Forms & Brochures – Large Business Group Plans

• 2023 Enhanced Choice Medical Portfolio: 1/1/23 effective – English (PDF)
• 2023 Enhanced Choice Supplemental Portfolio: 1/1/23 effective – English (PDF)
• 2022 Enhanced Choice Medical Portfolio: 1/1/22 effective – English (PDF)
• 2022 Enhanced Choice Supplemental Portfolio: 1/1/22 effective – English (PDF)
• 2022 Starting Line-Up Medical Portfolio: 1/1/22 effective – English (PDF)
• 2022 Starting Line-Up Supplemental Portfolio: 1/1/22 effective – English (PDF)
• Large Group Portfolio Book – English (PDF)
• CanopyCare HMO – Broker Flyer – English (PDF)
• Enhanced Choice Solutions 2023 – Broker Flyer – English (PDF)
• EOA Products Broker Brochure – English (PDF)
• EOA Deductible Plans Broker Flyer – English (PDF)
• ExcelCare Network Broker Flyer – English (PDF)
• Broker PPO Fast Facts flyer – English (PDF)

Presentation Folders

Note: For example only. Folders can be ordered on Step 2

• Generic Folder – English (PDF)
• Open Enrollment Folder – English (PDF)
• Open Enrollment Folder – En Español (Spanish) (PDF)

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)

2023 – Enrollment and Change Applications

• 2023 – Employee Enrollment and Change Form – English (PDF)
• 2023 – Employee Enrollment and Change Form – En Español (Spanish) (PDF)
• 2023 – Employee Enrollment and Change Form – 中文 (Chinese) (PDF)
• 2023 – Employee Enrollment and Change Form – 한국어 (Korean) (PDF)
• 2023 – Employee Enrollment and Change Form – Tiếng Việt (Vietnamese) (PDF)

2022 – Enrollment and Change Applications

• 2022 – Employee Enrollment and Change Form – English (PDF)
• 2022 – Employee Enrollment and Change Form – En Español (Spanish) (PDF)
• 2022 – Employee Enrollment and Change Form – 中文 (Chinese) (PDF)
• 2022 – Employee Enrollment and Change Form – 한국어 (Korean) (PDF)
• 2022 – Employee Enrollment and Change Form – Tiếng Việt (Vietnamese) (PDF)

Group Service Agreement/Policy Applications

• Group Size Attestation Form – English (PDF)
• Application for Group Service Agreement/Policy – English (PDF)
• Application for Group Term Life Insurance Policy Form – English (PDF)

Claims

• Commercial Medical Claim Form – English (PDF)
• Commercial Medical Claim Form – En Español (Spanish) (PDF)
• Commercial MHN 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

Dental and Vision Add-On or Change Form – English (PDF)

Health Net Life Insurance Forms

• Employee Enrollment and Change Form – English (PDF)
• Employee Enrollment and Change Form – En Español (Spanish) (PDF)
• Evidence of Insurability Life Form – English (PDF)
• Life Insurance Claim Form – English (PDF)
• Life Insurance Claim Form – En Español (Spanish) (PDF)
• Member Life Insurance Waiver of Premium Claim Form – English (PDF)

Broker and Employer Forms

HIPAA Disclosures

• Group Health Plan HIPAA Disclosure Forms – Disclosure Directive (DOCX)
• 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)

Health Care Reform Materials

• Questions to Help Determine Grandfathered Plan Status (Employer) – English (PDF)
• Preventive Care Services (ACA Non-Grandfathered Plans) – English (PDF)
• Preventive Care Services (ACA Non-Grandfathered Plans) – En Español (Spanish) (PDF)

SmartCare

• SmartCare Broker Brochure – English (PDF)
• SmartCare Employer Flyer – English (PDF)

Support Tools

• Commercial Sales Guidelines – English (PDF)
• Large Group Employer Guide – English (PDF)
• Health Net Financial Strength and Stability – English (PDF)
• Top Reasons for Health Net: Broker version – English (PDF)
• Babylon Flyer – English (PDF)
• Babylon Flyer – En Español (Spanish) (PDF)
• Behavioral Health / MHN Flyer (Custom) – English (PDF)
• Behavioral Health / MHN Flyer (Static) – English (PDF)
• Behavioral Health / MHN Flyer (Static) – En Español (Spanish) (PDF)
• Children's Anxiety Flyer – English (PDF)
• Same Day Care – English (PDF)
• Same Day Care – En Español (Spanish) (PDF)
• HealthNet.com Flyer – English (PDF)
• HealthNet.com Flyer – En Español (Spanish) (PDF)
• Health Net Value Add Programs – English (PDF)
• HMO Flu Shot Flyer – English (PDF)
• HMO Flu Shot Flyer – En Español (Spanish) (PDF)
• MPX flyer – English (PDF)
• MPX flyer – En Español (Spanish) (PDF)
• Understanding the Continuity of Care Policy – English (PDF)
• ID Card Express Program – English (PDF)
• MinuteClinic Brochure – English (PDF)
• MinuteClinic Brochure – En Español (Spanish) (PDF)
• 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.

Health Net Beginnings

• Health Net Beginnings – English (PDF)
• Health Net Beginnings – En Español (Spanish) (PDF)

Online Support Tools

Group Administrator Registration Guide – English (PDF)

First Health National (Out-of-State) PPO

• First Health Physician Nomination Form – English (PDF)
• Broker First Health National PPO Network FAQ – English (PDF)
• Member First Health National PPO Network FAQ – English (PDF)

• Pharmacy Benefits Member Guide – English (PDF)
• Pharmacy Benefits Member Guide – En Español (Spanish) (PDF)
• Generic vs Brand-Name Drugs Information – English (PDF)
• Coverage of Blood Glucose Test Strips – For New Members – 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)
• CVS Caremark Mail Order Pharmacy – English (PDF)
• CVS Caremark Mail Order Pharmacy – En Español (Spanish)(PDF)
• Home Infusion Fact Sheet – English (PDF)

Broker/Employer

• Broker – Salud HMO y Más flyer – English (PDF)
• Broker/Employer – Salud HMO y Más/Scripps Health flyer – English (PDF)

Member

• Salud HMO y Más Brochure – English (PDF)
• Salud HMO y Más Brochure – En Español (Spanish) (PDF)

• Ancillary sell sheet – English (PDF)
• Broker Supplemental Benefit Multi-Bundling Flyer – English (PDF)

Dental Materials

• Dental Provider Search Flyer – English (PDF)
• Your Dental Website (member) – English (PDF)

Vision Materials

Vision Website (member) – English (PDF)

Health Net Life

Health Net Life Product Guide (Employer) – English (PDF)

These forms are customizable to allow for the addition of benefit level.

• Basic Life Insurance with AD&D – English (PDF)
• Basic Life Insurance with AD&D – En Español (Spanish) (PDF)
• Basic Life Insurance no AD&D – English (PDF)

• Decision Power^® Member Brochure – English (PDF)
• Decision Power^® Member Brochure – En Español (Spanish) (PDF)
• Healthy Discounts Member Flyer – English (PDF)
• Healthy Discounts Member Flyer – En Español (Spanish) (PDF)
• myStrength Program Flyer – English (PDF)
• myStrength Program Flyer – En Español (Spanish) (PDF)
• Active&Fit Enrollment Fee Promotion Flyer – English (PDF)
• Preventive Screening Guidelines – English (PDF)
• Preventive Screening Guidelines – 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 Health Coaching (Lifestyle Management Flyer) – English (PDF)
• Sharecare Health Coaching (Lifestyle Management FAQs) – English (PDF)
• Sharecare RealAge Program Overview – English (PDF)
• Sharecare RealAge Program FAQs – English (PDF)
• Sharecare Green Day Overview – English (PDF)
• Sharecare How to Link Trackers Guide – English (PDF)
• Tips to Stop Smoking – English & Spanish (PDF)
• Wellness Tools – English (PDF)
• Wellness Tools – En Español (Spanish) (PDF)
• 2023 Wellness Webinar Flyer – English (PDF)
• 2023 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 – English (PDF)
• Preventive Screening Guidelines – En Español (Spanish) (PDF)
• 2023 Wellness Webinar Flyer – English (PDF)
• 2023 Wellness Webinar Flyer – En Español (Spanish) (PDF)
• Wellness Rewards Program FAQs for Employers – English (PDF)

Travel Guides

• HMO Travel Guide – English (PDF)
• HMO Travel Guide – En Español (Spanish) (PDF)

Claim forms can also be found under the Applications and Forms section on this page.

• PPO Travel Guide – English (PDF)
• PPO Travel Guide – En Español (Spanish) (PDF)

Claim forms can also be found under the Applications and Forms section on this page.

Additional Materials

• Understanding your Explanation of Benefits (EOB) – English/Spanish (PDF)
• Understanding Your Billing Statement – English (PDF)

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.

• 2023 HSA-compatible PPO Member brochure – English (PDF)
• HSA Employer Flyer – English (PDF)

Full Network HMO

• Full Network HMO-10-250a ($1,500/$3,000) - JMW - English (PDF)
• Full Network HMO-15-250a ($2,500/$7,500) - JMX - English (PDF)
• Full Network HMO-20-0 ($1,500/$3,000) - JMZ - English (PDF)
• Full Network HMO-20-20% ($2,500/$7,500) - JN0 - English (PDF)
• Full Network HMO-25-750a ($3,500/$10,500) - JN2 - English (PDF)
• Full Network HMO-30-20% ($2,500/$7,500) - JN3 - English (PDF)
• Full Network HMO-20-500a ($2,500/$7,500) - JN1 - English (PDF)
• Full Network HMO-30-30% ($3,500/$10,500) - JN4 - English (PDF)
• Full Network HMO-30-1000a ($3,500/$10,500) - JN6 - English (PDF)
• Full Network HMO-40-30% ($3,500/$10,500) - JN8 - English (PDF)
• Full Network HMO-30-250d ($4,500/$9,000) - JN5 - English (PDF)
• Full Network HMO-40-500d ($4,500/$9,000) - JNB - English (PDF)
• Full Network HMO-0-1000d ($5,500/$11,000) - JMU - English (PDF)
• Full Network HMO-35-30% ($5,500/$11,000) - JN7 - English (PDF)
• Full Network HMO-40-40% ($5,500/$11,000) - JN9 - English (PDF)
• Full Network HMO-10-30% ($6,500/$13,000) - JMV - English (PDF)
• Full Network HMO-15-1500d ($6,500/$13,000) - JMY - English (PDF)
• Full Network HMO-40-1500d ($6,500/$13,000) - JNC - English (PDF)
• Full Network HMO-50-1500d ($7,500/$15,000) - JND - English (PDF)
• Full Network HMO-60-1500a ($9,100/$18,200) - JNE - English (PDF)
• Full Network HMO-60-1500a ($9,100/$18,200) – JNE – En Español (Spanish) (PDF)

ExcelCare HMO

• ExcelCare HMO-10-250a ($1,500/$3,000) - JPO - English (PDF)
• ExcelCare HMO-15-250a ($2,500/$7,500) - JPP - English (PDF)
• ExcelCare HMO-20-0 ($1,500/$3,000) - JPR - English (PDF)
• ExcelCare HMO-20-20% ($2,500/$7,500) - JPS - English (PDF)
• ExcelCare HMO-25-750a ($3,500/$10,500) - JPU - English (PDF)
• ExcelCare HMO-30-20% ($2,500/$7,500) - JPV - English (PDF)
• ExcelCare HMO-20-500a ($2,500/$7,500) - JPT - English (PDF)
• ExcelCare HMO-30-30% ($3,500/$10,500) - JPW - English (PDF)
• ExcelCare HMO-40-30% ($3,500/$10,500) - JQ0 - English (PDF)
• ExcelCare HMO-30-1000a ($3,500/$10,500) - JPY - English (PDF)
• ExcelCare HMO-30-250d ($4,500/$9,000) - JPX - English (PDF)
• ExcelCare HMO-40-500d ($4,500/$9,000) - JQ2 - English (PDF)
• ExcelCare HMO-0-1000d ($5,500/$11,000) - JPM - English (PDF)
• ExcelCare HMO-35-30% ($5,500/$11,000) - JPZ - English (PDF)
• ExcelCare HMO-40-40% ($5,500/$11,000) - JQ1 - English (PDF)
• ExcelCare HMO-10-30% ($6,500/$13,000) - JPN - English (PDF)
• ExcelCare HMO-15-1500d ($6,500/$13,000) - JPQ - English (PDF)
• ExcelCare HMO-40-1500d ($6,500/$13,000) - JQ3 - English (PDF)
• ExcelCare HMO-50-1500d ($7,500/$15,000) - JQ4 - English (PDF)
• ExcelCare HMO-60-1500a ($9,100/$18,200) - JQ5 - English (PDF)

SmartCare HMO

• SmartCare HMO-10-250a ($1,500/$3,000) - JLK - English (PDF)
• SmartCare HMO-15-250a ($2,500/$7,500) - JLL - English (PDF)
• SmartCare HMO-20-0 ($1,500/$3,000) - JLN - English (PDF)
• SmartCare HMO-20-20% ($2,500/$7,500) - JLO - English (PDF)
• SmartCare HMO-25-750a ($3,500/$10,500) - JLQ - English (PDF)
• SmartCare HMO-30-20% ($2,500/$7,500) - JLR - English (PDF)
• SmartCare HMO-20-500a ($2,500/$7,500) - JLP - English (PDF)
• SmartCare HMO-30-30% ($3,500/$10,500) - JLS - English (PDF)
• SmartCare HMO-30-250d ($4,500/$9,000) - JLT - English (PDF)
• SmartCare HMO-30-1000a ($3,500/$10,500) - JLU - English (PDF)
• SmartCare HMO-40-500d ($4,500/$9,000) - JLY - English (PDF)
• SmartCare HMO-0-1000d ($5,500/$11,000) - JLI - English (PDF)
• SmartCare HMO-35-30% ($5,500/$11,000) - JLV - English (PDF)
• SmartCare HMO-40-30% ($3,500/$10,500) - JLW - English (PDF)
• SmartCare HMO-40-40% ($5,500/$11,000) - JLX - English (PDF)
• SmartCare HMO-10-30% ($6,500/$13,000) - JLJ - English (PDF)
• SmartCare HMO-15-1500d ($6,500/$13,000) - JLM - English (PDF)
• SmartCare HMO-40-1500d ($6,500/$13,000) - JLZ - English (PDF)
• SmartCare HMO-50-1500d ($7,500/$15,000) - JM0 - English (PDF)
• SmartCare HMO-60-1500a ($9,100/$18,200) - JM1 - English (PDF)

Salud HMO y Más

• Salud HMO y Más-10-250a ($1,500-$3,000) - JOE-JOF - English (PDF)
• Salud HMO y Más-15-250a ($2,500-$7,500) - JOH-JOI - English (PDF)
• Salud HMO y Más-20-20% ($2,500-$7,500) - JON-JOO - English (PDF)
• Salud HMO y Más-20-0 ($1,500-$3,000) - JOL-JOM - English (PDF)
• Salud HMO y Más-25-750a ($3,500-$10,500) - JOT-JOU - English (PDF)
• Salud HMO y Más-30-20% ($2,500-$7,500) - JOV-JOW - English (PDF)
• Salud HMO y Más-30-30% ($3,500-$10,500) - JOX-JOY - English (PDF)
• Salud HMO y Más-20-500a ($2,500-$7,500) - JOQ-JOR - English (PDF)
• Salud HMO y Más-30-250d ($4,500-$9,000) - JOZ-JP0 - English (PDF)
• Salud HMO y Más-30-1000a ($3,500-$10,500) - JP2-JP3 - English (PDF)
• Salud HMO y Más-40-500d ($4,500-$9,000) - JPD-JPE - English (PDF)
• Salud HMO y Más-0-1000d ($5,500-$11,000) - JO9-JOB - English (PDF)
• Salud HMO y Más-35-30% ($5,500-$11,000) - JP6-JP7 - English (PDF)
• Salud HMO y Más-40-30% ($3,500-$10,500) - JP8-JP9 - English (PDF)
• Salud HMO y Más-40-40% ($5,500-$11,000) - JPB-JPC - English (PDF)
• Salud HMO y Más-10-30% ($6,500-$13,000) - JOC-JOD - English (PDF)
• Salud HMO y Más-15-1500d ($6,500-$13,000) - JOJ-JOK - English (PDF)
• Salud HMO y Más-40-1500d ($6,500-$13,000) - JPF-JPG - English (PDF)
• Salud HMO y Más-50-1500d ($7,500-$15,000) - JPI-JPJ - English (PDF)
• Salud HMO y Más-60-1500a ($9,100-$18,200) - JPK-JPL - English (PDF)

Salud HMO y Más – Facility Deductible

• Salud HMO y Más-FD-20-500-10% ($3,500-$10,500) - JOP - English (PDF)
• Salud HMO y Más-FD-25-750-20% ($3,500-$10,500) - JOS - English (PDF)
• Salud HMO y Más-FD-30-1000-20% ($3,500-$10,500) - JP1 - English (PDF)
• Salud HMO y Más-FD-30-1500-30% ($3,500-$10,500) - JP4 - English (PDF)
• Salud HMO y Más-FD-30-2000-30% ($3,500-$10,500) - JP5 - English (PDF)
• Salud HMO y Más-FD-0-1000-20% ($4,500-$9,000) - JO8 - English (PDF)
• Salud HMO y Más-FD-10-1500-30% ($5,500-$11,000) - JOG - English (PDF)
• Salud HMO y Más-FD-40-3000-40% ($5,500-$11,000) - JPH - English (PDF)

Salud Mexico

• Salud Mexico-5-0 ($1,500/$4,500) - JNF - English (PDF)

CanopyCare HMO

• CanopyCare HMO-0-250a ($1,500/$3,000) - JM2 - English (PDF)
• CanopyCare HMO-15-250a ($2,500/$7,500) - JM7 - English (PDF)
• CanopyCare HMO-20-0 ($1,500/$3,000) - JM9 - English (PDF)
• CanopyCare HMO-20-20% ($2,500/$7,500) - JMB - English (PDF)
• CanopyCare HMO-20-1000a ($2,500/$7,500) - JMF - English (PDF)
• CanopyCare HMO-25-750a ($3,500/$10,500) - JMI - English (PDF)
• CanopyCare HMO-30-20% ($2,500/$7,500) - JMJ - English (PDF)
• CanopyCare HMO-30-1000a ($3,500/$10,500) - JML - English (PDF)
• CanopyCare HMO-30-1500a ($2,500/$7,500) - JMM - English (PDF)
• CanopyCare HMO-20-500a ($2,500/$7,500) - JMD - English (PDF)
• CanopyCare HMO-30-30% ($3,500/$10,500) - JMK - English (PDF)
• CanopyCare HMO-0-1000d ($5,500/$11,000) - JM4 - English (PDF)
• CanopyCare HMO-35-30% ($5,500/$11,000) - JMN - English (PDF)
• CanopyCare HMO-40-30% ($3,500/$10,500) - JMO - English (PDF)
• CanopyCare HMO-40-40% ($5,500/$11,000) - JMP - English (PDF)
• CanopyCare HMO-40-1000d ($5,500/$11,000) - JMQ - English (PDF)
• CanopyCare HMO-10-30% ($6,500/$13,000) - JM5 - English (PDF)
• CanopyCare HMO-15-1500d ($6,500/$13,000) - JM8 - English (PDF)
• CanopyCare HMO-40-1500d ($6,500/$13,000) - JMR - English (PDF)
• CanopyCare HMO-50-1500d ($7,500/$15,000) - JMT - English (PDF)

CanopyCare HMO - Facility Deductible

• CanopyCare HMO-FD-20-500-10% ($3,000/$6,000) - JMC - English (PDF)
• CanopyCare HMO-FD-20-1000-20% ($3,000/$6,000) - JME - English (PDF)
• CanopyCare HMO-FD-20-1500-20% ($4,000/$8,000) - JMG - English (PDF)
• CanopyCare HMO-FD-0-1000-20% ($4,500/$9,000) - JM3 - English (PDF)
• CanopyCare HMO-FD-20-2500-20% ($5,000/$10,000) - JMH - English (PDF)
• CanopyCare HMO-FD-10-1500-30% ($5,500/$11,000) - JM6 - English (PDF)
• CanopyCare HMO-FD-40-3000-30% ($6,000/$12,000) - JMS - English (PDF)

Full Network EOA

• Full Network EOA-10-250a ($1,500/$3,000) - JNJ - English (PDF)
• Full Network EOA-15-250a ($2,500/$7,500) - JNL - English (PDF)
• Full Network EOA-20-0 ($1,500/$3,000) - JNN - English (PDF)
• Full Network EOA-20-20% ($2,500/$7,500) - JNO - English (PDF)
• Full Network EOA-25-750a ($3,500/$10,500) - JNS - English (PDF)
• Full Network EOA-30-20% ($2,500/$7,500) - JNT - English (PDF)
• Full Network EOA-20-500a ($2,500/$7,500) - JNQ - English (PDF)
• Full Network EOA-30-30% ($3,500/$10,500) - JNU - English (PDF)
• Full Network EOA-40-30% ($3,500/$10,500) - JO1 - English (PDF)
• Full Network EOA-30-1000a ($3,500/$10,500) - JNX - English (PDF)
• Full Network EOA-30-250d ($4,500/$9,000) - JNV - English (PDF)
• Full Network EOA-40-500d ($4,500/$9,000) - JO3 - English (PDF)
• Full Network EOA-0-1000d ($5,500/$11,000) - JNH - English (PDF)
• Full Network EOA-35-30% ($5,500/$11,000) - JO0 - English (PDF)
• Full Network EOA-40-40% ($5,500/$11,000) - JO2 - English (PDF)
• Full Network EOA-10-30% ($6,500/$13,000) - JNI - English (PDF)
• Full Network EOA-15-1500d ($6,500/$13,000) - JNM - English (PDF)
• Full Network EOA-40-1500d ($6,500/$13,000) - JO4 - English (PDF)
• Full Network EOA-50-1500d ($7,500/$15,000) - JO6 - English (PDF)
• Full Network EOA-60-1500a ($9,100/$18,200) - JO7 - English (PDF)

Full Network EOA - Facility Deductible

• Full Network EOA-FD-20-500-10% ($3,500/$10,500) - JNP - English (PDF)
• Full Network EOA-FD-25-750-20% ($3,500/$10,500) - JNR - English (PDF)
• Full Network EOA-FD-30-1000-20% ($3,500/$10,500) - JNW - English (PDF)
• Full Network EOA-FD-30-1500-30% ($3,500/$10,500) - JNY - English (PDF)
• Full Network EOA-FD-30-2000-30% ($3,500/$10,500) - JNZ - English (PDF)
• Full Network EOA-FD-0-1000-20% ($4,500/$9,000) - JNG - English (PDF)
• Full Network EOA-FD-10-1500-30% ($5,500/$11,000) - JNK - English (PDF)
• Full Network EOA-FD-40-3000-40% ($5,500/$11,000) - JO5 - English (PDF)

ExcelCare EOA

• ExcelCare-EOA-10-250a ($1,500/$3,000) - JR4 - English (PDF)
• ExcelCare-EOA-15-250a ($2,500/$7,500) - JR6 - English (PDF)
• ExcelCare-EOA-20-0 ($1,500/$3,000) - JR8 - English (PDF)
• ExcelCare-EOA-20-20% ($2,500/$7,500) - JR9 - English (PDF)
• ExcelCare-EOA-25-750a ($3,500/$10,500) - JRE - English (PDF)
• ExcelCare-EOA-30-20% ($2,500/$7,500) - JRF - English (PDF)
• ExcelCare-EOA-20-500a ($2,500/$7,500) - JRC - English (PDF)
• ExcelCare-EOA-30-30% ($3,500/$10,500) - JRG - English (PDF)
• ExcelCare-EOA-30-1000a ($3,500/$10,500) - JRJ - English (PDF)
• ExcelCare-EOA-40-30% ($3,500/$10,500) - JRN - English (PDF)
• ExcelCare-EOA-30-250d ($4,500/$9,000) - JRH - English (PDF)
• ExcelCare-EOA-40-500d ($4,500/$9,000) - JRP - English (PDF)
• ExcelCare-EOA-0-1000d ($5,500/$11,000) - JR2 - English (PDF)
• ExcelCare-EOA-35-30% ($5,500/$11,000) - JRM - English (PDF)
• ExcelCare-EOA-40-40% ($5,500/$11,000) - JRO - English (PDF)
• ExcelCare-EOA-10-30% ($6,500/$13,000) - JR3 - English (PDF)
• ExcelCare-EOA-15-1500d ($6,500/$13,000) - JR7 - English (PDF)
• ExcelCare-EOA-40-1500d ($6,500/$13,000) - JRQ - English (PDF)
• ExcelCare-EOA-50-1500d ($7,500/$15,000) - JRS - English (PDF)
• ExcelCare-EOA-60-1500a ($9,100/$18,200) - JRT - English (PDF)

ExcelCare EOA - Facility Deductible

• ExcelCare-EOA-FD-20-500-10% ($3,500/$10,500) - JRB - English (PDF)
• ExcelCare-EOA-FD-25-750-20% ($3,500/$10,500) - JRD - English (PDF)
• ExcelCare-EOA-FD-30-1000-20% ($3,500/$10,500) - JRI - English (PDF)
• ExcelCare-EOA-FD-30-1500-30% ($3,500/$10,500) - JRK - English (PDF)
• ExcelCare-EOA-FD-30-2000-30% ($3,500/$10,500) - JRL - English (PDF)
• ExcelCare-EOA-FD-0-1000-20% ($4,500/$9,000) - JR1 - English (PDF)
• ExcelCare-EOA-FD-10-1500-30% ($5,500/$11,000) - JR5 - English (PDF)
• ExcelCare-EOA-FD-40-3000-40% ($5,500/$11,000) - JRR - English (PDF)

PPO

• PPO-JQ7-10/0/10% ($2,000/$6,000) - English (PDF)
• PPO-JQ8-10/250/10% ($3,000/$9,000) - English (PDF)
• PPO-JQC-15/500/10% ($3,000/$9,000) - English (PDF)
• PPO-JQF-20/250/10% ($3,000/$9,000) - English (PDF)
• PPO-JQI-30/500/10% ($3,000/$9,000) - English (PDF)
• PPO-JQK-30/1000/20% ($3,000/$9,000) - English (PDF)
• PPO-JQ9-10/250/20% ($4,000/$12,000) - English (PDF)
• PPO-JQD-15/500/20% ($4,000/$12,000) - English (PDF)
• PPO-JQG-20/250/20% ($4,000/$12,000) - English (PDF)
• PPO-JQH-20/500/20% ($4,000/$12,000) - English (PDF)
• PPO-JQJ-30/500/30% ($4,000/$12,000) - English (PDF)
• PPO-JQL-30/1000/20% ($4,000/$12,000) - English (PDF)
• PPO-JQ6-0/1000/20% ($5,000/$10,000) - English (PDF)
• PPO-JQM-30/2000/30% ($5,000/$10,000) - English (PDF)
• PPO-JQN-30/3000/30% ($5,000/$10,000) - English (PDF)
• PPO-JQB-10/1500/30% ($6,000/$12,000) - English (PDF)
• PPO-JQP-30/4000/30% ($6,000/$12,000) - English (PDF)
• PPO-JQO-30/3000/30% ($6,000/$12,000) - English (PDF)
• PPO-JQE-15/3000/30% ($7,000/$14,000) - English (PDF)
• PPO-JQR-40/5000/30% ($7,000/$14,000) - English (PDF)
• PPO-JQQ-40/3500/30% ($7,000/$14,000) - English (PDF)
• PPO-JQS-60/5000/30% ($9,100/$18,200) - English (PDF)
• PPO-JQS-60/5000/30% ($9,100/$18,200) – En Español (Spanish) (PDF)

PPO (HSA-compatible) (Includes pre-set pharmacy plans)

• HSA-PPO-JR0-2000/0% I ($2,000) - English (PDF)
• HSA-PPO-JQX-3000/0% F ($3,000/$6,000) - English (PDF)
• HSA-PPO-JQZ-1500/0% I ($1,500) - English (PDF)
• HSA-PPO-JQY-3000/0% F ($3,000/$6,000) - English (PDF)
• HSA-PPO-JQU-3000/20% ($4,000/$8,000) - English (PDF)
• HSA-PPO-JQT-4000/0% ($4,000/$8,000) - English (PDF)
• HSA-PPO-JQW-3000/30% ($5,000/$10,000) - English (PDF)
• HSA-PPO-JQV-5000/20% ($6,000/$12,000) - English (PDF)

Pharmacy HMO

(combined medical and pharmacy OOPM)

• No deductible ($5/$25/$50): EEK,EEL,EEM,EEN,EEO,EEP,EEQ,EER – English (PDF)
• No deductible ($10/$30/$55): EES,EET,EEU,EEV,EEW,EEX,EEY,EEZ – English (PDF)
• No deductible ($15/$35/$60): EF0,EF1,EF2,EF3,EF4,EF5,EF6,EF7 – English (PDF)
• $100 deductible ($10/$30/$55): EF8,EF9,EFA,EFB,EFC,EFD,EFE,EFF – English (PDF)
• $100 deductible ($15/$35/$60): EFG,EFH,EFJ,EFK,EFL,EFM,EFN,EFP – English (PDF)
• $300 deductible ($15/$40/$65): EFQ,EFR,EFS,EFT,EFU,EFV,EFW,EFX – English (PDF)

Pharmacy POS – Elect Open Access (EOA)/ExcelCare EOA

• No deductible ($5/$25/$50): EGN,EGP,EGQ,EGR,EGS,EGT,EGU,EGV – English (PDF)
• No deductible ($10/$30/$55): EGW,EGX,EGY,EGZ,EH0,EH1,EH2,EH3 – English (PDF)
• No deductible ($15/$35/$60): EH4,EH5,EH6,EH7,EH9,EHA,EHB,EHC – English (PDF)
• $100 deductible ($10/$30/$55): EHD,EHE,EHF,EHG,EHH,EHJ,EHK,EHL – English (PDF)
• $100 deductible ($15/$35/$60): EHM,EHN,EHP,EHQ,EHR,EHS,EHT,EHU – English (PDF)
• $300 deductible ($15/$40/$65): EHV,EHW,EHX,EHY,EHZ,EJ0,EJ1,EJ2 – English (PDF)

Pharmacy HMO – Salud HMO y Más

(combined medical and pharmacy OOPM)

• No deductible ($5/$25/$50): EJ3,EJ4,EJ5,EJ6,EJ7,EJ8,EJ9,EJA – English (PDF)
• No deductible ($10/$30/$55): EJB,EJC,EJD,EJE,EJF,EJG,EJH,EJJ – English (PDF)
• $100 deductible ($15/$35/$60): EJK,EJL,EJM,EJN,EJO,EJP,EJQ,EJR – English (PDF)
• $300 deductible ($15/$40/$65): EJS,EJT,EJU,EJV,EJW,EJX,EJY,EJZ – English (PDF)

CanopyCare HMO

• No deductible ($5/$25/$50): EEK,EEL,EEM,EEN,EEO,EEP,EEQ,EFY,EFZ,EG0,EG1 – English (PDF)
• No deductible ($10/$30/$55): EES,EET,EEU,EEV,EEW,EEX,EEY,EG2,EG3,EG4,EG5 – English (PDF)
• No deductible ($15/$35/$60): EF0,EF1,EF2,EF3,EF4,EF5,EF6,EG6,EG7,EG8,EG9 – English (PDF)
• $100 deductible ($10/$30/$55): EF8,EF9,EFA,EFB,EFC,EFD,EFE,EGA,EGB,EGC,EGD – English (PDF)
• $100 deductible ($15/$35/$60): EFG,EFH,EFJ,EFK,EFL,EFM,EFN,EGE,EGF,EGG,EGH – English (PDF)
• $300 deductible ($15/$40/$65): EFQ,EFR,EFS,EFT,EFU,EFV,EFW,EGJ,EGK,EGL,EGM – English (PDF)

Pharmacy PPO

(combined medical and pharmacy OOPM)

• No deductible ($5/$25/$50): DA0,DA1,DB0,DB1,D18,D32,D48 – English (PDF)
• No deductible ($10/$30/$55): D49,DC0,DC1,DI0,DI2,DI3,DI4 – English (PDF)
• No deductible ($15/$35/$60): DI5,DI6,DI7,DI8,DI9,DJ0,DK0 – English (PDF)
• $100 deductible ($10/$30/$55): DK1,DL0,DL1,DM0,DM1,DN0,DN1 – English (PDF)
• $100 deductible ($15/$35/$60): DP0,DP1,DQ0,DQ1,DR0,DR1,DS0 – English (PDF)
• $300 deductible ($15/$40/$65): DT0,DT1,DU0,DU1,DV0,DV1,DW0 – English (PDF)

Pharmacy HSA-compatible PPO

(combined medical and pharmacy OOPM)

• $1,500 deductible ($0/$0/$0): DW1 – English (PDF)
• $2,000 deductible ($0/$0/$0): DX0 – English (PDF)
• $3,000 deductible ($0/$0/$0): DY0,DX1 – English (PDF)
• $3,000 deductible ($10/$30/$55): DY1 – English (PDF)
• $3,000 deductible ($15/$35/$60): A00 – English (PDF)
• $4,000 deductible ($0/$0/$0): AG0 – English (PDF)
• $5,000 deductible ($10/$30/$55): AG1 – English (PDF)

Chiropractic / Acupuncture

• HMO Chiropractic / Acupuncture – Combined – English (PDF)
• PPO Chiropractic / Acupuncture – Combined – English (PDF)
• PPO-HSA Chiropractic / Acupuncture – Combined – English (PDF)
• HMO Chiropractic only – 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

Dental – HMO

• Dental – HMO – Health Net Plus 85 – Plan Overview – English (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 – 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 – 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 – English (PDF)
• Dental – PPO – Classic 2 1500 – English (PDF)
• Dental – PPO – Classic 3 1500 – English (PDF)
• Dental – PPO – Classic 4 1500 – English (PDF)
• Dental – PPO – Classic 5 1500 – English (PDF)
• Dental – PPO – Classic 5 1500 – En Español (Spanish) (PDF)
• Dental – PPO – Classic 6 1500 – English (PDF)
• Dental – PPO – Classic Plus 1 2000 – English (PDF)
• Dental – PPO – Classic Plus 2 2000 – English (PDF)
• Dental – PPO – Essential 1 1000 – English (PDF)
• Dental – PPO – Essential 2 1000 – English (PDF)
• Dental – PPO – Essential 2 1000 – En Español (Spanish) (PDF)
• Dental – PPO – Essential 3 1000 – English (PDF)
• Dental – PPO – Essential 4 1000 – English (PDF)
• Dental – PPO – Essential 5 1500 – English (PDF)
• Dental – PPO – Essential 6 1500 – English (PDF)
• Dental – PPO – Essential 6 1500 – En Español (Spanish) (PDF)
• Dental – PPO – Essential Value 1 1000 – English (PDF)
• Dental – PPO – Basic 500 – English (PDF)

Vision Plans

• Vision Plans – Exam Only – English (PDF)
• Vision Plans – Elite 1010-1 – English (PDF)
• Vision Plans – Plus 20-1 – English (PDF)
• Vision Plans – Preferred 1025-2 – English (PDF)
• Vision Plans – Preferred 1025-3 – English (PDF)
• Vision Plans – Preferred 1025-3 – En Español (Spanish) (PDF)
• Vision Plans – Preferred Value 10-3 – English (PDF)
• Vision Plans – Supreme 010-2 – English (PDF)

Full Network HMO

• Full Network HMO-HSM-10/250a ($1,500 / $3,000) - English (PDF)
• Full Network HMO-HSN-15/0 ($2,500 / $7,500) - English (PDF)
• Full Network HMO-HSO-15/250a ($2,500 / $7,500) - English (PDF)
• Full Network HMO-HSQ-20/20% ($2,500 / $7,500) - English (PDF)
• Full Network HMO-HSR-20/250a ($2,500 / $7,500) - English (PDF)
• Full Network HMO-HSU-30/20% ($2,500 / $7,500) - English (PDF)
• Full Network HMO-HSZ-40/20% ($2,500 / $7,500) - English (PDF)
• Full Network HMO-HSS-20/500a ($3,500 / $10,500) - English (PDF)
• Full Network HMO-HST-20/500d ($3,500 / $10,500) - English (PDF)
• Full Network HMO-HSV-30/30% ($3,500 / $10,500) - English (PDF)
• Full Network HMO-HSX-30/1000a ($3,500 / $10,500) - English (PDF)
• Full Network HMO-HT0-40/30% ($3,500 / $10,500) - English (PDF)
• Full Network HMO-HSW-30/250d ($4,500 / $9,000) - English (PDF)
• Full Network HMO-HT2-40/500d ($4,500 / $9,000) - English (PDF)
• Full Network HMO-HSK-0/1000d ($5,500 / $11,000) - English (PDF)
• Full Network HMO-HSY-35/30% ($5,500 / $11,000) - English (PDF)
• Full Network HMO-HT1-40/40% ($5,500 / $11,000) - English (PDF)
• Full Network HMO-HSL-10/30% ($6,500 / $13,000) - English (PDF)
• Full Network HMO-HSP-15/1500d ($6,500 / $13,000) - English (PDF)
• Full Network HMO-HT3-40/1500d ($6,500 / $13,000) - English (PDF)
• Full Network HMO-HT4-50/1500d ($6,500 / $13,000) - English (PDF)
• Full Network HMO-HT5-60/1500a ($8,700 / $17,400) - English (PDF)

ExcelCare HMO

• ExcelCare HMO-HVE-10/250a ($1,500 / $3,000) - English (PDF)
• ExcelCare HMO-HVF-15/250a ($2,500 / $7,500) - English (PDF)
• ExcelCare HMO-HVI-20/250a ($2,500 / $7,500) - English (PDF)
• ExcelCare HMO-HVH-20/20% ($2,500 / $7,500) - English (PDF)
• ExcelCare HMO-HVK-30/20% ($2,500 / $7,500) - English (PDF)
• ExcelCare HMO-HVJ-20/500a ($3,500 / $10,500) - English (PDF)
• ExcelCare HMO-HVL-30/30% ($3,500 / $10,500) - English (PDF)
• ExcelCare HMO-HVP-40/30% ($3,500 / $10,500) - English (PDF)
• ExcelCare HMO-HVN-30/1000a ($3,500 / $10,500) - English (PDF)
• ExcelCare HMO-HVM-30/250d ($4,500 / $9,000) - English (PDF)
• ExcelCare HMO-HVR-40/500d ($4,500 / $9,000) - English (PDF)
• ExcelCare HMO-HVC-0/1000d ($5,500 / $11,000) - English (PDF)
• ExcelCare HMO-HVO-35/30% ($5,500 / $11,000) - English (PDF)
• ExcelCare HMO-HVQ-40/40% ($5,500 / $11,000) - English (PDF)
• ExcelCare HMO-HVD-10/30% ($6,500 / $13,000) - English (PDF)
• ExcelCare HMO-HVG-15/1500d ($6,500 / $13,000) - English (PDF)
• ExcelCare HMO-HVS-40/1500d ($6,500 / $13,000) - English (PDF)
• ExcelCare HMO-HVT-50/1500d ($6,500 / $13,000) - English (PDF)
• ExcelCare HMO-HVU-60/1500a ($8,700 / $17,400) - English (PDF)

SmartCare HMO

• SmartCare HMO-HS4-10/250a ($1,500 / $3,000) - English (PDF)
• SmartCare HMO-HS5-15/250a ($2,500 / $7,500) - English (PDF)
• SmartCare HMO-HS7-20/20% ($2,500 / $7,500) - English (PDF)
• SmartCare HMO-HS9-30/20% ($2,500 / $7,500) - English (PDF)
• SmartCare HMO-HS8-20/500a ($3,500 / $10,500) - English (PDF)
• SmartCare HMO-HSB-30/30% ($3,500 / $10,500) - English (PDF)
• SmartCare HMO-HSC-30/250d ($4,500 / $9,000) - English (PDF)
• SmartCare HMO-HSF-40/500d ($4,500 / $9,000) - English (PDF)
• SmartCare HMO-HS2-0/1000d ($5,500 / $11,000) - English (PDF)
• SmartCare HMO-HSD-35/30% ($5,500 / $11,000) - English (PDF)
• SmartCare HMO-HSE-40/40% ($5,500 / $11,000) - English (PDF)
• SmartCare HMO-HSH-50/50% ($5,500 / $11,000) - English (PDF)
• SmartCare HMO-HS3-10/30% ($6,500 / $13,000) - English (PDF)
• SmartCare HMO-HS6-15/1500d ($6,500 / $13,000) - English (PDF)
• SmartCare HMO-HSG-40/1500d ($6,500 / $13,000) - English (PDF)
• SmartCare HMO-HSI-50/1500d ($6,500 / $13,000) - English (PDF)
• SmartCare HMO-HSJ-60/1500a ($8,700 / $17,400) - English (PDF)

Salud HMO y Más / Salud San Diego

• Salud y Más HMO-HU8-HU9-10/250a ($1,500 / $3,000) - English (PDF)
• Salud y Más HMO-HUC-HUD-15/250a ($2,500 / $7,500) - English (PDF)
• Salud y Más HMO-HUG-HUH-20/20% ($2,500 / $7,500) - English (PDF)
• Salud y Más HMO-HUL-HUM-30/20% ($2,500 / $7,500) - English (PDF)
• Salud y Más HMO-HUN-HUO-30/30% ($3,500 / $10,500) - English (PDF)
• Salud y Más HMO-HUJ-HUK-20/500a ($3,500 / $10,500) - English (PDF)
• Salud y Más HMO-HUP-HUQ-30/250d ($4,500 / $9,000) - English (PDF)
• Salud y Más HMO-HUX-HUY-40/500d ($4,500 / $9,000) - English (PDF)
• Salud y Más HMO-HU4-HU5-0/1000d ($5,500 / $11,000) - English (PDF)
• Salud y Más HMO-HUT-HUU-35/30% ($5,500 / $11,000) - English (PDF)
• Salud y Más HMO-HUV-HUW-40/40% ($5,500 / $11,000) - English (PDF)
• Salud y Más HMO-HU6-HU7-10/30% ($6,500 / $13,000) - English (PDF)
• Salud y Más HMO-HUE-HUF-15/1500d ($6,500 / $13,000) - English (PDF)
• Salud y Más HMO-HUZ-HV0-40/1500d ($6,500 / $13,000) - English (PDF)
• Salud y Más HMO-HV2-HV3-50/1500d ($6,500 / $13,000) - English (PDF)
• Salud y Más HMO-HV4-HV5-60/1500a ($8,700 / $17,400) - English (PDF)

Salud HMO y Más – Facility Deductible

• Salud y Más FD-HUI-20/500/10% ($3,500 / $10,500) - English (PDF)
• Salud y Más FD-HUR-30/1000/20% ($3,500 / $10,500) - English (PDF)
• Salud y Más FD-HUS-30/1500/30% ($3,500 / $10,500) - English (PDF)
• Salud y Más FD-HU3-0/1000/20% ($4,500 / $9,000) - English (PDF)
• Salud y Más FD-HUB-10/1500/30% ($5,500 / $11,000) - English (PDF)
• Salud y Más FD-HV1-40/3000/40% ($5,500 / $11,000) - English (PDF)
• Salud y Más FD-HV6-60/4000/40% ($8,700 / $17,400) - English (PDF)

Salud Mexico

• Salud Mexico-HU2-5/0 ($1,500 / $4,500) - English (PDF)

CanopyCare HMO

• CanopyCare HMO-HZ0-0/250a ($1,500 / $3,000) - English (PDF)
• CanopyCare HMO-HZ5-15/250a ($2,500 / $7,500) - English (PDF)
• CanopyCare HMO-HZ7-20/20% ($2,500 / $7,500) - English (PDF)
• CanopyCare HMO-HZC-20/1000a ($2,500 / $7,500) - English (PDF)
• CanopyCare HMO-HZF-30/20% ($2,500 / $7,500) - English (PDF)
• CanopyCare HMO-HZH-30/1500a ($2,500 / $7,500) - English (PDF)
• CanopyCare HMO-HZ9-20/500a ($3,500 / $10,500) - English (PDF)
• CanopyCare HMO-HZG-30/30% ($3,500 / $10,500) - English (PDF)
• CanopyCare HMO-HZ2-0/1000d ($5,500 / $11,000) - English (PDF)
• CanopyCare HMO-HZI-35/30% ($5,500 / $11,000) - English (PDF)
• CanopyCare HMO-HZJ-40/40% ($5,500 / $11,000) - English (PDF)
• CanopyCare HMO-HZK-40/1000d ($5,500 / $11,000) - English (PDF)
• CanopyCare HMO-HZ3-10/30% ($6,500 / $13,000) - English (PDF)
• CanopyCare HMO-HZ6-15/1500d ($6,500 / $13,000) - English (PDF)
• CanopyCare HMO-HZL-40/1500d ($6,500 / $13,000) - English (PDF)
• CanopyCare HMO-HZN-50/1500d ($6,500 / $13,000) - English (PDF)

CanopyCare HMO - Facility Deductible

• CanopyCare HMO FD-HZ8-20/500/10% ($3,000 / $6,000) - English (PDF)
• CanopyCare HMO FD-HZB-20/1000/20% ($3,000 / $6,000) - English (PDF)
• CanopyCare HMO FD-HZD-20/1500/20% ($4,000 / $8,000) - English (PDF)
• CanopyCare HMO FD-HZ1-0/1000/20% ($4,500 / $9,000) - English (PDF)
• CanopyCare HMO FD-HZE-20/2500/20% ($5,000 / $10,000) - English (PDF)
• CanopyCare HMO FD-HZ4-10/1500/30% ($5,500 / $11,000) - English (PDF)
• CanopyCare HMO FD-HZM-40/3000/30% ($6,000 / $12,000) - English (PDF)

POS-Elect Open Access (EOA)

• EOA-HTB-10/250a ($1,500 / $3,000) - English (PDF)
• EOA-HT8-10/0 ($2,500 / $7,500) - English (PDF)
• EOA-HTD-15/250a ($2,500 / $7,500) - English (PDF)
• EOA-HTF-20/20% ($2,500 / $7,500) - English (PDF)
• EOA-HTG-20/250a ($2,500 / $7,500) - English (PDF)
• EOA-HTK-30/20% ($2,500 / $7,500) - English (PDF)
• EOA-HTR-40/20% ($2,500 / $7,500) - English (PDF)
• EOA-HTI-20/500a ($3,500 / $10,500) - English (PDF)
• EOA-HTJ-20/500d ($3,500 / $10,500) - English (PDF)
• EOA-HTL-30/30% ($3,500 / $10,500) - English (PDF)
• EOA-HTS-40/30% ($3,500 / $10,500) - English (PDF)
• EOA-HTO-30/1000a ($3,500 / $10,500) - English (PDF)
• EOA-HTM-30/250d ($4,500 / $9,000) - English (PDF)
• EOA-HTU-40/500d ($4,500 / $9,000) - English (PDF)
• EOA-HT7-0/1000d ($5,500 / $11,000) - English (PDF)
• EOA-HTQ-35/30% ($5,500 / $11,000) - English (PDF)
• EOA-HTT-40/40% ($5,500 / $11,000) - English (PDF)
• EOA-HT9-10/30% ($6,500 / $13,000) - English (PDF)
• EOA-HTE-15/1500d ($6,500 / $13,000) - English (PDF)
• EOA-HTV-40/1500d ($6,500 / $13,000) - English (PDF)
• EOA-HTX-50/1500d ($6,500 / $13,000) - English (PDF)
• EOA-HTY-60/1500a ($8,700 / $17,400) - English (PDF)

POS-Elect Open Access (EOA) – Facility Deductible

• EOA FD-HTH-20/500/10% ($3,500 / $10,500) - English (PDF)
• EOA FD-HTN-30/1000/20% ($3,500 / $10,500) - English (PDF)
• EOA FD-HTP-30/1500/30% ($3,500 / $10,500) - English (PDF)
• EOA FD-HT6-0/1000/20% ($4,500 / $9,000) - English (PDF)
• EOA FD-HTC-10/1500/30% ($5,500 / $11,000) - English (PDF)
• EOA FD-HTW-40/3000/40% ($5,500 / $11,000) - English (PDF)
• EOA FD-HTZ-60/4000/40% ($8,700 / $17,400) - English (PDF)

ExcelCare EOA

• ExcelCare EOA-HVY-10/250a ($1,500 / $3,000) - English (PDF)
• ExcelCare EOA-HW0-15/250a ($2,500 / $7,500) - English (PDF)
• ExcelCare EOA-HW2-20/20% ($2,500 / $7,500) - English (PDF)
• ExcelCare EOA-HW3-20/250a ($2,500 / $7,500) - English (PDF)
• ExcelCare EOA-HW6-30/20% ($2,500 / $7,500) - English (PDF)
• ExcelCare EOA-HWE-40/20% ($2,500 / $7,500) - English (PDF)
• ExcelCare EOA-HW5-20/500a ($3,500 / $10,500) - English (PDF)
• ExcelCare EOA-HW7-30/30% ($3,500 / $10,500) - English (PDF)
• ExcelCare EOA-HWB-30/1000a ($3,500 / $10,500) - English (PDF)
• ExcelCare EOA-HWF-40/30% ($3,500 / $10,500) - English (PDF)
• ExcelCare EOA-HW8-30/250d ($4,500 / $9,000) - English (PDF)
• ExcelCare EOA-HWH-40/500d ($4,500 / $9,000) - English (PDF)
• ExcelCare EOA-HVW-0/1000d ($5,500 / $11,000) - English (PDF)
• ExcelCare EOA-HWD-35/30% ($5,500 / $11,000) - English (PDF)
• ExcelCare EOA-HWG-40/40% ($5,500 / $11,000) - English (PDF)
• ExcelCare EOA-HVZ-10/1500/30% ($5,500 / $11,000) - English (PDF)
• ExcelCare EOA-HVX-10/30% ($6,500 / $13,000) - English (PDF)
• ExcelCare EOA-HW1-15/1500d ($6,500 / $13,000) - English (PDF)
• ExcelCare EOA-HWI-40/1500d ($6,500 / $13,000) - English (PDF)
• ExcelCare EOA-HWK-50/1500d ($6,500 / $13,000) - English (PDF)
• ExcelCare EOA-HWL-60/1500a ($8,700 / $17,400) - English (PDF)

ExcelCare EOA - Facility Deductible

• ExcelCare EOA FD-HW4-20/500/10% ($3,500 / $10,500) - English (PDF)
• ExcelCare EOA FD-HW9-30/1000/20% ($3,500 / $10,500) - English (PDF)
• ExcelCare EOA FD-HWC-30/1500/30% ($3,500 / $10,500) - English (PDF)
• ExcelCare EOA FD-HVV-0/1000/20% ($4,500 / $9,000) - English (PDF)
• ExcelCare EOA FD-HWJ-40/3000/40% ($5,500 / $11,000) - English (PDF)
• ExcelCare EOA FD-HWM-60/4000/40% ($8,700 / $17,400) - English (PDF)

PPO

• PPO-HWO-0/1000/20% ($5,000 / $10,000) - English (PDF)
• PPO-HWP-10/0/10% ($2,000 / $6,000) - English (PDF)
• PPO-HWQ-10/0/10% ($3,000 / $9,000) - English (PDF)
• PPO-HWR-10/250/10% ($3,000 / $9,000) - English (PDF)
• PPO-HWU-15/250/10% ($3,000 / $9,000) - English (PDF)
• PPO-HWV-15/500/10% ($3,000 / $9,000) - English (PDF)
• PPO-HWY-20/250/10% ($3,000 / $9,000) - English (PDF)
• PPO-HX1-30/500/10% ($3,000 / $9,000) - English (PDF)
• PPO-HX4-30/1000/20% ($3,000 / $9,000) - English (PDF)
• PPO-HWS-10/250/20% ($4,000 / $12,000) - English (PDF)
• PPO-HWW-15/500/20% ($4,000 / $12,000) - English (PDF)
• PPO-HWZ-20/250/20% ($4,000 / $12,000) - English (PDF)
• PPO-HX0-20/500/20% ($4,000 / $12,000) - English (PDF)
• PPO-HX2-30/500/20% ($4,000 / $12,000) - English (PDF)
• PPO-HX3-30/500/30% ($4,000 / $12,000) - English (PDF)
• PPO-HX5-30/1000/20% ($4,000 / $12,000) - English (PDF)
• PPO-HX6-30/2000/30% ($5,000 / $10,000) - English (PDF)
• PPO-HX7-30/3000/30% ($5,000 / $10,000) - English (PDF)
• PPO-HWT-10/1500/30% ($6,000 / $12,000) - English (PDF)
• PPO-HX9-30/4000/30% ($6,000 / $12,000) - English (PDF)
• PPO-HX8-30/3000/30% ($6,000 / $12,000) - English (PDF)
• PPO-HWX-15/3000/30% ($7,000 / $14,000) - English (PDF)
• PPO-HXD-40/5000/30% ($7,000 / $14,000) - English (PDF)
• PPO-HXB-30/4000/30% ($7,000 / $14,000) - English (PDF)
• PPO-HXC-40/3500/30% ($7,000 / $14,000) - English (PDF)
• PPO-HXE-60/5000/30% ($8,700 / $17,400) - English (PDF)
• PPO-HXN-2800/0% F ($2,800 / $5,600) - English (PDF)

PPO (HSA-compatible) (Includes pre-set pharmacy plans)

• HSA-HXO-2800/30% F ($3,000 / $6,000) - English (PDF)
• HSA-HXP-2000/0% I ($2,000) - English (PDF)
• HSA-HXQ-1500/30% I ($3,000) - English (PDF)
• HSA-HXF-2800/0% ($2,800 / $5,600) - English (PDF)
• HSA-HXK-2800/30% ($3,000 / $6,000) - English (PDF)
• HSA-HXG-3000/0% ($3,000 / $6,000) - English (PDF)
• HSA-HXI-3000/20% ($4,000 / $8,000) - English (PDF)
• HSA-HXH-4000/0% ($4,000 / $8,000) - English (PDF)
• HSA-HXL-2800/30% ($5,000 / $10,000) - English (PDF)
• HSA-HXM-3000/30% ($5,000 / $10,000) - English (PDF)
• HSA-HXJ-5000/20% ($6,000 / $12,000) - English (PDF)

Pharmacy HMO

(combined medical and pharmacy OOPM)

• No deductible ($5/$25/$45) - D7A, D7B, D7C, D7D, D7E, D7F, D7G – English (PDF)
• No deductible ($10/$30/$50) - D7H, D7J, D7K, D7L, D7M, D7N, D7P – English (PDF)
• No deductible ($15/$35/$55) - D7Q, D7R, D7S, D7T, D7U, D7V, D7W – English (PDF)
• $100 deductible ($10/$30/$50) - D8E, D8F, D8G, D8H, D8J, D8K, D8L – English (PDF)
• $100 deductible ($15/$35/$55) - D7X, D7Y, D7Z, D8A, D8B, D8C, D8D – English (PDF)
• $300 deductible ($15/$40/$60) - D8M, D8N, D8P, D8Q, D8R, D8S, D8T – English (PDF)

Pharmacy POS – Elect Open Access (EOA)/ExcelCare EOA

• No deductible ($5/$25/$45) - D8U, D8V, D8W, D8X, D8Y, D8Z, D9A – English (PDF)
• No deductible ($10/$30/$50) - D9B, D9C, D9D, D9E, D9F, D9G, D9H – English (PDF)
• No deductible ($15/$35/$55) - D9J, D9K, D9L, D9M, D9N, D9P, D9Q – English (PDF)
• $100 deductible ($10/$30/$50) - D9R, D9S, D9T, D9U, D9V, D9W, D9X – English (PDF)
• $100 deductible ($15/$35/$55) - BA1, BA2, BA3, BA4, BA5, D9Y, D9Z – English (PDF)
• $300 deductible ($15/$40/$60) - BA6, BA7, BA8, BA9, BAA, BAB, BAC – English (PDF)

Pharmacy HMO – Salud HMO y Más

(combined medical and pharmacy OOPM)

• No deductible ($5/$25/$45) - D5W, D5X, D5Y, D5Z, D6A, D6B, D6C – English (PDF)
• No deductible ($10/$30/$50) - D6D, D6E, D6F, D6G, D6H, D6J, D6K – English (PDF)
• $100 deductible ($15/$35/$55) - D6L, D6M, D6N, D6P, D6Q, D6R, D6S – English (PDF)
• $300 deductible ($15/$40/$60) - D6T, D6U, D6V, D6W, D6X, D6Y, D6Z – English (PDF)

CanopyCare HMO

• No deductible ($5/$25/$45) - BC0, BC1, BC2, BC3, D7A, D7B, D7C, D7D, D7E, D7F – English (PDF)
• No deductible ($10/$30/$50) - BC4, BC5, BC6, BC7, D7H, D7J, D7K, D7L, D7M, D7N – English (PDF)
• No deductible ($15/$35/$55) - BC8, BC9, BCA, BCB, D7Q, D7R, D7S, D7T, D7U, D7V – English (PDF)
• $100 deductible ($10/$30/$50) - BCG, BCH, BCJ, BCK, D8E, D8F, D8G, D8H, D8J, D8K – English (PDF)
• $100 deductible ($15/$35/$55) - BCC, BCD, BCE, BCF, D7X, D7Y, D7Z, D8A, D8B, D8C – English (PDF)
• $300 deductible ($15/$40/$60) - BCL, BCM, BCN, BCP, D8M, D8N, D8P, D8Q, D8R, D8S – English (PDF)

Pharmacy PPO

(combined medical and pharmacy OOPM)

• No deductible ($5/$25/$45) - BAD, BAE, BAF, BAG, BAH, BAJ, BAK – English (PDF)
• No deductible ($10/$30/$50) - BAL, BAM, BAN, BAP, BAQ, BAR, BAS – English (PDF)
• No deductible ($15/$35/$55) - BAT, BAU, BAV, BAW, BAX, BAY, BAZ – English (PDF)
• $100 deductible ($10/$30/$50) - BB0, BB1, BB2, BB3, BB4, BB5, BB6 – English (PDF)
• $100 deductible ($15/$35/$55) - BB7, BB8, BB9, BBA, BBB, BBC, BBD – English (PDF)
• $300 deductible ($15/$40/$60) - BBE, BBF, BBG, BBH, BBJ, BBK, BBL – English (PDF)

Pharmacy HSA-compatible PPO

(combined medical and pharmacy OOPM)

• $1,500 deductible ($15/$35/$55) - D5K – English (PDF)
• $2,000 deductible ($0/$0/$0) - D5L – English (PDF)
• $2,800 deductible ($0/$0/$0) - D5Q, D5P – English (PDF)
• $2,800 deductible ($15/$35/$55) - D5O, D5N, D5M – English (PDF)
• $3,000 deductible ($0/$0/$0) - D5R – English (PDF)
• $3,000 deductible ($10/$30/$50) - D5S – English (PDF)
• $3,000 deductible ($15/$35/$55) - D5T – English (PDF)
• $4,000 deductible ($0/$0/$0) - D5U – English (PDF)
• $5,000 deductible ($10/$30/$50) - D5V – English (PDF)

Chiropractic / Acupuncture

• Chiropractic / Acupuncture – Combined – HMO/EOA – English (PDF)
• Chiropractic / Acupuncture – Combined – SmartCare $15 – English (PDF)
• Chiropractic / Acupuncture – Combined – SmartCare $25 – English (PDF)
• Chiropractic / Acupuncture – Combined – Custom – English (PDF)

Chiropractic Care

Chiropractic Care – HMO/EOA – English (PDF)

Dental – HMO

• Dental – HMO – Health Net Plus 85 – Plan Overview – English (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 – 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 – 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 – English (PDF)
• Dental – PPO – Classic 2 1500 – English (PDF)
• Dental – PPO – Classic 3 1500 – English (PDF)
• Dental – PPO – Classic 4 1500 – English (PDF)
• Dental – PPO – Classic 5 1500 – English (PDF)
• Dental – PPO – Classic 5 1500 – En Español (Spanish) (PDF)
• Dental – PPO – Classic 6 1500 – English (PDF)
• Dental – PPO – Classic Plus 1 2000 – English (PDF)
• Dental – PPO – Classic Plus 2 2000 – English (PDF)
• Dental – PPO – Essential 1 1000 – English (PDF)
• Dental – PPO – Essential 2 1000 – English (PDF)
• Dental – PPO – Essential 2 1000 – En Español (Spanish) (PDF)
• Dental – PPO – Essential 3 1000 – English (PDF)
• Dental – PPO – Essential 4 1000 – English (PDF)
• Dental – PPO – Essential 5 1500 – English (PDF)
• Dental – PPO – Essential 6 1500 – English (PDF)
• Dental – PPO – Essential 6 1500 – En Español (Spanish) (PDF)
• Dental – PPO – Essential Value 1 1000 – English (PDF)
• Dental – PPO – Basic 500 – English (PDF)

Vision Plans

• Vision Plans – Exam Only – English (PDF)
• Vision Plans – Elite 1010-1 – English (PDF)
• Vision Plans – Plus 20-1 – English (PDF)
• Vision Plans – Preferred 1025-2 – English (PDF)
• Vision Plans – Preferred 1025-3 – English (PDF)
• Vision Plans – Preferred 1025-3 – En Español (Spanish) (PDF)
• Vision Plans – Preferred Value 10-3 – English (PDF)
• Vision Plans – Supreme 010-2 – English (PDF)

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 – San Diego County – English (PDF)
• How Soon Can I See the Doctor – English (PDF)
• How Soon Can I See the Doctor – En Español (Spanish) (PDF)
• ProviderSearch Information – English (PDF)
• ProviderSearch Information – En Español (Spanish) (PDF)
• County Reference Quick Guide – English (PDF)