Forms & Brochures – Large Business Group Plans
How to View/Download Files
To view or download a file, click the desired language link. The PDF file will open in a new window or tab of your browser. From there, you can also download or print the file.
- Large Group Portfolio Book – English (PDF)
- 2027 Enhanced Choice Medical Portfolio: January 1, 2027 effective – English (PDF)
- 2027 Enhanced Choice Supplemental Portfolio: January 1, 2027 effective – English (PDF)
- 2026 Enhanced Choice Medical Portfolio: January 1, 2026 effective – English (PDF)
- EOA Products Broker Brochure – English (PDF)
- EOA Deductible Plans Broker Flyer 2027 – English (PDF)
- ExcelCare Network Broker Flyer – English (PDF)
- PPO Strength Flyer – English (PDF)
Presentation Folders
Note: For example only. Folders can be ordered on CustomPoint
Open Enrollment Product flyers
To be used as inserts with the OE Folders, may not be used as stand-alone flyers.
- Open Enrollment Product flyer – HMO – English (PDF)
- Open Enrollment Product flyer – HMO – En Español (Spanish) (PDF)
- Open Enrollment Product flyer – PPO – English (PDF)
- Open Enrollment Product flyer – PPO – En Español (Spanish) (PDF)
- Open Enrollment Product flyer – EOA – English (PDF)
- Open Enrollment Product flyer – EOA – En Español (Spanish) (PDF)
2027 – Enrollment and Change Applications
- 2027 – Employee Enrollment and Change Form – English (PDF)
- 2027 – Employee Enrollment and Change Form – En Español (Spanish) (PDF)
- 2027 – Employee Enrollment and Change Form – 中文 (Chinese) (PDF)
- 2027 – Employee Enrollment and Change Form – 한국어 (Korean) (PDF)
2026 – Enrollment and Change Applications
Claims
- Commercial Medical Claim Form – English (PDF)
- Commercial Medical Claim Form – En Español (Spanish) (PDF)
- Commercial Behavioral Health Claim Form – English (PDF)
- Dental Claim Form – English (PDF)
- Vision Claim Form – English (PDF)
- Prescription Drug Claim Form – English (PDF)
- Prescription Drug Claim Form – En Español (Spanish) (PDF)
Transition of Care
- Continuity of Care Request Form – English (PDF)
- Continuity of Care Request Form – En Español (Spanish) (PDF)
- Prescription Transition form – English (PDF)
- Prescription Transition form – En Español (Spanish) (PDF)
Dental and Vision Add-On or Change Form
Broker and Employer Forms
HIPAA Disclosures
- Group Health Plan HIPAA Disclosure Forms – Disclosure Directive (DOC)
- Group Health Plan HIPAA Disclosure Forms – Large Group Claims Data Request & Attestation – English (PDF)
- Authorization For Disclosure of PHI – English (PDF)
- Authorization For Disclosure of PHI – En Español (Spanish) (PDF)
- Authorization For Disclosure of PHI –
(Chinese) (PDF) - Authorization For Disclosure of PHI –
(Korean) (PDF)
SmartCare
Care Access
- Same Day Care – English (PDF)
- Same Day Care – En Español (Spanish) (PDF)
- Health Net Doula Program – English (PDF)
- Health Net Doula Program – En Español (Spanish) (PDF)
- Teladoc Commercial Mental Health Flyer – English (PDF)
- Teladoc Health Member FAQs – English (PDF)
- Teladoc Health Member FAQs – En Español (Spanish) (PDF)
- Teladoc Health Member Flyer – English (PDF)
- Teladoc Health Member Flyer – En Español (Spanish) (PDF)
- Understanding the Continuity of Care Policy (Broker/Employer) – English (PDF)
- Tools to Help You Compare Hospitals in Your Area – English (PDF)
National PPO Network (Out-of-State PPO)
- Broker Cigna Healthcare PPO Network FAQ – English (PDF)
- Cigna Healthcare PPO Member Guide – English (PDF)
Preventive Care
Additional Member/Prospect Materials
- Health Net Beginnings – English (PDF)
- Health Net Beginnings – En Español (Spanish) (PDF)
- LGBTQ+ Benefits Flyer – English (PDF)
- LGBTQ+ Benefits Flyer – En Español (Spanish) (PDF)
- HealthNet.com Flyer – English (PDF)
- HealthNet.com Flyer – En Español (Spanish) (PDF)
- HealthNet.com Plus Flyer – English (PDF)
- HealthNet.com Plus Flyer – En Español (Spanish) (PDF)
- Find a Provider Information – English (PDF)
- Find a Provider Information – En Español (Spanish) (PDF)
- HMO Flu Shot Flyer – English (PDF)
- HMO Flu Shot Flyer – En Español (Spanish) (PDF)
- Your Cardiovascular Health is Key to a Healthy Life (PDF)
Behavioral Health
- Behavioral Health Guide – English (PDF)
- Behavioral Health Guide – En Español (Spanish) (PDF)
- Child Behavioral Health Flyer – English (PDF)
- Protect Your Child's Physical and Mental Well Being – English (PDF)
- Teladoc Mental Health Digital Program – English (PDF)
- Teladoc Mental Health Digital Program – En Español (Spanish) (PDF)
Glossaries
- Uniform Glossary of Health Coverage and Medical Terms – English (PDF)
- Uniform Glossary of Health Coverage and Medical Terms – En Español (Spanish) (PDF)
- Uniform Glossary of Health Coverage and Medical Terms – (Chinese) (PDF)
- Uniform Glossary of Health Coverage and Medical Terms – Navajo (PDF)
- Uniform Glossary of Health Coverage and Medical Terms – (Korean) (PDF)
Health insurance companies and group health plans are required to make available a uniform glossary of health coverage and medical terms commonly used in plan documents. The Uniform Glossary is meant to help the consumer, understand some of the most common language used in health insurance documents.
- Weight-loss Drug Broker Flyer – English (PDF)
- Employer Group Pharmacy Benefit Member Guide – English (PDF)
- Guía de Beneficios de Farmacia para Afiliados – En Español (Spanish) (PDF)
- Mail Service Pharmacy™ and Maintenance Choice® Program – English (PDF)
- Mail Service Pharmacy™ and Maintenance Choice® Program – En Español (Spanish) (PDF)
- Generic vs Brand-Name Drugs Information – English (PDF)
- Information on Free Blood Glucose Meters – English (PDF)
- Take Medications the Right Way – English (PDF)
- Prescription Drug Claim Form – English (PDF)
- Prescription Drug Claim Form – En Español (Spanish) (PDF)
- Prescription Transition form – English (PDF)
- Prescription Transition form – En Español (Spanish) (PDF)
- Preventive Drug and Device List – English (PDF)
- CVS Caremark Mail Order Pharmacy – English (PDF)
- CVS Caremark Mail Order Pharmacy – En Español (Spanish) (PDF)
- Home Infusion Fact Sheet – English (PDF)
- Salud HMO y Más Flyer – English (PDF)
- Salud HMO y Más Flyer – En Español (Spanish) (PDF)
- Salud HMO y Más Member Brochure 2026 – English (PDF)
- Salud HMO y Más Member Brochure 2026 – En Español (Spanish) (PDF)
- Salud HMO y Más SIMNSA Flyer – English (PDF)
- Salud HMO y Más SIMNSA Flyer – En Español (Spanish) (PDF)
- Ancillary sell sheet – English (PDF)
- 2026 – Dental and Vision Rate Guide – English (PDF)
- 2025 – Dental and Vision Rate Guide – English (PDF)
- Broker Supplemental Benefit Multi-Bundling Flyer – English (PDF)
Dental Materials
- Dental Benefits Flyer – English (PDF)
- Dental Provider Search Flyer – English (PDF)
- Your Dental Website (member) – English (PDF)
Vision Materials
- CA Wellness Member Brochure – English (PDF)
- CA Wellness Member Brochure – En Español (Spanish) (PDF)
- Health Support Programs – Behavioral Health – English (PDF)
- Health Support Programs – Behavioral Health – En Español (Spanish) (PDF)
- Health Support Programs – Physical Health – English (PDF)
- Health Support Programs – Physical Health – En Español (Spanish) (PDF)
- Healthy Discounts Member Flyer – English (PDF)
- Healthy Discounts Member Flyer – En Español (Spanish) (PDF)
- Teladoc Mental Health Digital Program – English (PDF)
- Teladoc Mental Health Digital Program – En Español (Spanish) (PDF)
- Active&Fit™ Direct Program Flyer – English (PDF)
- Active&Fit™ Direct Program Flyer – En Español (Spanish) (PDF)
- Sharecare Unwinding Flyer – English (PDF)
- Sharecare Unwinding FAQs – English (PDF)
- Sharecare Eat Right Now Program Flyer – English (PDF)
- Sharecare Eat Right Now FAQs – English (PDF)
- Sharecare FAQs – English (PDF)
- Sharecare Craving to Quit – English (PDF)
- Sharecare Craving to Quit – En Español (Spanish) (PDF)
- Sharecare Health Coaching (Lifestyle Management) Flyer – English (PDF)
- Sharecare Health Coaching (Lifestyle Management) FAQs – English (PDF)
- Sharecare RealAge Program Overview – English (PDF)
- Sharecare RealAge Program Overview – En Español (Spanish) (PDF)
- Sharecare RealAge Program FAQs – English (PDF)
- Sharecare RealAge Program FAQs – En Español (Spanish) (PDF)
- Sharecare Green Day Overview – English (PDF)
- Sharecare How to Link Trackers Guide – English (PDF)
- Sign Up for Teladoc Health – English (PDF)
- Teladoc Health Member FAQs – English (PDF)
- Teladoc Health Member FAQs – En Español (Spanish) (PDF)
- Teladoc Health Member Flyer – English (PDF)
- Teladoc Health Member Flyer – En Español (Spanish) (PDF)
- Teladoc Mental Health Flyer – English (PDF)
- Tips to Stop Smoking – English & Spanish (PDF)
- Wellness Tools – English (PDF)
- Wellness Tools – En Español (Spanish) (PDF)
- 2026 Wellness Webinar Flyer – English (PDF)
- 2026 Wellness Webinar Flyer – En Español (Spanish) (PDF)
Broker / Employer Materials
- Wellness Employer Broker Toolkit – English (PDF)
- Healthy Discounts Member Flyer – English (PDF)
- Healthy Discounts Member Flyer – En Español (Spanish) (PDF)
- National Observances Calendar for Employers – English (PDF)
- Preventive Screening Guidelines (Commercial Groups) – English (PDF)
- Preventive Screening Guidelines (Commercial Groups) – En Español (Spanish) (PDF)
- Wellness Rewards Program FAQs for Employers – English (PDF)
- Wellness Rewards Program FAQs for Employers – En Español (Spanish) (PDF)
Travel Guides
Claim forms can also be found under the Applications and Forms section on this page.
Claim forms can also be found under the Applications and Forms section on this page.
Additional Materials
Are your clients looking for greater convenience, service and choice in consumer directed health care benefits? We have partnered with HealthEquity for HRA and HSA integration alongside our Large group products. A proven expert in financial arrangement integration and administration, HealthEquity offers easy-to-use tools and comprehensive resources. Our PPO high deductible health plans (HDHP's), can be offered alongside their integrated health savings account (HSA), while all of our PPO plans can be offered with their integrated health reimbursement account (HRA).
Learn more about HealthEquity HSA & HRA Plans on the HealthEquity website. Go to HealthEquity sales resource site.
Full Network HMO
- Full Network HMO-10/250a ($1,500 / $3,000) – NMH – English (PDF)
- Full Network HMO-15/1500d ($6,500 / $13,000) – NMI – English (PDF)
- Full Network HMO-15/250a ($2,500 / $5,000) – NMJ – English (PDF)
- Full Network HMO-20/0 ($1,500 / $3,000) – NMK – English (PDF)
- Full Network HMO-20/20% ($2,500 / $5,000) – NML – English (PDF)
- Full Network HMO-20/250a ($1,500 / $3,000) – NMM – English (PDF)
- Full Network HMO-20/500a ($2,500 / $5,000) – NMN – English (PDF)
- Full Network HMO-25/750a ($2,500 / $5,000) – NMO – English (PDF)
- Full Network HMO-30/1000a ($3,500 / $7,000) – NMP – English (PDF)
- Full Network HMO-30/20% ($2,500 / $5,000) – NMQ – English (PDF)
- Full Network HMO-30/250d ($4,500 / $9,000) – NMR – English (PDF)
- Full Network HMO-30/30% ($3,500 / $7,000) – NMS – English (PDF)
- Full Network HMO-30/500a ($2,500 / $5,000) – NMT – English (PDF)
- Full Network HMO-35/30% ($5,500 / $11,000) – NMU – English (PDF)
- Full Network HMO-35/750a ($3,500 / $7,000) – NMV – English (PDF)
- Full Network HMO-40/1500d ($6,500 / $13,000) – NMW – English (PDF)
- Full Network HMO-40/30% ($3,500 / $7,000) – NMX – English (PDF)
- Full Network HMO-40/40% ($5,500 / $11,000) – NMY – English (PDF)
- Full Network HMO-40/500d ($4,500 / $9,000) – NMZ – English (PDF)
- Full Network HMO-40/750a ($4,500 / $9,000) – NN0 – English (PDF)
- Full Network HMO-50/1500d ($7,500 / $15,000) – NN1 – English (PDF)
- Full Network HMO-60/1500a ($9,500 / $19,000) – NN2 – English (PDF)
ExcelCare HMO
- ExcelCare HMO-10/250a ($1,500 / $3,000) – NO7 – English (PDF)
- ExcelCare HMO-15/1500d ($6,500 / $13,000) – NO8 – English (PDF)
- ExcelCare HMO-15/250a ($2,500 / $5,000) – NO9 – English (PDF)
- ExcelCare HMO-20/0 ($1,500 / $3,000) – NOB – English (PDF)
- ExcelCare HMO-20/20% ($2,500 / $5,000) – NOD – English (PDF)
- ExcelCare HMO-20/250a ($1,500 / $3,000) – NOE – English (PDF)
- ExcelCare HMO-20/500a ($2,500 / $5,000) – NOG – English (PDF)
- ExcelCare HMO-25/750a ($2,500 / $5,000) – NOH – English (PDF)
- ExcelCare HMO-30/1000a ($3,500 / $7,000) – NOJ – English (PDF)
- ExcelCare HMO-30/20% ($2,500 / $5,000) – NOK – English (PDF)
- ExcelCare HMO-30/250d ($4,500 / $9,000) – NOL – English (PDF)
- ExcelCare HMO-30/30% ($3,500 / $7,000) – NOM – English (PDF)
- ExcelCare HMO-30/500a ($2,500 / $5,000) – NOO – English (PDF)
- ExcelCare HMO-35/30% ($5,500 / $11,000) – NOS – English (PDF)
- ExcelCare HMO-35/750a ($3,500 / $7,000) – NOU – English (PDF)
- ExcelCare HMO-40/1500d ($6,500 / $13,000) – NOV – English (PDF)
- ExcelCare HMO-40/30% ($3,500 / $7,000) – NOW – English (PDF)
- ExcelCare HMO-40/40% ($5,500 / $11,000) – NOY – English (PDF)
- ExcelCare HMO-40/500d ($4,500 / $9,000) – NP0 – English (PDF)
- ExcelCare HMO-40/750a ($4,500 / $9,000) – NP1 – English (PDF)
- ExcelCare HMO-50/1500d ($7,500 / $15,000) – NP2 – English (PDF)
- ExcelCare HMO-60/1500a ($9,500 / $19,000) – NP5 – English (PDF)
ExcelCare HMO – Facility Deductible
- ExcelCare HMO Facility Deductible-20/1500/20% ($3,500 / $7,000) – NOC – English (PDF)
- ExcelCare HMO Facility Deductible-20/500/10% ($3,500 / $7,000) – NOF – English (PDF)
- ExcelCare HMO Facility Deductible-30/1000/20% ($3,500 / $7,000) – NOI – English (PDF)
- ExcelCare HMO Facility Deductible-30/1500/30% ($3,500 / $7,000) – NOP – English (PDF)
- ExcelCare HMO Facility Deductible-30/2000/30% ($3,500 / $7,000) – NOQ – English (PDF)
- ExcelCare HMO Facility Deductible-30/3000/30% ($4,500 / $9,000) – NOR – English (PDF)
- ExcelCare HMO Facility Deductible-40/3000/40% ($5,500 / $11,000) – NOX – English (PDF)
- ExcelCare HMO Facility Deductible-40/4000/40% ($6,500 / $13,000) – NOZ – English (PDF)
- ExcelCare HMO Facility Deductible-50/4500/40% ($6,500 / $13,000) – NP3 – English (PDF)
- ExcelCare HMO Facility Deductible-50/5500/40% ($7,500 / $15,000) – NP4 – English (PDF)
SmartCare HMO
- SmartCare HMO-10/250a ($1,500 / $3,000) – NLK – English (PDF)
- SmartCare HMO-15/1500d ($6,500 / $13,000) – NLL – English (PDF)
- SmartCare HMO-15/250a ($2,500 / $5,000) – NLM – English (PDF)
- SmartCare HMO-20/0 ($1,500 / $3,000) – NLN – English (PDF)
- SmartCare HMO-20/20% ($2,500 / $5,000) – NLP – English (PDF)
- SmartCare HMO-20/250a ($1,500 / $3,000) – NLQ – English (PDF)
- SmartCare HMO-20/500a ($2,500 / $5,000) – NLS – English (PDF)
- SmartCare HMO-25/750a ($2,500 / $5,000) – NLT – English (PDF)
- SmartCare HMO-30/1000a ($3,500 / $7,000) – NLV – English (PDF)
- SmartCare HMO-30/20% ($2,500 / $5,000) – NLW – English (PDF)
- SmartCare HMO-30/250d ($4,500 / $9,000) – NLX – English (PDF)
- SmartCare HMO-30/30% ($3,500 / $7,000) – NLY – English (PDF)
- SmartCare HMO-30/500a ($2,500 / $5,000) – NLZ – English (PDF)
- SmartCare HMO-35/30% ($5,500 / $11,000) – NM3 – English (PDF)
- SmartCare HMO-35/750a ($3,500 / $7,000) – NM4 – English (PDF)
- SmartCare HMO-40/1500d ($6,500 / $13,000) – NM5 – English (PDF)
- SmartCare HMO-40/30% ($3,500 / $7,000) – NM6 – English (PDF)
- SmartCare HMO-40/40% ($5,500 / $11,000) – NM8 – English (PDF)
- SmartCare HMO-40/500d ($4,500 / $9,000) – NMB – English (PDF)
- SmartCare HMO-40/750a ($4,500 / $9,000) – NMC – English (PDF)
- SmartCare HMO-50/1500d ($7,500 / $15,000) – NMD – English (PDF)
- SmartCare HMO-60/1500a ($9,500 / $19,000) – NMG – English (PDF)
SmartCare HMO – Facility Deductible
- SmartCare HMO Facility Deductible-20/1500/20% ($3,500 / $7,000) – NLO – English (PDF)
- SmartCare HMO Facility Deductible-20/500/10% ($3,500 / $7,000) – NLR – English (PDF)
- SmartCare HMO Facility Deductible-30/1000/20% ($3,500 / $7,000) – NLU – English (PDF)
- SmartCare HMO Facility Deductible-30/1500/30% ($3,500 / $7,000) – NM0 – English (PDF)
- SmartCare HMO Facility Deductible-30/2000/30% ($3,500 / $7,000) – NM1 – English (PDF)
- SmartCare HMO Facility Deductible-30/3000/30% ($4,500 / $9,000) – NM2 – English (PDF)
- SmartCare HMO Facility Deductible-40/3000/40% ($5,500 / $11,000) – NM7 – English (PDF)
- SmartCare HMO Facility Deductible-40/4000/40% ($6,500 / $13,000) – NM9 – English (PDF)
- SmartCare HMO Facility Deductible-50/4500/40% ($6,500 / $13,000) – NME – English (PDF)
- SmartCare HMO Facility Deductible-50/5500/40% ($7,500 / $15,000) – NMF – English (PDF)
Salud HMO y Más
- Salud HMO y Más / Salud HMO y Más San Diego-10/250a ($1,500 / $3,000) – NO2 / NO3 – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-20/0 ($1,500 / $3,000) – NR5 / NR6 – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-15/250a ($2,500 / $5,000) – NO4 / NO5 – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-20/250a ($1,500 / $3,000) – NRC / NRD – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-20/20% ($2,500 / $5,000) – NR9 / NRB – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-20/500a ($2,500 / $5,000) – NRG / NRH – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-30/500a ($2,500 / $5,000) – NRW / NRX – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-30/20% ($2,500 / $5,000) – NRQ / NRR – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-25/750a ($2,500 / $5,000) – NRI / NRJ – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-30/30% ($3,500 / $7,000) – NRU / NRV – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-30/1000a ($3,500 / $7,000) – NRM / NRN – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-40/30% ($3,500 / $7,000) – NS8 / NS9 – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-30/250d ($4,500 / $9,000) – NRS / NRT – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-35/750a ($3,500 / $7,000) – NS4 / NS5 – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-40/500d ($4,500 / $9,000) – NSH / NSI – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-40/750a ($4,500 / $9,000) – NSJ / NSK – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-35/30% ($5,500 / $11,000) – NS2 / NS3 – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-40/40% ($5,500 / $11,000) – NSD / NSE – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-15/1500d ($6,500 / $13,000) – NR3 / NR4 – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-40/1500d ($6,500 / $13,000) – NS6 / NS7 – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-50/1500d ($7,500 / $15,000) – NSL / NSM – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego-60/1500a ($9,500 / $19,000) – NSR / NSS – English (PDF)
Salud HMO y Más – Facility Deductible
- Salud HMO y Más / Salud HMO y Más San Diego Facility Deductible-20/1500/20% ($3,500 / $7,000) – NR7 / NR8 – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego Facility Deductible-20/500/10% ($3,500 / $7,000) – NRE / NRF – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego Facility Deductible-30/1000/20% ($3,500 / $7,000) – NRK / NRL – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego Facility Deductible-30/1500/30% ($3,500 / $7,000) – NRO / NRP – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego Facility Deductible-30/2000/30% ($3,500 / $7,000) – NRY / NRZ – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego Facility Deductible-30/3000/30% ($4,500 / $9,000) – NS0 / NS1 – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego Facility Deductible-40/3000/40% ($5,500 / $11,000) – NSB / NSC – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego Facility Deductible-40/4000/40% ($6,500 / $13,000) – NSF / NSG – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego Facility Deductible-50/4500/40% ($6,500 / $13,000) – NSN / NSO – English (PDF)
- Salud HMO y Más / Salud HMO y Más San Diego Facility Deductible-50/5500/40% ($7,500 / $15,000) – NSP / NSQ – English (PDF)
Full Network EOA
- Full Network EOA-10/250a ($1,500 / $3,000) – NN3 – English (PDF)
- Full Network EOA-15/1500d ($6,500 / $13,000) – NN4 – English (PDF)
- Full Network EOA-15/250a ($2,500 / $5,000) – NN5 – English (PDF)
- Full Network EOA-20/0 ($1,500 / $3,000) – NN6 – English (PDF)
- Full Network EOA-20/20% ($2,500 / $5,000) – NN8 – English (PDF)
- Full Network EOA-20/250a ($1,500 / $3,000) – NN9 – English (PDF)
- Full Network EOA-20/500a ($2,500 / $5,000) – NNC – English (PDF)
- Full Network EOA-25/750a ($2,500 / $5,000) – NND – English (PDF)
- Full Network EOA-30/1000a ($3,500 / $7,000) – NNF – English (PDF)
- Full Network EOA-30/20% ($2,500 / $5,000) – NNG – English (PDF)
- Full Network EOA-30/250d ($4,500 / $9,000) – NNH – English (PDF)
- Full Network EOA-30/30% ($3,500 / $7,000) – NNI – English (PDF)
- Full Network EOA-30/500a ($2,500 / $5,000) – NNJ – English (PDF)
- Full Network EOA-35/30% ($5,500 / $11,000) – NNN – English (PDF)
- Full Network EOA-35/750a ($3,500 / $7,000) – NNO – English (PDF)
- Full Network EOA-40/1500d ($6,500 / $13,000) – NNP – English (PDF)
- Full Network EOA-40/30% ($3,500 / $7,000) – NNQ – English (PDF)
- Full Network EOA-40/40% ($5,500 / $11,000) – NNS – English (PDF)
- Full Network EOA-40/500d ($4,500 / $9,000) – NNU – English (PDF)
- Full Network EOA-40/750a ($4,500 / $9,000) – NNV – English (PDF)
- Full Network EOA-50/1500d ($7,500 / $15,000) – NNW – English (PDF)
- Full Network EOA-60/1500a ($9,500 / $19,000) – NNZ – English (PDF)
Full Network EOA – Facility Deductible
- Full Network EOA Facility Deductible-20/1500/20% ($3,500 / $7,000) – NN7 – English (PDF)
- Full Network EOA Facility Deductible-20/500/10% ($3,500 / $7,000) – NNB – English (PDF)
- Full Network EOA Facility Deductible-30/1000/20% ($3,500 / $7,000) – NNE – English (PDF)
- Full Network EOA Facility Deductible-30/1500/30% ($3,500 / $7,000) – NNK – English (PDF)
- Full Network EOA Facility Deductible-30/2000/30% ($3,500 / $7,000) – NNL – English (PDF)
- Full Network EOA Facility Deductible-30/3000/30% ($4,500 / $9,000) – NNM – English (PDF)
- Full Network EOA Facility Deductible-40/3000/40% ($5,500 / $11,000) – NNR – English (PDF)
- Full Network EOA Facility Deductible-40/4000/40% ($6,500 / $13,000) – NNT – English (PDF)
- Full Network EOA Facility Deductible-50/4500/40% ($6,500 / $13,000) – NNX – English (PDF)
- Full Network EOA Facility Deductible-50/5500/40% ($7,500 / $15,000) – NNY – English (PDF)
ExcelCare EOA
- ExcelCare EOA-10/250a ($1,500 / $3,000) – NP6 – English (PDF)
- ExcelCare EOA-15/1500d ($6,500 / $13,000) – NP7 – English (PDF)
- ExcelCare EOA-15/250a ($2,500 / $5,000) – NP8 – English (PDF)
- ExcelCare EOA-20/0 ($1,500 / $3,000) – NP9 – English (PDF)
- ExcelCare EOA-20/20% ($2,500 / $5,000) – NPC – English (PDF)
- ExcelCare EOA-20/250a ($1,500 / $3,000) – NPD – English (PDF)
- ExcelCare EOA-20/500a ($2,500 / $5,000) – NPF – English (PDF)
- ExcelCare EOA-25/750a ($2,500 / $5,000) – NPG – English (PDF)
- ExcelCare EOA-30/1000a ($3,500 / $7,000) – NPI – English (PDF)
- ExcelCare EOA-30/20% ($2,500 / $5,000) – NPJ – English (PDF)
- ExcelCare EOA-30/250d ($4,500 / $9,000) – NPK – English (PDF)
- ExcelCare EOA-30/30% ($3,500 / $7,000) – NPL – English (PDF)
- ExcelCare EOA-30/500a ($2,500 / $5,000) – NPM – English (PDF)
- ExcelCare EOA-35/30% ($5,500 / $11,000) – NPQ – English (PDF)
- ExcelCare EOA-35/750a ($3,500 / $7,000) – NPR – English (PDF)
- ExcelCare EOA-40/1500d ($6,500 / $13,000) – NPS – English (PDF)
- ExcelCare EOA-40/30% ($3,500 / $7,000) – NPT – English (PDF)
- ExcelCare EOA-40/40% ($5,500 / $11,000) – NPV – English (PDF)
- ExcelCare EOA-40/500d ($4,500 / $9,000) – NPX – English (PDF)
- ExcelCare EOA-40/750a ($4,500 / $9,000) – NPY – English (PDF)
- ExcelCare EOA-50/1500d ($7,500 / $15,000) – NPZ – English (PDF)
- ExcelCare EOA-60/1500a ($9,500 / $19,000) – NQ2 – English (PDF)
ExcelCare EOA – Facility Deductible
- ExcelCare EOA Facility Deductible-20/1500/20% ($3,500 / $7,000) – NPB – English (PDF)
- ExcelCare EOA Facility Deductible-20/500/10% ($3,500 / $7,000) – NPE – English (PDF)
- ExcelCare EOA Facility Deductible-30/1000/20% ($3,500 / $7,000) – NPH – English (PDF)
- ExcelCare EOA Facility Deductible-30/1500/30% ($3,500 / $7,000) – NPN – English (PDF)
- ExcelCare EOA Facility Deductible-30/2000/30% ($3,500 / $7,000) – NPO – English (PDF)
- ExcelCare EOA Facility Deductible-30/3000/30% ($4,500 / $9,000) – NPP – English (PDF)
- ExcelCare EOA Facility Deductible-40/3000/40% ($5,500 / $11,000) – NPU – English (PDF)
- ExcelCare EOA Facility Deductible-40/4000/40% ($6,500 / $13,000) – NPW – English (PDF)
- ExcelCare EOA Facility Deductible-50/4500/40% ($6,500 / $13,000) – NQ0 – English (PDF)
- ExcelCare EOA Facility Deductible-50/5500/40% ($7,500 / $15,000) – NQ1 – English (PDF)
PPO
- PPO-0/1000/20% ($5,000 / $10,000) – NQ3 – English (PDF)
- PPO-10/0/10% ($2,000 / $4,000) – NQ4 – English (PDF)
- PPO-10/250/10% ($3,000 / $6,000) – NQ5 – English (PDF)
- PPO-10/250/20% ($4,000 / $8,000) – NQ6 – English (PDF)
- PPO-15/250/10% ($2,000 / $4,000) – NQ7 – English (PDF)
- PPO-15/500/20% ($3,000 / $6,000) – NQ8 – English (PDF)
- PPO-15/500/20% ($4,000 / $8,000) – NQ9 – English (PDF)
- PPO-20/250/10% ($3,000 / $6,000) – NQB – English (PDF)
- PPO-20/250/20% ($4,000 / $8,000) – NQC – English (PDF)
- PPO-20/2500/20% ($5,000 / $10,000) – NQD – English (PDF)
- PPO-20/500/20% ($3,000 / $6,000) – NQE – English (PDF)
- PPO-20/500/20% ($4,000 / $8,000) – NQF – English (PDF)
- PPO-25/1000/10% ($3,000 / $6,000) – NQG – English (PDF)
- PPO-30/1000/20% ($3,000 / $6,000) – NQH – English (PDF)
- PPO-30/1000/20% ($4,000 / $8,000) – NQL – English (PDF)
- PPO-30/2000/30% ($5,000 / $10,000) – NQM – English (PDF)
- PPO-30/3000/30% ($5,000 / $10,000) – NQN – English (PDF)
- PPO-30/3000/30% ($6,000 / $12,000) – NQO – English (PDF)
- PPO-30/4000/30% ($6,000 / $12,000) – NQP – English (PDF)
- PPO-30/500/10% ($3,000 / $6,000) – NQI – English (PDF)
- PPO-30/500/30% ($4,000 / $8,000) – NQJ – English (PDF)
- PPO-30/750/20% ($5,000 / $10,000) – NQK – English (PDF)
- PPO-35/1000/20% ($5,000 / $10,000) – NQQ – English (PDF)
- PPO-40/3500/30% ($7,000 / $14,000) – NQR – English (PDF)
- PPO-40/5000/30% ($7,000 / $14,000) – NQS – English (PDF)
- PPO-60/5000/30% ($9,500 / $19,000) – NQT – English (PDF)
PPO (HSA-compatible) (Includes pre-set pharmacy plans)
- PPO HSA-1750/0% I ($1,750) – NR1 – English (PDF)
- PPO HSA-2000/0% I ($2,000) – NR2 – English (PDF)
- PPO HSA-3500/0% F ($3,500 / $7,000) – NQZ – English (PDF)
- PPO HSA-3500/0% F ($3,500 / $7,000) – NR0 – English (PDF)
- PPO HSA-3500/20% ($4,000 / $8,000) – NQV – English (PDF)
- PPO HSA-3500/20% ($5,000 / $10,000) – NQW – English (PDF)
- PPO HSA-3500/30% ($5,000 / $10,000) – NQY – English (PDF)
- PPO HSA-4000/0% ($4,000 / $8,000) – NQU – English (PDF)
- PPO HSA-5000/20% ($6,000 / $12,000) – NQX – English (PDF)
Pharmacy HMO
(combined medical and pharmacy OOPM)
- No deductible ($5/$25/$50): 2EA,2EB,2EC,2ED,2EE,2EF,2EG,2EH – English (PDF)
- No deductible ($10/$30/$55): 2EJ,2EK,2EL,2EM,2EN,2EP,2EQ,2ER – English (PDF)
- No deductible ($15/$35/$60): 2ES,2ET,2EU,2EV,2EW,2EX,2EY,2EZ – English (PDF)
- $100 deductible ($5/$25/$50): 2EA,2EB,2EC,2ED,2EE,2EF,2EG,2EH – English (PDF)
- $100 deductible ($10/$30/$55): 2F0,2F1,2F2,2F3,2F4,2F5,2F6,2F7 – English (PDF)
- $100 deductible ($15/$35/$60): 2FG,2FH,2FJ,2FK,2FL,2FM,2FN,2FP – English (PDF)
- $300 deductible ($15/$40/$65): 2FQ,2FR,2FS,2FT,2FU,2FV,2FW,2FX – English (PDF)
Pharmacy POS – Elect Open Access (EOA)/ExcelCare EOA
- No deductible ($5/$25/$50): 2FY,2FZ,2G0,2G1,2G2,2G3,2G4,2G5 – English (PDF)
- No deductible ($10/$30/$55): 2G6,2G7,2G8,2G9,2GA,2GB,2GC,2GD – English (PDF)
- No deductible ($15/$35/$60): 2GE,2GF,2GG,2GH,2GJ,2GK,2GL,2GM – English (PDF)
- $100 deductible ($5/$25/$50): 2GN,2GP,2GQ,2GR,2GS,2GT,2GU,2GV – English (PDF)
- $100 deductible ($10/$30/$55): 2GW,2GX,2GY,2GZ,2H0,2H1,2H2,2H3 – English (PDF)
- $100 deductible ($15/$35/$60): 2H4,2H5,2H6,2H7,2H8,2H9,2HA,2HB – English (PDF)
- $300 deductible ($15/$40/$65): 2HC,2HD,2HE,2HF,2HG,2HH,2HJ,2HK – English (PDF)
Pharmacy HMO – Salud HMO y Más
(combined medical and pharmacy OOPM)
- No deductible ($5/$25/$50): 2HL,2HM,2HN,2HP,2HQ,2HR,2HS,2HT – English (PDF)
- No deductible ($10/$30/$55): 2HU,2HV,2HW,2HX,2HY,2HZ,2IO,2I1 – English (PDF)
- $100 deductible ($5/$25/$50): 2I2,2I3,2I4,2I5,2I6,2I7,2I8,2I9 – English (PDF)
- $100 deductible ($15/$35/$60): 2IA,2IB,2IC,2ID,2IE,2IF,2IG,2IH – English (PDF)
- $300 deductible ($15/$40/$65): 2IJ,2IK,2IL,2IM,2IN,2IP,2IQ,2IR – English (PDF)
Pharmacy PPO
(combined medical and pharmacy OOPM)
- No deductible ($5/$25/$50): 2IS,2IT,2IU,2IV,2IW,2IX,2IY – English (PDF)
- No deductible ($10/$30/$55): 2JZ,2J0,2J1,2J2,2J3,2J4,2J5 – English (PDF)
- No deductible ($15/$35/$60): 2J6,2J7,2J8,2J9,2JA,2JB,2JC – English (PDF)
- $100 deductible ($5/$25/$50): 2JD,2JE,2JF,2JG,2JH,2JJ,2JK – English (PDF)
- $100 deductible ($10/$30/$55): 2JL,2JM,2JN,2JP,2JQ,2JR,2JS – English (PDF)
- $100 deductible ($15/$35/$60): 2JT,2JU,2JV,2JW,2JX,2JY,2JZ – English (PDF)
- $300 deductible ($15/$40/$65): 2K0,2K1,2K2,2K3,2K4,2K5,2K6 – English (PDF)
Pharmacy HSA-compatible PPO
(combined medical and pharmacy OOPM)
- $1,750 deductible ($0/$0/$0): 2KC – English (PDF)
- $2,000 deductible ($0/$0/$0): 2K8 – English (PDF)
- $3,500 deductible ($0/$0/$0): 2KD,2KE – English (PDF)
- $3,500 deductible ($10/$30/$55): 2KF – English (PDF)
- $3,500 deductible ($15/$35/$60): 2KG – English (PDF)
- $4,000 deductible ($0/$0/$0): 2KA – English (PDF)
- $5,000 deductible ($10/$30/$55): 2KB – English (PDF)
- $3,500 deductible ($10/$30/$55): 2K9 – English (PDF)
Dental – HMO
- Dental – HMO – Health Net Plus 85 – Plan Overview – English (PDF)
- Dental – HMO – Health Net Plus 85 – Plan Overview – En Español (Spanish) (PDF)
- Dental – HMO – Health Net Plus 85 – Schedule of Benefits – English (PDF)
- Dental – HMO – Health Net Plus 100 – Plan Overview – English (PDF)
- Dental – HMO – Health Net Plus 100 – Plan Overview – En Español (Spanish) (PDF)
- Dental – HMO – Health Net Plus 100 – Schedule of Benefits – English (PDF)
- Dental – HMO – Health Net Plus 150 – Plan Overview – English (PDF)
- Dental – HMO – Health Net Plus 150 – Plan Overview – En Español (Spanish) (PDF)
- Dental – HMO – Health Net Plus 150 – Schedule of Benefits – English (PDF)
- Dental – HMO – Health Net Plus 185 – Plan Overview – English (PDF)
- Dental – HMO – Health Net Plus 185 – Plan Overview – En Español (Spanish) (PDF)
- Dental – HMO – Health Net Plus 185 – Schedule of Benefits – English (PDF)
- Dental – HMO – Health Net Plus 225 – Plan Overview – English (PDF)
- Dental – HMO – Health Net Plus 225 – Plan Overview – En Español (Spanish) (PDF)
- Dental – HMO – Health Net Plus 225 – Schedule of Benefits – English (PDF)
Dental – PPO
- Dental – PPO – Classic 1 1500 (0 | 10 | 40 | w/1500 Ortho) – English (PDF)
- Dental – PPO – Classic 1 1500 (0 | 10 | 40 | w/1500 Ortho) – En Español (Spanish) (PDF)
- Dental – PPO – Classic 3 1500 (0 | 20 | 50 | w/1500 Ortho) – English (PDF)
- Dental – PPO – Classic 3 1500 (0 | 20 | 50 | w/1500 Ortho) – En Español (Spanish) (PDF)
- Dental – PPO – Classic 6 1500 (0 | 20 | 50) – English (PDF)
- Dental – PPO – Classic 6 1500 (0 | 20 | 50) – En Español (Spanish) (PDF)
- Dental – PPO – Classic 7 Unlimited (0 | 20 | 50) – English (PDF)
- Dental – PPO – Classic 7 Unlimited (0 | 20 | 50) – En Español (Spanish) (PDF)
- Dental – PPO – Classic Plus 1 2000 (0 | 10 | 40 | w/1500 Ortho & Max Advantage) – English (PDF)
- Dental – PPO – Classic Plus 1 2000 (0 | 10 | 40 | w/1500 Ortho & Max Advantage) – En Español (Spanish) (PDF)
- Dental – PPO – Essential 1 1000 (0 | 20 | 50 | w/1000 Ortho) – English (PDF)
- Dental – PPO – Essential 1 1000 (0 | 20 | 50 | w/1000 Ortho) – En Español (Spanish) (PDF)
- Dental – PPO – Essential 4 1000 (0 | 20 | 50) – English (PDF)
- Dental – PPO – Essential 4 1000 (0 | 20 | 50) – En Español (Spanish) (PDF)
- DDental – PPO – Essential 5 1500 (0 | 20 | 50 | w/1500 Ortho) – English (PDF)
- Dental – PPO – Essential 5 1500 (0 | 20 | 50 | w/1500 Ortho) – En Español (Spanish) (PDF)
- Dental – PPO – Essential 6 1500 (0 | 20 | 50) – English (PDF)
- Dental – PPO – Essential 6 1500 (0 | 20 | 50) – En Español (Spanish) (PDF)
- Dental – PPO – Essential 10 3000 (0 | 20 | 50 | w/3000 Ortho) – English (PDF)
- Dental – PPO – Essential 10 3000 (0 | 20 | 50 | w/3000 Ortho) – En Español (Spanish) (PDF)
- Dental – PPO – Essential 11 5000 (0 | 20 | 50 | w/5000 Ortho) – English (PDF)
- Dental – PPO – Essential 11 5000 (0 | 20 | 50 | w/5000 Ortho) – En Español (Spanish) (PDF)
- Dental – PPO – Basic 500 (0 | 40 | Not Covered) – English (PDF)
- Dental – PPO – Basic 500 (0 | 40 | Not Covered) – En Español (Spanish) (PDF)
Vision Plans
- Vision Plans – Exam Only (24 | Not Covered | Not Covered) – English (PDF)
- Vision Plans – Elite 1010-1 (150 Frames – 12 | 12 | 12) – English (PDF)
- Vision Plans – Plus 20-1 (Frames Discount – 12 | Ultd | Ultd) – English (PDF)
- Vision Plans – Preferred 1025-2 (100 Frames -12 | 12 | 24) – English (PDF)
- Vision Plans – Preferred 1025-3 (100 Frames – 12 | 24 | 24) – English (PDF)
- Vision Plans – Preferred Value 10-3 (100 Frames – Not Covered | 24 | 24) – English (PDF)
- Vision Plans – Supreme 010-2 (120 Frames – 12 | 12 | 24) – English (PDF)
Note: All flyers are customizable. To save the PDF with your benefit information included:
- Select File > Print
- In drop-down mention next to "Printer", select Adobe PDF
- Save in Documents
Full Network HMO
- Full Network HMO-10/250a ($1,500 / $3,000) – MZI – English (PDF)
- Full Network HMO-20/250a ($1,500 / $3,000) – MZN – English (PDF)
- Full Network HMO-20/0 ($1,500 / $3,000) – MZL – English (PDF)
- Full Network HMO-15/250a ($2,500 / $5,000) – MZK – English (PDF)
- Full Network HMO-20/20% ($2,500 / $5,000) – MZM – English (PDF)
- Full Network HMO-20/500a ($2,500 / $5,000) – MZO – English (PDF)
- Full Network HMO-30/500a ($2,500 / $5,000) – MZU – English (PDF)
- Full Network HMO-30/20% ($2,500 / $5,000) – MZR – English (PDF)
- Full Network HMO-25/750a ($2,500 / $5,000) – MZP – English (PDF)
- Full Network HMO-30/30% ($3,500 / $7,000) – MZT – English (PDF)
- Full Network HMO-30/1000a ($3,500 / $7,000) – MZQ – English (PDF)
- Full Network HMO-35/750a ($3,500 / $7,000) – MZW – English (PDF)
- Full Network HMO-40/30% ($3,500 / $7,000) – MZY – English (PDF)
- Full Network HMO-30/250d ($4,500 / $9,000) – MZS – English (PDF)
- Full Network HMO-40/500d ($4,500 / $9,000) – N00 – English (PDF)
- Full Network HMO-40/750a ($4,500 / $9,000) – N01 – English (PDF)
- Full Network HMO-35/30% ($5,500 / $11,000) – MZV – English (PDF)
- Full Network HMO-40/40% ($5,500 / $11,000) – MZZ – English (PDF)
- Full Network HMO-15/1500d ($6,500 / $13,000) – MZJ – English (PDF)
- Full Network HMO-40/1500d ($6,500 / $13,000) – MZX – English (PDF)
- Full Network HMO-50/1500d ($7,500 / $15,000) – N02 – English (PDF)
- Full Network HMO-60/1500a ($9,200 / $18,400) – N03 – English (PDF)
ExcelCare HMO
- ExcelCare HMO-10/250a ($1,500 / $3,000) – N3Q – English (PDF)
- ExcelCare HMO-20/0 ($1,500 / $3,000) – N3T – English (PDF)
- ExcelCare HMO-15/250a ($2,500 / $5,000) – N3S – English (PDF)
- ExcelCare HMO-20/250a ($1,500 / $3,000) – N3V – English (PDF)
- ExcelCare HMO-20/20% ($2,500 / $5,000) – N3U – English (PDF)
- ExcelCare HMO-20/500a ($2,500 / $5,000) – N3W – English (PDF)
- ExcelCare HMO-30/500a ($2,500 / $5,000) – N42 – English (PDF)
- ExcelCare HMO-35/750a ($3,500 / $7,000) – N44 – English (PDF)
- ExcelCare HMO-30/20% ($2,500 / $5,000) – N3Z – English (PDF)
- ExcelCare HMO-25/750a ($2,500 / $5,000) – N3X – English (PDF)
- ExcelCare HMO-30/30% ($3,500 / $7,000) – N41 – English (PDF)
- ExcelCare HMO-30/1000a ($3,500 / $7,000) – N3Y – English (PDF)
- ExcelCare HMO-40/30% ($3,500 / $7,000) – N46 – English (PDF)
- ExcelCare HMO-30/250d ($4,500 / $9,000) – N40 – English (PDF)
- ExcelCare HMO-40/500d ($4,500 / $9,000) – N48 – English (PDF)
- ExcelCare HMO-35/30% ($5,500 / $11,000) – N43 – English (PDF)
- ExcelCare HMO-40/40% ($5,500 / $11,000) – N47 – English (PDF)
- ExcelCare HMO-40/750a ($4,500 / $9,000) – N49 – English (PDF)
- ExcelCare HMO-15/1500d ($6,500 / $13,000) – N3R – English (PDF)
- ExcelCare HMO-40/1500d ($6,500 / $13,000) – N45 – English (PDF)
- ExcelCare HMO-50/1500d ($7,500 / $15,000) – N4B – English (PDF)
- ExcelCare HMO-60/1500a ($9,200 / $18,400) – N4C – English (PDF)
ExcelCare HMO – Facility Deductible
- ExcelCare HMO Facility Deductible-20/500/10% ($3,500 / $7,000) – N4D – English (PDF)
- ExcelCare HMO Facility Deductible-20/1500/20% ($3,500 / $7,000) – N4E – English (PDF)
- ExcelCare HMO Facility Deductible-30/1000/20% ($3,500 / $7,000) – N4F – English (PDF)
- ExcelCare HMO Facility Deductible-30/1500/30% ($3,500 / $7,000) – N4G – English (PDF)
- ExcelCare HMO Facility Deductible-30/2000/30% ($3,500 / $7,000) – N4H – English (PDF)
- ExcelCare HMO Facility Deductible-30/3000/30% ($4,500 / $9,000) – N4I – English (PDF)
- ExcelCare HMO Facility Deductible-40/3000/40% ($5,500 / $11,000) – N4J – English (PDF)
- ExcelCare HMO Facility Deductible-40/4000/40% ($6,500 / $13,000) – N4K – English (PDF)
- ExcelCare HMO Facility Deductible-50/4500/40% ($6,500 / $13,000) – N4L – English (PDF)
- ExcelCare HMO Facility Deductible-50/5500/40% ($7,500 / $15,000) – N4M – English (PDF)
SmartCare HMO
- SmartCare HMO-10/250a ($1,500 / $3,000) – MYV – English (PDF)
- SmartCare HMO-20/0 ($1,500 / $3,000) – MYY – English (PDF)
- SmartCare HMO-15/250a ($2,500 / $5,000) – MYX – English (PDF)
- SmartCare HMO-20/250a ($1,500 / $3,000) – MZ0 – English (PDF)
- SmartCare HMO-20/20% ($2,500 / $5,000) – MYZ – English (PDF)
- SmartCare HMO-20/500a ($2,500 / $5,000) – MZ1 – English (PDF)
- SmartCare HMO-30/500a ($2,500 / $5,000) – MZ7 – English (PDF)
- SmartCare HMO-35/750a ($3,500 / $7,000) – MZ9 – English (PDF)
- SmartCare HMO-30/20% ($2,500 / $5,000) – MZ4 – English (PDF)
- SmartCare HMO-25/750a ($2,500 / $5,000) – MZ2 – English (PDF)
- SmartCare HMO-30/30% ($3,500 / $7,000) – MZ6 – English (PDF)
- SmartCare HMO-30/1000a ($3,500 / $7,000) – MZ3 – English (PDF)
- SmartCare HMO-40/30% ($3,500 / $7,000) – MZC – English (PDF)
- SmartCare HMO-30/250d ($4,500 / $9,000) – MZ5 – English (PDF)
- SmartCare HMO-40/500d ($4,500 / $9,000) – MZE – English (PDF)
- SmartCare HMO-40/750a ($4,500 / $9,000) – MZF – English (PDF)
- SmartCare HMO-35/30% ($5,500 / $11,000) – MZ8 – English (PDF)
- SmartCare HMO-40/40% ($5,500 / $11,000) – MZD – English (PDF)
- SmartCare HMO-15/1500d ($6,500 / $13,000) – MYW – English (PDF)
- SmartCare HMO-40/1500d ($6,500 / $13,000) – MZB – English (PDF)
- SmartCare HMO-50/1500d ($7,500 / $15,000) – MZG – English (PDF)
- SmartCare HMO-60/1500a ($9,200 / $18,400) – MZH – English (PDF)
Salud HMO y Más
- Salud HMO y Más-10/250a ($1,500 / $3,000) – N05 / N06 – English (PDF)
- Salud HMO y Más-20/0 ($1,500 / $3,000) – N0C / N0D – English (PDF)
- Salud HMO y Más-15/250a ($2,500 / $5,000) – N09 / N0B – English (PDF)
- Salud HMO y Más-20/250a ($1,500 / $3,000) – N0H / N0J – English (PDF)
- Salud HMO y Más-20/20% ($2,500 / $5,000) – N0F / N0G – English (PDF)
- Salud HMO y Más-20/500a ($2,500 / $5,000) – N0L / N0M – English (PDF)
- Salud HMO y Más-30/500a ($2,500 / $5,000) – N12 / N13 – English (PDF)
- Salud HMO y Más-30/20% ($2,500 / $5,000) – N0U / N0V – English (PDF)
- Salud HMO y Más-25/750a ($2,500 / $5,000) – N0N / N0P – English (PDF)
- Salud HMO y Más-30/30% ($3,500 / $7,000) – N0Z / N10 – English (PDF)
- Salud HMO y Más-30/1000a ($3,500 / $7,000) – N0R / N0S – English (PDF)
- Salud HMO y Más-40/30% ($3,500 / $7,000) – N1B / N1C – English (PDF)
- Salud HMO y Más-30/250d ($4,500 / $9,000) – N0X / N0Y – English (PDF)
- Salud HMO y Más-35/750a ($3,500 / $7,000) – N16 / N17 – English (PDF)
- Salud HMO y Más-40/500d ($4,500 / $9,000) – N1H / N1J – English (PDF)
- Salud HMO y Más-40/750a ($4,500 / $9,000) – N1L / N1K – English (PDF)
- Salud HMO y Más-35/30% ($5,500 / $11,000) – N14 / N15 – English (PDF)
- Salud HMO y Más-40/40% ($5,500 / $11,000) – N1E / N1F – English (PDF)
- Salud HMO y Más-15/1500d ($6,500 / $13,000) – N07 / N08 – English (PDF)
- Salud HMO y Más-40/1500d ($6,500 / $13,000) – N18 / N19 – English (PDF)
- Salud HMO y Más-50/1500d ($7,500 / $15,000) – N1M / N1N – English (PDF)
- Salud HMO y Más-60/1500a ($9,200 / $18,400) – N1R / N1S – English (PDF)
Salud HMO y Más – Facility Deductible
- Salud HMO y Más Facility Deductible-20/1500/20% ($3,500 / $7,000) – N0E / NCM – English (PDF)
- Salud HMO y Más Facility Deductible-20/500/10% ($3,500 / $7,000) – N0K / NCN – English (PDF)
- Salud HMO y Más Facility Deductible-30/1000/20% ($3,500 / $7,000) – N0Q / NCO – English (PDF)
- Salud HMO y Más Facility Deductible-30/1500/30% ($3,500 / $7,000) – N0T / NCP – English (PDF)
- Salud HMO y Más Facility Deductible-30/2000/30% ($3,500 / $7,000) – N0W / NCQ – English (PDF)
- Salud HMO y Más Facility Deductible-30/3000/30% ($4,500 / $9,000) – N11 / NCR – English (PDF)
- Salud HMO y Más Facility Deductible-40/3000/40% ($5,500 / $11,000) – N1D / NCS – English (PDF)
- Salud HMO y Más Facility Deductible-40/4000/40% ($6,500 / $13,000) – N1G / NCT – English (PDF)
- Salud HMO y Más Facility Deductible-50/4500/40% ($6,500 / $13,000) – N1P / NCU – English (PDF)
- Salud HMO y Más Facility Deductible-50/5500/40% ($7,500 / $15,000) – N1Q / NCV – English (PDF)
Full Network EOA
- Full Network EOA-10/250a ($1,500 / $3,000) – N1T – English (PDF)
- Full Network EOA-20/0 ($1,500 / $3,000) – N1W – English (PDF)
- Full Network EOA-15/250a ($2,500 / $5,000) – N1V – English (PDF)
- Full Network EOA-20/250a ($1,500 / $3,000) – N1Y – English (PDF)
- Full Network EOA-20/20% ($2,500 / $5,000) – N1X – English (PDF)
- Full Network EOA-20/500a ($2,500 / $5,000) – N1Z – English (PDF)
- Full Network EOA-30/500a ($2,500 / $5,000) – N25 – English (PDF)
- Full Network EOA-35/750a ($3,500 / $7,000) – N27 – English (PDF)
- Full Network EOA-30/20% ($2,500 / $5,000) – N22 – English (PDF)
- Full Network EOA-25/750a ($2,500 / $5,000) – N20 – English (PDF)
- Full Network EOA-30/30% ($3,500 / $7,000) – N24 – English (PDF)
- Full Network EOA-30/1000a ($3,500 / $7,000) – N21 – English (PDF)
- Full Network EOA-40/30% ($3,500 / $7,000) – N29 – English (PDF)
- Full Network EOA-30/250d ($4,500 / $9,000) – N23 – English (PDF)
- Full Network EOA-40/500d ($4,500 / $9,000) – N2C – English (PDF)
- Full Network EOA-40/750a ($4,500 / $9,000) – N2D – English (PDF)
- Full Network EOA-35/30% ($5,500 / $11,000) – N26 – English (PDF)
- Full Network EOA-40/40% ($5,500 / $11,000) – N2B – English (PDF)
- Full Network EOA-15/1500d ($6,500 / $13,000) – N1U – English (PDF)
- Full Network EOA-40/1500d ($6,500 / $13,000) – N28 – English (PDF)
- Full Network EOA-50/1500d ($7,500 / $15,000) – N2E – English (PDF)
- Full Network EOA-60/1500a ($9,200 / $18,400) – N2F – English (PDF)
Full Network EOA – Facility Deductible
- Full Network EOA Facility Deductible-20/500/10% ($3,500 / $7,000) – N2H – English (PDF)
- Full Network EOA Facility Deductible-20/1500/20% ($3,500 / $7,000) – N2G – English (PDF)
- Full Network EOA Facility Deductible-30/1000/20% ($3,500 / $7,000) – N2I – English (PDF)
- Full Network EOA Facility Deductible-30/1500/30% ($3,500 / $7,000) – N2J – English (PDF)
- Full Network EOA Facility Deductible-30/2000/30% ($3,500 / $7,000) – N2K – English (PDF)
- Full Network EOA Facility Deductible-30/3000/30% ($4,500 / $9,000) – N2L – English (PDF)
- Full Network EOA Facility Deductible-40/3000/40% ($5,500 / $11,000) – N2M – English (PDF)
- Full Network EOA Facility Deductible-40/4000/40% ($6,500 / $13,000) – N2N – English (PDF)
- Full Network EOA Facility Deductible-50/4500/40% ($6,500 / $13,000) – N2O – English (PDF)
- Full Network EOA Facility Deductible-50/5500/40% ($7,500 / $15,000) – N2P – English (PDF)
ExcelCare EOA
- ExcelCare EOA-10/250a ($1,500 / $3,000) – N4N – English (PDF)
- ExcelCare EOA-20/0 ($1,500 / $3,000) – N4Q – English (PDF)
- ExcelCare EOA-15/250a ($2,500 / $5,000) – N4P – English (PDF)
- ExcelCare EOA-20/250a ($1,500 / $3,000) – N4S – English (PDF)
- ExcelCare EOA-20/20% ($2,500 / $5,000) – N4R – English (PDF)
- ExcelCare EOA-20/500a ($2,500 / $5,000) – N4T – English (PDF)
- ExcelCare EOA-30/500a ($2,500 / $5,000) – N4Z – English (PDF)
- ExcelCare EOA-35/750a ($3,500 / $7,000) – N51 – English (PDF)
- ExcelCare EOA-30/20% ($2,500 / $5,000) – N4W – English (PDF)
- ExcelCare EOA-25/750a ($2,500 / $5,000) – N4U – English (PDF)
- ExcelCare EOA-30/30% ($3,500 / $7,000) – N4Y – English (PDF)
- ExcelCare EOA-30/1000a ($3,500 / $7,000) – N4V – English (PDF)
- ExcelCare EOA-40/30% ($3,500 / $7,000) – N53 – English (PDF)
- ExcelCare EOA-30/250d ($4,500 / $9,000) – N4X – English (PDF)
- ExcelCare EOA-40/500d ($4,500 / $9,000) – N55 – English (PDF)
- ExcelCare EOA-40/750a ($4,500 / $9,000) – N56 – English (PDF)
- ExcelCare EOA-35/30% ($5,500 / $11,000) – N50 – English (PDF)
- ExcelCare EOA-40/40% ($5,500 / $11,000) – N54 – English (PDF)
- ExcelCare EOA-15/1500d ($6,500 / $13,000) – N4O – English (PDF)
- ExcelCare EOA-40/1500d ($6,500 / $13,000) – N52 – English (PDF)
- ExcelCare EOA-50/1500d ($7,500 / $15,000) – N57 – English (PDF)
- ExcelCare EOA-60/1500a ($9,200 / $18,400) – N58 – English (PDF)
ExcelCare EOA – Facility Deductible
- ExcelCare EOA Facility Deductible-20/500/10% ($3,500 / $7,000) – N5B – English (PDF)
- ExcelCare EOA Facility Deductible-20/1500/20% ($3,500 / $7,000) – N59 – English (PDF)
- ExcelCare EOA Facility Deductible-30/1000/20% ($3,500 / $7,000) – N5C – English (PDF)
- ExcelCare EOA Facility Deductible-30/1500/30% ($3,500 / $7,000) – N5D – English (PDF)
- ExcelCare EOA Facility Deductible-30/2000/30% ($3,500 / $7,000) – N5E – English (PDF)
- ExcelCare EOA Facility Deductible-30/3000/30% ($4,500 / $9,000) – N5F – English (PDF)
- ExcelCare EOA Facility Deductible-40/3000/40% ($5,500 / $11,000) – N5G – English (PDF)
- ExcelCare EOA Facility Deductible-40/4000/40% ($6,500 / $13,000) – N5H – English (PDF)
- ExcelCare EOA Facility Deductible-50/4500/40% ($6,500 / $13,000) – N5I – English (PDF)
- ExcelCare EOA Facility Deductible-50/5500/40% ($7,500 / $15,000) – N5J – English (PDF)
PPO
- PPO-10/0/10% ($2,000 / $4,000) – N2R – English (PDF)
- PPO-10/250/10% ($3,000 / $6,000) – N2S – English (PDF)
- PPO-15/250/10% ($2,000 / $4,000) – N2U – English (PDF)
- PPO-15/500/10% ($3,000 / $6,000) – N2V – English (PDF)
- PPO-25/1000/10% ($3,000 / $6,000) – N32 – English (PDF)
- PPO-20/250/10% ($3,000 / $6,000) – N2X – English (PDF)
- PPO-20/500/10% ($3,000 / $6,000) – N30 – English (PDF)
- PPO-30/500/10% ($3,000 / $6,000) – N39 – English (PDF)
- PPO-30/750/20% ($5,000 / $10,000) – N3C – English (PDF)
- PPO-30/1000/20% ($3,000 / $6,000) – N33 – English (PDF)
- PPO-10/250/20% ($4,000 / $8,000) – N2T – English (PDF)
- PPO-15/500/20% ($4,000 / $8,000) – N2W – English (PDF)
- PPO-20/250/20% ($4,000 / $8,000) – N2Y – English (PDF)
- PPO-20/500/20% ($4,000 / $8,000) – N31 – English (PDF)
- PPO-20/2500/20% ($5,000 / $10,000) – N2Z – English (PDF)
- PPO-30/500/30% ($4,000 / $8,000) – N3B – English (PDF)
- PPO-30/1000/20% ($4,000 / $8,000) – N34 – English (PDF)
- PPO-35/1000/20% ($5,000 / $10,000) – N3D – English (PDF)
- PPO-0/1000/20% ($5,000 / $10,000) – N2Q – English (PDF)
- PPO-30/2000/30% ($5,000 / $10,000) – N35 – English (PDF)
- PPO-30/3000/30% ($5,000 / $10,000) – N36 – English (PDF)
- PPO-30/4000/30% ($6,000 / $12,000) – N38 – English (PDF)
- PPO-30/3000/30% ($6,000 / $12,000) – N37 – English (PDF)
- PPO-40/5000/30% ($7,000 / $14,000) – N3F – English (PDF)
- PPO-40/3500/30% ($7,000 / $14,000) – N3E – English (PDF)
- PPO-60/5000/30% ($9,200 / $18,400) – N3G – English (PDF)
PPO (HSA-compatible) (Includes pre-set pharmacy plans)
- PPO HSA-1700/0% I ($1,700) – N3O – English (PDF)
- PPO HSA-2000/0% I ($2,000) – N3P – English (PDF)
- PPO HSA-3400/0% F ($3,400 / $6,800) – N3M – English (PDF)
- PPO HSA-3400/0% F ($3,400 / $6,800) – N3N – English (PDF)
- PPO HSA-3400/20% ($4,000 / $8,000) – N3I – English (PDF)
- PPO HSA-3500/20% ($5,000 / $10,000) – N3J – English (PDF)
- PPO HSA-4000/0% ($4,000 / $8,000) – N3H – English (PDF)
- PPO HSA-3400/30% ($5,000 / $10,000) – N3L – English (PDF)
- PPO HSA-5000/20% ($6,000 / $12,000) – N3K – English (PDF)
Pharmacy HMO
(combined medical and pharmacy OOPM)
- No deductible ($5/$25/$50): 1F8,1F9,1G0,1G1,1G2,1G3,1G4,1G5 – English (PDF)
- No deductible ($10/$30/$55): 1G6,1G7,1G8,1G9,1H0,1H1,1H2,1H3 – English (PDF)
- No deductible ($15/$35/$60): 1H4,1H5,1H6,1H7,1H8,1H9,1J0,1J1 – English (PDF)
- $100 deductible ($5/$25/$50): 1J2,1J3,1J4,1J5,1J6,1J7,1J8,1J9 – English (PDF)
- $100 deductible ($10/$30/$55): 1K0,1K1,1K2,1K3,1K4,1K5,1K6,1K7 – English (PDF)
- $100 deductible ($15/$35/$60): 1K8,1K9,1L0,1L1,1L2,1L3,1L4,1L5 – English (PDF)
- $300 deductible ($15/$40/$65): 1L6,1L7,1L8,1L9,1M0,1M1,1M2,1M3 – English (PDF)
Pharmacy POS – Elect Open Access (EOA)/ExcelCare EOA
- No deductible ($5/$25/$50): 1Q8,1Q9,1R0,1R1,1R2,1R3,1R4,1R5 – English (PDF)
- No deductible ($10/$30/$55): 1R6,1R7,1R8,1R9,1S0,1S1,1S2,1S3 – English (PDF)
- No deductible ($15/$35/$60): 1S4,1S5,1S6,1S7,1S8,1S9,1T0,1T1 – English (PDF)
- $100 deductible ($5/$25/$50): 1T2,1T3,1T4,1T5,1T6,1T7,1T8,1T9 – English (PDF)
- $100 deductible ($10/$30/$55): 1U0,1U1,1U2,1U3,1U4,1U5,1U6,1U7 – English (PDF)
- $100 deductible ($15/$35/$60): 1U8,1U9,1V0,1V1,1V2,1V3,1V4,1V5 – English (PDF)
- $300 deductible ($15/$40/$65): 1V6,1V7,1V8,1V9,1W0,1W1,1W2,1W3 – English (PDF)
Pharmacy HMO – Salud HMO y Más
(combined medical and pharmacy OOPM)
- No deductible ($5/$25/$50): 1W4,1W5,1W6,1W7,1W8,1W9,1X0,1X1 – English (PDF)
- No deductible ($10/$30/$55): 1X2,1X3,1X4,1X5,1X6,1X7,1X8,1X9 – English (PDF)
- $100 deductible ($5/$25/$50): 1Y0,1Y1,1Y2,1Y3,1Y4,1Y5,1Y6,1Y7 – English (PDF)
- $100 deductible ($15/$35/$60): 1Y8,1Y9,1Z0,1Z1,1Z2,1Z3,1Z4,1Z5 – English (PDF)
- $300 deductible ($15/$40/$65): 1Z6,1Z7,1Z8,1Z9,2A0,2A1,2A2,2A3 – English (PDF)
Pharmacy PPO
(combined medical and pharmacy OOPM)
- No deductible ($5/$25/$50): 1A0,1A1,1A2,1A3,1A4,1A5,1A6 – English (PDF)
- No deductible ($10/$30/$55): A17,1A8,1A9,1B0,1B1,1B2,1B3,1F0,1F2,1F6 – English (PDF)
- No deductible ($15/$35/$60): 1B4,1B5,1B6,1B7,1B8,1B9,1C0,1F7 – English (PDF)
- $100 deductible ($5/$25/$50): 1C1,1C2,1C3,1C4,1C5,1C6,1C7 – English (PDF)
- $100 deductible ($10/$30/$55): 1C8,1C9,1D0,1D1,1D2,1D3,1D4 – English (PDF)
- $100 deductible ($15/$35/$60): 1D5,1D6,1D7,1D8,1D9,1E0,1E1 – English (PDF)
- $300 deductible ($15/$40/$65): 1E2,1E3,1E4,1E5,1E6,1E7,1E8 – English (PDF)
Pharmacy HSA-compatible PPO
(combined medical and pharmacy OOPM)
- $1,700 deductible ($0/$0/$0): 1F3 – English (PDF)
- $2,000 deductible ($0/$0/$0): 1E9 – English (PDF)
- $3,400 deductible ($0/$0/$0): 1F4,1F5 – English (PDF)
- $3,400 deductible ($10/$30/$55): 1F6 – English (PDF)
- $3,400 deductible ($15/$35/$60): 1F7 – English (PDF)
- $4,000 deductible ($0/$0/$0): 1F1 – English (PDF)
- $5,000 deductible ($10/$30/$55): 1F2 – English (PDF)
- $3,500 deductible ($10/$30/$55): 1F0 – English (PDF)
Dental – HMO
- Dental – HMO – Health Net Plus 85 – Plan Overview – English (PDF)
- Dental – HMO – Health Net Plus 85 – Plan Overview – En Español (Spanish) (PDF)
- Dental – HMO – Health Net Plus 85 – Schedule of Benefits – English (PDF)
- Dental – HMO – Health Net Plus 100 – Plan Overview – English (PDF)
- Dental – HMO – Health Net Plus 100 – Plan Overview – En Español (Spanish) (PDF)
- Dental – HMO – Health Net Plus 100 – Schedule of Benefits – English (PDF)
- Dental – HMO – Health Net Plus 150 – Plan Overview – English (PDF)
- Dental – HMO – Health Net Plus 150 – Plan Overview – En Español (Spanish) (PDF)
- Dental – HMO – Health Net Plus 150 – Schedule of Benefits – English (PDF)
- Dental – HMO – Health Net Plus 185 – Plan Overview – English (PDF)
- Dental – HMO – Health Net Plus 185 – Plan Overview – En Español (Spanish) (PDF)
- Dental – HMO – Health Net Plus 185 – Schedule of Benefits – English (PDF)
- Dental – HMO – Health Net Plus 225 – Plan Overview – English (PDF)
- Dental – HMO – Health Net Plus 225 – Plan Overview – En Español (Spanish) (PDF)
- Dental – HMO – Health Net Plus 225 – Schedule of Benefits – English (PDF)
Dental – PPO
- Dental – PPO – Classic 1 1500 (0 | 10 | 40 | w/1500 Ortho) – English (PDF)
- Dental – PPO – Classic 1 1500 (0 | 10 | 40 | w/1500 Ortho) – En Español (Spanish) (PDF)
- Dental – PPO – Classic 2 1500 (0 | 10 | 40) – English (PDF)
- Dental – PPO – Classic 2 1500 (0 | 10 | 40) – En Español (Spanish) (PDF)
- Dental – PPO – Classic 3 1500 (0 | 20 | 50 | w/1500 Ortho) – English (PDF)
- Dental – PPO – Classic 3 1500 (0 | 20 | 50 | w/1500 Ortho) – En Español (Spanish) (PDF)
- Dental – PPO – Classic 4 1500 (0 | 20 | 50) – English (PDF)
- Dental – PPO – Classic 4 1500 (0 | 20 | 50) – En Español (Spanish) (PDF)
- Dental – PPO – Classic 5 1500 (0 | 20 | 50 | w/1500 Ortho) – English (PDF)
- Dental – PPO – Classic 5 1500 (0 | 20 | 50 | w/1500 Ortho) – En Español (Spanish) (PDF)
- Dental – PPO – Classic 6 1500 (0 | 20 | 50) – English (PDF)
- Dental – PPO – Classic 6 1500 (0 | 20 | 50) – En Español (Spanish) (PDF)
- Dental – PPO – Classic 7 Unlimited (0 | 20 | 50) – English (PDF)
- Dental – PPO – Classic 7 Unlimited (0 | 20 | 50) – En Español (Spanish) (PDF)
- Dental – PPO – Classic 11 Unlimited (0 | 10 | 40 | w/3000 Ortho) – English (PDF)
- Dental – PPO – Classic 11 Unlimited (0 | 10 | 40 | w/3000 Ortho) – En Español (Spanish) (PDF)
- Dental – PPO – Classic Plus 1 2000 (0 | 10 | 40 | w/1500 Ortho & Max Advantage) – English (PDF)
- Dental – PPO – Classic Plus 1 2000 (0 | 10 | 40 | w/1500 Ortho & Max Advantage) – En Español (Spanish) (PDF)
- Dental – PPO – Classic Plus 2 2000 (0 | 10 | 40 | w/1500 Ortho & Max Advantage) – English (PDF)
- Dental – PPO – Classic Plus 2 2000 (0 | 10 | 40 | w/1500 Ortho & Max Advantage) – En Español (Spanish) (PDF)
- Dental – PPO – Essential 1 1000 (0 | 20 | 50 | w/1000 Ortho) – English (PDF)
- Dental – PPO – Essential 1 1000 (0 | 20 | 50 | w/1000 Ortho) – En Español (Spanish) (PDF)
- Dental – PPO – Essential 2 1000 (0 | 20 | 50) – English (PDF)
- Dental – PPO – Essential 2 1000 (0 | 20 | 50) – En Español (Spanish) (PDF)
- Dental – PPO – Essential 3 1000 (0 | 20 | 50 | w/1000 Ortho) – English (PDF)
- Dental – PPO – Essential 3 1000 (0 | 20 | 50 | w/1000 Ortho) – En Español (Spanish) (PDF)
- Dental – PPO – Essential 4 1000 (0 | 20 | 50) – English (PDF)
- Dental – PPO – Essential 4 1000 (0 | 20 | 50) – En Español (Spanish) (PDF)
- DDental – PPO – Essential 5 1500 (0 | 20 | 50 | w/1500 Ortho) – English (PDF)
- Dental – PPO – Essential 5 1500 (0 | 20 | 50 | w/1500 Ortho) – En Español (Spanish) (PDF)
- Dental – PPO – Essential 6 1500 (0 | 20 | 50) – English (PDF)
- Dental – PPO – Essential 6 1500 (0 | 20 | 50) – En Español (Spanish) (PDF)
- Dental – PPO – Essential 10 3000 (0 | 20 | 50 | w/3000 Ortho) – English (PDF)
- Dental – PPO – Essential 10 3000 (0 | 20 | 50 | w/3000 Ortho) – En Español (Spanish) (PDF)
- Dental – PPO – Essential 11 5000 (0 | 20 | 50 | w/5000 Ortho) – English (PDF)
- Dental – PPO – Essential 11 5000 (0 | 20 | 50 | w/5000 Ortho) – En Español (Spanish) (PDF)
- Dental – PPO – Essential Value 1 1000 (0 | 20 | 50) – English (PDF)
- Dental – PPO – Essential Value 1 1000 (0 | 20 | 50) – En Español (Spanish) (PDF)
- Dental – PPO – Basic 500 (0 | 40 | Not Covered) – English (PDF)
- Dental – PPO – Basic 500 (0 | 40 | Not Covered) – En Español (Spanish) (PDF)
Vision Plans
- Vision Plans – Exam Only (24 | Not Covered | Not Covered) – English (PDF)
- Vision Plans – Elite 1010-1 (150 Frames – 12 | 12 | 12) – English (PDF)
- Vision Plans – Plus 20-1 (Frames Discount – 12 | Ultd | Ultd) – English (PDF)
- Vision Plans – Preferred 1025-2 (100 Frames -12 | 12 | 24) – English (PDF)
- Vision Plans – Preferred 1025-3 (100 Frames – 12 | 24 | 24) – English (PDF)
- Vision Plans – Preferred Value 10-3 (100 Frames – Not Covered | 24 | 24) – English (PDF)
- Vision Plans – Supreme 010-2 (120 Frames – 12 | 12 | 24) – English (PDF)
Note: All flyers are customizable. To save the PDF with your benefit information included:
- Select File > Print
- In drop down mention next to "Printer", select Adobe PDF
- Save in Documents
Refer to County Reference Quick Guide to determine service areas in each directory.
- Tailored Networks Comparison Lists – Northern California – English (PDF)
- Tailored Networks Comparison Lists – Central California – English (PDF)
- Tailored Networks Comparison Lists – Los Angeles County – English (PDF)
- Tailored Networks Comparison Lists – Orange County – English (PDF)
- Tailored Networks Comparison Lists – Riverside County – English (PDF)
- Tailored Networks Comparison Lists – San Bernardino County – English (PDF)
- Tailored Networks Comparison Lists – Imperial County – English (PDF)
- Tailored Networks Comparison Lists – San Diego County – English (PDF)
- Timely Access Member Flyer – English (PDF)
- Timely Access Member Flyer – En Español (Spanish) (PDF)
- Find a Provider Information – English (PDF)
- Find a Provider Information – En Español (Spanish) (PDF)
Covered California Collateral
Visit Covered California's printable materials such as fact sheets and collateral on their website.