB   12/09/19

Platinum 90 0/15 + Child Dental (SPN) 541kB   02/26/19

Platinum 90 0/15 + Child Dental (CHI) 799kB   12/10/19

Gold 80 0/30 + Child Dental (ENG) 528kB   12/09/19

Gold 80 0/30 + Child Dental (SPN) 541kB   02/26/19

Gold 80 0/30 + Child Dental (CHI) 773kB   12/10/19

Silver 70 2000/45 + Child Dental (ENG) 526kB   12/09/19

Silver 70 2000/45 + Child Dental (SPN) 541kB   02/26/19

Silver 70 2000/45 + Child Dental (CHI) 775kB   12/10/19

Bronze 60 6300/75 + Child Dental (ENG) 534kB   12/09/19

Bronze 60 6300/75 + Child Dental (SPN) 542kB   02/26/19

Bronze 60 6300/75 + Child Dental (CHI) 783kB   12/10/19


HMO

Platinum 10 (ENG) 515kB   12/09/19

Platinum 10 (SPN) 525kB   02/26/19

Platinum 10 (CHI) 727kB   12/10/19

Platinum 20 (ENG) 516kB   12/09/19

Platinum 20 (SPN) 525kB   02/26/19

Platinum 20 (CHI) 728kB   12/10/19

Platinum 30 (ENG) 471kB   12/09/19

Platinum 30 (SPN) 470kB   02/26/19

Platinum 30 (CHI) 671kB   12/10/19

Gold 30 (ENG) 517kB   12/09/19

Gold 30 (SPN) 525kB   02/26/19

Gold 30 (CHI) 712kB   12/10/19

Gold 35 (ENG) 463kB   12/09/19

Gold 35 (SPN) 470kB   02/26/19

Gold 35 (CHI) 671kB   12/10/19

Gold 40 (ENG) 543kB   12/09/19

Gold 40 (SPN) 524kB   02/26/19

Gold 40 (CHI) 728kB   12/10/19

Silver 50 (ENG) 516kB   12/09/19

Silver 50 (SPN) 524kB   02/26/19

Silver 50 (CHI) 729kB   12/10/19


WholeCare HMO

Platinum 10 (ENG) 549kB   12/09/19

Platinum 10 (SPN) 3.9MB   12/08/19

Platinum 10 (CHI) 790kB   12/10/19

Platinum 20 (ENG) 552kB   12/09/19

Platinum 20 (SPN) 3.9MB   12/08/19

Platinum 20 (CHI) 790kB   12/10/19

Platinum 30 (ENG) 505kB   12/09/19

Platinum 30 (SPN) 3MB   12/08/19

Platinum 30 (CHI) 769kB   12/10/19

Gold 30 (ENG) 549kB   12/09/19

Gold 30 (SPN) 3.9MB   12/08/19

Gold 30 (CHI) 720kB   12/10/19

Gold 35 (ENG) 485kB   12/09/19

Gold 35 (SPN) 6.3MB   12/08/19

Gold 35 (CHI) 739kB   12/10/19

Gold 40 (ENG) 551kB   12/09/19

Gold 40 (SPN) 3.7MB   12/08/19

Gold 40 (CHI) 790kB   12/10/19

Silver 50 (ENG) 550kB   12/09/19

Silver 50 (SPN) 528kB   02/28/19

Silver 50 (CHI) 791kB   12/10/19


SmartCare HMO

Platinum 10 (ENG) 528kB   12/09/19

Platinum 10 (SPN) 4.3MB   12/08/19

Platinum 10 (CHI) 790kB   12/10/19

Platinum 20 (ENG) 529kB   12/09/19

Platinum 20 (SPN) 3.9MB   12/08/19

Platinum 20 (CHI) 790kB   12/10/19

Platinum 30 (ENG) 484kB   12/09/19

Platinum 30 (SPN) 2.9MB   12/08/19

Platinum 30 (CHI) 768kB   12/10/19

Gold 30 (ENG) 523kB   12/09/19

Gold 30 (SPN) 4.3MB   12/08/19

Gold 30 (CHI) 791kB   12/10/19

Gold 35 (ENG) 491kB   12/09/19

Gold 35 (SPN) 3MB   12/08/19

Gold 35 (CHI) 741kB   12/10/19

Gold 40 (ENG) 557kB   12/09/19

Gold 40 (SPN) 3.9MB   12/08/19

Gold 40 (CHI) 791kB   12/10/19

Silver 50 (ENG) 557kB   12/09/19

Silver 50 (SPN) 3.9MB   12/08/19

Silver 50 (CHI) 791kB   12/10/19


Salud HMO y Más

Platinum 10 (ENG) 557kB   12/09/19

Platinum 10 (SPN) 4.3MB   12/08/19

Platinum 10 (CHI) 739kB   12/10/19

Platinum 20 (ENG) 557kB   12/09/19

Platinum 20 (SPN) 3.8MB   12/08/19

Platinum 20 (CHI) 740kB   12/10/19

Platinum 30 (ENG) 2.3MB   12/09/19

Platinum 30 (SPN) 2.9MB   12/08/19

Platinum 30 (CHI) 705kB   12/10/19

Gold 30 (ENG) 556kB   12/09/19

Gold 30 (SPN) 3.9MB   12/08/19

Gold 30 (CHI) 740kB   12/10/19

Gold 35 (ENG) 2.3MB   12/09/19

Gold 35 (SPN) 2.9MB   12/08/19

Gold 35 (CHI) 703kB   12/10/19

Gold 40 (ENG) 545kB   12/09/19

Gold 40 (SPN) 4.3MB   12/08/19

Gold 40 (CHI) 738kB   12/10/19

Silver 50 (ENG) 557kB   12/09/19

Silver 50 (SPN) 3.8MB   12/08/19

Silver 50 (CHI) 743kB   12/10/19


CommunityCare HMO

Gold 5 (ENG) 547kB   12/09/19

Gold 5 (SPN) 538kB   05/02/19

Gold 5 (CHI) 939kB   12/10/19

Silver 20 (ENG) 545kB   12/09/19

Silver 20 (SPN) 527kB   12/09/19

Silver 20 (CHI) 784kB   12/10/19

Bronze 45 (ENG) 545kB   12/09/19

Bronze 45 (SPN) 536kB   05/02/19

Bronze 45 (CHI) 776kB   12/10/19


Summary of Benefits

Enhanced Care PPO

Platinum 90 250/15 3.2MB   01/07/19

Platinum 90 250/15 w/inf 3.2MB   01/07/19

Gold 80 1000/30 3.1MB   01/07/19

Gold 80 1000/30 w/inf 3.1MB   01/07/19

Gold Value 3.2MB   01/07/19

Gold Value w/inf 3.2MB   01/07/19

Silver 70 2000/55 3.2MB   01/08/19

Silver 70 2000/55 w/inf 3.2MB   01/07/19

Silver Value 3.2MB   01/08/19

Silver Value w/inf 3.2MB   01/08/19

Silver 70 HDHP 1350/40 3.2MB   01/08/19

Silver 70 HDHP 1350/40 w/inf 3.2MB   01/08/19

Bronze 60 HDHP 5600/15 3.1MB   01/07/19

Bronze 60 HDHP 5600/15 w/inf 3.1MB   01/07/19


PPO

Platinum 90 0/15 3.1MB   01/08/19

Platinum 90 0/15 w/inf 3.1MB   01/08/19

Platinum 90 250/15 3.1MB   01/08/19

Platinum 90 250/15 w/inf 3.1MB   01/08/19

Gold 80 0/30 3.1MB   01/08/19

Gold 80 0/30 w/inf 3.1MB   01/08/19

Gold 80 1000/30 3.1MB   01/08/19

Gold 80 1000/30 w/inf 3.1MB   01/08/19

Gold 80 Value 750/10 3.1MB   01/08/19

Gold 80 Value 750/10 w/inf 3.1MB   01/08/19

Silver 70 2000/45 3.1MB   01/08/19

Silver 70 2000/45 w/inf 3.1MB   01/08/19

Silver 70 2000/55 3.2MB   01/08/19

Silver 70 2000/55 w/inf 3.2MB   01/08/19

Silver 70 Value 1700/30 3.1MB   01/08/19

Silver 70 Value 1700/30 w/inf 3.1MB   01/08/19

Silver 70 HDHP 1350/40 3.1MB   01/08/19

Silver 70 HDHP 1350/40 w/inf 3.1MB   01/08/19

Bronze 60 6300/75 3.1MB   01/08/19

Bronze 60 6300/75 w/inf 3.1MB   01/08/19

Bronze 60 HDHP 5600/15 3.1MB   01/08/19

Bronze 60 HDHP 5600/15 w/inf 3.1MB   01/08/19


PureCare HSP

Platinum 90 0/15 3.5MB   01/08/19

Platinum 90 0/15 w/inf 3.5MB   01/08/19

Gold 80 0/30 2.9MB   01/08/19

Gold 80 0/30 w/inf 2.9MB   01/08/19

Silver 70 2000/45 3.5MB   01/08/19

Silver 70 2000/45 w/inf 3.5MB   01/08/19

Bronze 60 6300/75 2.9MB   01/08/19

Bronze 60 6300/75 w/inf 2.9MB   01/08/19


HMO

Platinum 10 2.1MB   01/07/19

Platinum 10 w/inf 2.1MB   01/07/19

Platinum 20 2MB   01/07/19

Platinum 20 w/inf 2.1MB   01/07/19

Platinum 30 2MB   01/07/19

Platinum 30 w/inf 2.1MB   01/07/19

Gold 30 2MB   01/07/19

Gold 30 w/inf 2.1MB   01/07/19

Gold 35 2MB   01/07/19

Gold 35 w/inf 2.1MB   01/07/19

Gold 40 2MB   01/07/19

Gold 40 w/inf 2.1MB   01/07/19

Silver 50 2MB   01/07/19

Silver 50 w/inf 2MB   01/07/19


WholeCare HMO

Platinum 10 2.1MB   01/07/19

Platinum 10 w/inf 2.1MB   01/07/19

Platinum 20 2.1MB   01/07/19

Platinum 20 w/inf 2.1MB   01/07/19

Platinum 30 2.1MB   01/07/19

Platinum 30 w/inf 2.1MB   01/07/19

Gold 30 2.1MB   01/07/19

Gold 30 w/inf 2.1MB   01/07/19

Gold 35 2.1MB   01/07/19

Gold 35 w/inf 2.1MB   01/07/19

Gold 40 2.1MB   01/07/19

Gold 40 w/inf 2.1MB   01/07/19

Silver 50 2.1MB   01/07/19

Silver 50 w/inf 3.5MB   01/07/19


SmartCare HMO

Platinum 10 2.1MB   01/07/19

Platinum 10 w/inf 2.1MB   01/07/19

Platinum 20 2.1MB   01/07/19

Platinum 20 w/inf 2.1MB   01/07/19

Platinum 30 2.1MB   01/07/19

Platinum 30 w/inf 2.1MB   01/07/19

Gold 30 2.1MB   01/07/19

Gold 30 w/inf 2.1MB   01/07/19

Gold 35 2.1MB   01/07/19

Gold 35 w/inf 2.1MB   01/07/19

Gold 40 2.1MB   01/07/19

Gold 40 w/inf 2.1MB   01/07/19

Silver 50 2.4MB   01/07/19

Silver 50 w/inf 2.4MB   01/07/19


Salud HMO y Más

Platinum 10 3.5MB   01/08/19

Platinum 10 w/inf 3.5MB   01/08/19

Platinum 20 3.5MB   01/08/19

Platinum 20 w/inf 3.5MB   01/08/19

Platinum 30 3.5MB   01/08/19

Platinum 30 w/inf 3.5MB   01/08/19

Gold 30 3.5MB   01/08/19

Gold 30 w/inf 3.6MB   01/08/19

Gold 35 2.1MB   01/08/19

Gold 35 w/inf 2.1MB   01/08/19

Gold 40 2.1MB   01/08/19

Gold 40 w/inf 2.1MB   01/08/19

Silver 50 3.5MB   01/08/19

Silver 50 w/inf 3.5MB   01/08/19


CommunityCare HMO

Gold 5 3.5MB   01/07/19

Gold 5 w/inf 3.5MB   01/07/19

Silver 20 2.1MB   01/07/19

Silver 20 w/inf 2.1MB   01/07/19

Bronze 45 3.5MB   01/07/19

Bronze 45 w/inf 3.5MB   01/07/19


Certificate of Insurance

EnhancedCare PPO

Platinum 90 250/15 + Child Dental 4.2MB   10/31/18

Platinum 90 250/15 + Child Dental w/inf 4.2MB   10/31/18

Gold 80 1000/30 + Child Dental Alt 2.9MB   10/31/18

Gold 80 1000/30 + Child Dental Alt w/inf 2.9MB   10/31/18

Gold Value 4.2MB   10/31/18

Gold Value w/inf 4.2MB   10/31/18

Silver Value 2.9MB   10/31/18

Silver Value w/inf 2.9MB   10/31/18

Silver 70 2000/55 + Child Dental Alt 2.9MB   10/31/18

Silver 70 2000/55 + Child Dental Alt w/inf 3.3MB   03/12/19

Silver 70 HDHP 1350/40 + Child Dental Alt 2.9MB   10/31/18

Silver 70 HDHP 1350/40 + Child Dental Alt w/inf 2.9MB   10/31/18

Bronze 60 HDHP 5600/15 + Child Dental Alt 4.2MB   10/31/18

Bronze 60 HDHP 5600/15 + Child Dental Alt w/inf 4.2MB   10/31/18


Plan Brochures / Product Overviews


Portfolio Plan Desktopper

January 2020 135kB   01/05/20

January 2019 298kB   12/12/19


Portfolio Guide

January 2020 1.9MB   12/12/19

January 2019 1.3MB   12/08/19


Renewal Guide

Q1 2020 Renewal Guide 1.9MB   12/12/19

Q4 2019 Renewal Guide 1.9MB   12/12/19


Broker PPO Fast Facts

English 82kB   12/12/19


Member Open Enrollment PPO Brochure

English 783kB   12/12/19


Presentation Folders

Generic Folder

English 564kB   12/09/19


Open Enrollment Folder

English 231kB   12/10/19

En Español (Spanish) 1.2MB   12/10/19


Open Enrollment Product flyers
To be used as inserts with the OE Folders, may not be used as stand-alone flyers.

HMO – Open Enrollment Product flyer

English 144kB   12/10/19

En Español (Spanish) 187kB   12/10/19


PPO – Open Enrollment Product flyer

English 155kB   12/10/19

En Español (Spanish) 657kB   12/10/19


POS – Open Enrollment Product flyer

En Español (Spanish) 144kB   12/10/19

En Español (Spanish) 91kB   12/10/19


Applications and Forms


Ancillary Add-On or Change Form

English 78kB   12/09/19


Enrollment and Change Applications

Top Reasons for Employee Enrollment Delays

English 653kB   12/09/19


Employee Enrollment and Change Form (2020)

English 708kB   12/12/19

En Español (Spanish) 687kB   11/18/19

Chinese (Chinese) 952kB   11/18/19

Korean (Korean) 777kB   11/18/19

Vietnamese (Vietnamese) 706kB   11/18/19

Must be completed & submitted at time of enrollment in order to enroll new employees & existing dependents. Also used for employees/dependents waiving coverage.


Employee Enrollment and Change Form (January 2019)

English 721kB   12/12/19

En Español (Spanish) 692kB   12/21/18

Chinese (Chinese) 1MB   12/10/19

Korean (Korean) 939kB   12/10/19

Vietnamese (Vietnamese) 772kB   12/10/19

Must be completed & submitted at time of enrollment in order to enroll new employees & existing dependents. Also used for employees/dependents waiving coverage.


Renewal Election and Open Enrollment Medical Plan Change Request Form

January 2020 939kB   12/12/19

January 2019 773kB   12/12/19


Group Service Agreement/Policy Applications

Group Size Attestation Form

English 504kB   12/12/19

Must be completed & signed by the Employer Group.


Application for Group Service Agreement/Policy

January 2020 639kB   10/17/19

January 2019 643kB   10/09/18

Must be completed & signed by the Employer Group and Broker at time of enrollment and submitted along with check for first month's premium and enrollment forms. For renewals, this form must be completed and signed by the Employer Group and submitted to SBG Account Management for processing.


Religious Exemption Employer Form

English 496kB   12/09/19


Transition of Care

Continuity of Care Assistance Request Form

English 2.6MB   01/24/20

En Español (Spanish) 932kB   01/24/20


Prescription Transition form

English 487kB   09/30/19

En Español (Spanish) 488kB   09/30/19


Claims

Commercial Medical Claim Form

English 1.4MB   01/27/20

En Español (Spanish) 1.2MB   01/27/20


Commercial MHN Claim Form

English 2.9MB   03/28/19


Prescription Drug Claim Form

English 661kB   01/07/20

En Español (Spanish) 654kB   01/07/20


Dental Claim Form

English 2.8MB   04/12/10


Vision Claim Form

English 84kB   04/14/10


HIPAA Disclosures

Group Health Plan HIPAA Disclosure Forms

Disclosure Directive 95kB   06/13/16


Authorization For Disclosure of PHI

English 0kB   12/31/69

En Español (Spanish) 0kB   12/31/69

Chinese (Chinese) 0kB   12/31/69

Korean (Korean) 0kB   12/31/69


Health Net Life Insurance Forms

Employee Enrollment and Change Form

English 983kB   12/10/19

En Español (Spanish) 612kB   12/10/19


Group Life Insurance Conversion Form

English 183kB   12/10/19


Evidence of Insurability Life Form

English 680kB   12/10/19


Additional Forms

Employer Group Size Verification Form

English 448kB   08/12/19


Electronic Check Form

English 54kB   08/12/19


Proof of Eligibility Statement For Sole Proprietor, Partner or Corporate Officer

English 49kB   06/03/19


Principal Business or Headquarters Address Questionnaire

English 60kB   05/09/17


Rate Guides
New to Health Net? Contact Health Net Account Management, 1-800-447-8812, option 2, for questions on standard benefit rates. Looking for CalChoice or Covered California Small Business rates? Visit the CalChoice website at https://www.calchoice.com/DownloadForms.aspx, or contact Covered California Small Business at 1-877-752-4737.
Standard

Q2 2020 – Standard Rate Guide

English 5.6MB   02/27/20

Rates effective April 1, 2020 through June 15, 2020


Q1 2020 – Standard Rate Guide

English 3.2MB   02/26/20

Rates effective January 1, 2020 through March 15, 2020


Q4 2019 – Standard Rate Guide

English 13.3MB   12/12/19

Rates effective October 1, 2019, through December 15, 2019


Q3 2019 – Standard Rate Guide

English 13.1MB   12/12/19

Rates effective July 1, 2019, through September 15, 2019


Q2 2019 – Standard Rate Guide

English 7.1MB   12/12/19

Rates effective April 1, 2019, through June 15, 2019


Q1 2019 – Standard Rate Guide

English 7.8MB   12/12/19

Rates effective January 1, 2019, through March 15, 2019


Covered California

Q1 2020 – Covered California Rate Guide

English 4MB   12/12/19

Rates effective January 1, 2020, through March 15, 2020


Q4 2019 – Covered California Rate Guide

English 4.6MB   12/12/19

Rates effective October 1, 2019, through December 15, 2019


Q3 2019 – Covered California Rate Guide

English 1.1MB   05/31/19

Rates effective July 1, 2019, through September 15, 2019


Q2 2019 – Covered California Rate Guide

English 3.5MB   12/12/19

Rates effective April 1, 2019, through June 15, 2019


Q1 2019 – Covered California Rate Guide

English 4.5MB   12/12/19

Rates effective January 1, 2019, through March 15, 2019


Cal-Choice

Q1 2020 – Cal-Choice Rate Guide

English 3.6MB   12/12/19

Rates effective January 1, 2020, through March 15, 2020


Q4 2019 – Cal-Choice Rate Guide

English 3.4MB   12/12/19

Rates effective October 1, 2019, through December 15, 2019


Q3 2019 – Cal-Choice Rate Guide

English 3.7MB   12/12/19

Rates effective July 1, 2019, through September 15, 2019


Q2 2019 – Cal-Choice Rate Guide

English 2.4MB   12/12/19

Rates effective April 1, 2019, through June 15, 2019


Q1 2019 – Cal-Choice Rate Guide

English 2.6MB   12/12/19

Rates effective January 1, 2019, through March 15, 2019


Underwriting Guidelines


Underwriting Promotions

English 67kB   12/12/19


October 2019

Enhanced Choice A

English 395kB   08/19/19


Enhanced Choice B

English 396kB   08/19/19


Dental and Vision

English 396kB   08/19/19


Health Net Life

English 397kB   08/19/19


July 2019

Enhanced Choice A

English 283kB   06/26/19


Enhanced Choice B

English 284kB   06/26/19


Dental and Vision

English 286kB   06/26/19


Health Net Life

English 284kB   06/26/19


April 2019

Enhanced Choice A

English 283kB   03/28/19


Enhanced Choice B

English 284kB   03/28/19


Dental and Vision

English 287kB   03/28/19


Health Net Life

English 284kB   03/28/19


Support Tools


Broker Portal Overview

English 3.8MB   07/15/16

Broker Portal Overview (Flip Book)


Health Care Reform Materials

Summary of Benefits and Coverage (SBC) Search Flyer

English 385kB   03/13/15

Download only


Summary of Benefits and Coverage (SBC) Instructions Sheet

English 46kB   12/12/19


Preventive Care Services Overview (ACA Non-Grandfathered Plans)

English 793kB   12/12/19

En Español (Spanish) 597kB   12/10/19


Support Tools

Heal flyer (PPO, POS and EOA plans only)

English 0kB   12/31/69

En Español (Spanish) 0kB   12/31/69

Available through your PPO insurance plan and the SELECT/ELECT 2 (PPO) tier of your SELECT (POS) or Elect Open Access health plan.


Teladoc (Telehealth) Introductory Flyer

English/Spanish 327kB   12/10/19


Teladoc (Telehealth) FAQs

English 230kB   12/10/19

En Español (Spanish) 278kB   12/10/19


Teladoc Caregiver flyer