Small Group Plan Materials and Downloads

Full Network PPO

• Evidence of Coverage – Full Network Bronze HDHP PPO 7000/0% – English (PDF)
• Evidence of Coverage – Full Network Bronze HDHP PPO 7000/0% + INF – English (PDF)
• Evidence of Coverage – Full Network Bronze PPO 6300/65 – English (PDF)
• Evidence of Coverage – Full Network Bronze PPO 6300/65 + INF – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 0/35 – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 0/35 + INF – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 1000/35 – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 1000/35 + INF – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 1600/0 – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 1600/0 + INF – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 350/25 – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 350/25 + INF – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 500/20 – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 500/20 + INF – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 750/15 – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 750/15 + INF – English (PDF)
• Evidence of Coverage – Full Network Platinum PPO 0/15 – English (PDF)
• Evidence of Coverage – Full Network Platinum PPO 0/15 + INF – English (PDF)
• Evidence of Coverage – Full Network Platinum PPO 250/15 – English (PDF)
• Evidence of Coverage – Full Network Platinum PPO 250/15 + INF – English (PDF)
• Evidence of Coverage – Full Network Silver HDHP PPO 1500/50% – English (PDF)
• Evidence of Coverage – Full Network Silver HDHP PPO 1500/50% + INF – English (PDF)
• Evidence of Coverage – Full Network Silver PPO 1700/50 – English (PDF)
• Evidence of Coverage – Full Network Silver PPO 1700/50 + INF – English (PDF)
• Evidence of Coverage – Full Network Silver PPO 2250/60 – English (PDF)
• Evidence of Coverage – Full Network Silver PPO 2250/60 + INF – English (PDF)
• Evidence of Coverage – Full Network Silver PPO 2500/55 – English (PDF)
• Evidence of Coverage – Full Network Silver PPO 2500/55 + INF – English (PDF)

Salud HMO y Mas

• Evidence of Coverage – Salud HMO y Más Gold $30 – English (PDF)
• Evidence of Coverage – Salud HMO y Más Gold $30 + INF – English (PDF)
• Evidence of Coverage – Salud HMO y Más Gold $35 – English (PDF)
• Evidence of Coverage – Salud HMO y Más Gold $35 + INF – English (PDF)
• Evidence of Coverage – Salud HMO y Más Gold $40 – English (PDF)
• Evidence of Coverage – Salud HMO y Más Gold $40 + INF – English (PDF)
• Evidence of Coverage – Salud HMO y Más Gold $50 – English (PDF)
• Evidence of Coverage – Salud HMO y Más Gold $50 + INF – English (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $0 – English (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $0 + INF – English (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $10 – English (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $10 + INF – English (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $20 – English (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $20 + INF – English (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $30 – English (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $30 + INF – English (PDF)
• Evidence of Coverage – Salud HMO y Más Silver $55 – English (PDF)
• Evidence of Coverage – Salud HMO y Más Silver $55 + INF – English (PDF)

Evidence of Coverage – CommunityCare HMO

• Evidence of Coverage – CommunityCare HMO Bronze $6300/$65 – English (PDF)
• Evidence of Coverage – CommunityCare HMO Bronze $6300/$65 + INF – English (PDF)
• Evidence of Coverage – CommunityCare HMO Silver $2250/$50 – English (PDF)
• Evidence of Coverage – CommunityCare HMO Silver $2250/$50 + INF – English (PDF)

Evidence of Coverage – Full Network HMO

• Evidence of Coverage – Full Network HMO Gold $30 – English (PDF)
• Evidence of Coverage – Full Network HMO Gold $30 + INF – English (PDF)
• Evidence of Coverage – Full Network HMO Gold $35 – English (PDF)
• Evidence of Coverage – Full Network HMO Gold $35 + INF – English (PDF)
• Evidence of Coverage – Full Network HMO Gold $40 – English (PDF)
• Evidence of Coverage – Full Network HMO Gold $40 + INF – English (PDF)
• Evidence of Coverage – Full Network HMO Gold $50 – English (PDF)
• Evidence of Coverage – Full Network HMO Gold $50 + INF – English (PDF)
• Evidence of Coverage – Full Network HMO Platinum $0 – English (PDF)
• Evidence of Coverage – Full Network HMO Platinum $0 + INF – English (PDF)
• Evidence of Coverage – Full Network HMO Platinum $10 – English (PDF)
• Evidence of Coverage – Full Network HMO Platinum $10 + INF – English (PDF)
• Evidence of Coverage – Full Network HMO Platinum $20 – English (PDF)
• Evidence of Coverage – Full Network HMO Platinum $20 + INF – English (PDF)
• Evidence of Coverage – Full Network HMO Platinum $30 – English (PDF)
• Evidence of Coverage – Full Network HMO Platinum $30 + INF – English (PDF)
• Evidence of Coverage – Full Network HMO Silver $55 – English (PDF)
• Evidence of Coverage – Full Network HMO Silver $55 + INF – English (PDF)

Evidence of Coverage – SmartCare HMO

• Evidence of Coverage – SmartCare HMO Gold $30 – English (PDF)
• Evidence of Coverage – SmartCare HMO Gold $30 + INF – English (PDF)
• Evidence of Coverage – SmartCare HMO Gold $35 – English (PDF)
• Evidence of Coverage – SmartCare HMO Gold $35 + INF – English (PDF)
• Evidence of Coverage – SmartCare HMO Gold $40 – English (PDF)
• Evidence of Coverage – SmartCare HMO Gold $40 + INF – English (PDF)
• Evidence of Coverage – SmartCare HMO Gold $50 – English (PDF)
• Evidence of Coverage – SmartCare HMO Gold $50 + INF – English (PDF)
• Evidence of Coverage – SmartCare HMO Platinum $0 – English (PDF)
• Evidence of Coverage – SmartCare HMO Platinum $0 + INF – English (PDF)
• Evidence of Coverage – SmartCare HMO Platinum $10 – English (PDF)
• Evidence of Coverage – SmartCare HMO Platinum $10 + INF – English (PDF)
• Evidence of Coverage – SmartCare HMO Platinum $20 – English (PDF)
• Evidence of Coverage – SmartCare HMO Platinum $20 + INF – English (PDF)
• Evidence of Coverage – SmartCare HMO Platinum $30 – English (PDF)
• Evidence of Coverage – SmartCare HMO Platinum $30 + INF – English (PDF)
• Evidence of Coverage – SmartCare HMO Silver $55 – English (PDF)
• Evidence of Coverage – SmartCare HMO Silver $55 + INF – English (PDF)

Evidence of Coverage – WholeCare HMO

• Evidence of Coverage – WholeCare HMO Gold $30 – English (PDF)
• Evidence of Coverage – WholeCare HMO Gold $30 + INF – English (PDF)
• Evidence of Coverage – WholeCare HMO Gold $35 – English (PDF)
• Evidence of Coverage – WholeCare HMO Gold $35 + INF – English (PDF)
• Evidence of Coverage – WholeCare HMO Gold $40 – English (PDF)
• Evidence of Coverage – WholeCare HMO Gold $40 + INF – English (PDF)
• Evidence of Coverage – WholeCare HMO Gold $50 – English (PDF)
• Evidence of Coverage – WholeCare HMO Gold $50 + INF – English (PDF)
• Evidence of Coverage – WholeCare HMO Platinum $0 – English (PDF)
• Evidence of Coverage – WholeCare HMO Platinum $0 + INF – English (PDF)
• Evidence of Coverage – WholeCare HMO Platinum $10 – English (PDF)
• Evidence of Coverage – WholeCare HMO Platinum $10 + INF – English (PDF)
• Evidence of Coverage – WholeCare HMO Platinum $20 – English (PDF)
• Evidence of Coverage – WholeCare HMO Platinum $20 + INF – English (PDF)
• Evidence of Coverage – WholeCare HMO Platinum $30 – English (PDF)
• Evidence of Coverage – WholeCare HMO Platinum $30 + INF – English (PDF)
• Evidence of Coverage – WholeCare HMO Silver $55 – English (PDF)
• Evidence of Coverage – WholeCare HMO Silver $55 + INF – English (PDF)

CommunityCare HMO

• Evidence of Coverage – CommunityCare Bronze 60 HMO 6300/65 + Child Dental (PDF)
• Evidence of Coverage – CommunityCare Bronze 60 HMO 6300/65 + Child Dental + INF (PDF)
• Evidence of Coverage – CommunityCare HMO Silver $1750/$50 + Child Dental (PDF)
• Evidence of Coverage – CommunityCare HMO Silver $1750/$50 + Child Dental + INF (PDF)

Evidence of Coverage – Full Network HMO

• Evidence of Coverage – Full Network HMO Gold $30 + Child Dental (PDF)
• Evidence of Coverage – Full Network HMO Gold $30 + Child Dental + INF (PDF)
• Evidence of Coverage – Full Network HMO Gold $35 + Child Dental (PDF)
• Evidence of Coverage – Full Network HMO Gold $35 + Child Dental + INF (PDF)
• Evidence of Coverage – Full Network HMO Gold $40 + Child Dental (PDF)
• Evidence of Coverage – Full Network HMO Gold $40 + Child Dental + INF (PDF)
• Evidence of Coverage – Full Network HMO Gold $50 + Child Dental (PDF)
• Evidence of Coverage – Full Network HMO Gold $50 + Child Dental + INF (PDF)
• Evidence of Coverage – Full Network HMO Platinum $0 + Child Dental (PDF)
• Evidence of Coverage – Full Network HMO Platinum $0 + Child Dental + INF (PDF)
• Evidence of Coverage – Full Network HMO Platinum $10 + Child Dental (PDF)
• Evidence of Coverage – Full Network HMO Platinum $10 + Child Dental + INF (PDF)
• Evidence of Coverage – Full Network HMO Platinum $20 + Child Dental (PDF)
• Evidence of Coverage – Full Network HMO Platinum $20 + Child Dental + INF (PDF)
• Evidence of Coverage – Full Network HMO Platinum $30 + Child Dental (PDF)
• Evidence of Coverage – Full Network HMO Platinum $30 + Child Dental + INF (PDF)
• Evidence of Coverage – Full Network HMO Silver $50 + Child Dental (PDF)
• Evidence of Coverage – Full Network HMO Silver $50 + Child Dental + INF (PDF)

Evidence of Coverage – SmartCare HMO

• Evidence of Coverage – SmartCare HMO Gold $30 + Child Dental (PDF)
• Evidence of Coverage – SmartCare HMO Gold $30 + Child Dental + INF (PDF)
• Evidence of Coverage – SmartCare HMO Gold $35 + Child Dental (PDF)
• Evidence of Coverage – SmartCare HMO Gold $35 + Child Dental + INF (PDF)
• Evidence of Coverage – SmartCare HMO Gold $40 + Child Dental (PDF)
• Evidence of Coverage – SmartCare HMO Gold $40 + Child Dental + INF (PDF)
• Evidence of Coverage – SmartCare HMO Gold $50 + Child Dental (PDF)
• Evidence of Coverage – SmartCare HMO Gold $50 + Child Dental + INF (PDF)
• Evidence of Coverage – SmartCare HMO Platinum $0 + Child Dental (PDF)
• Evidence of Coverage – SmartCare HMO Platinum $0 + Child Dental + INF (PDF)
• Evidence of Coverage – SmartCare HMO Platinum $10 + Child Dental (PDF)
• Evidence of Coverage – SmartCare HMO Platinum $10 + Child Dental + INF (PDF)
• Evidence of Coverage – SmartCare HMO Platinum $20 + Child Dental (PDF)
• Evidence of Coverage – SmartCare HMO Platinum $20 + Child Dental + INF (PDF)
• Evidence of Coverage – SmartCare HMO Platinum $30 + Child Dental (PDF)
• Evidence of Coverage – SmartCare HMO Platinum $30 + Child Dental +INF (PDF)
• Evidence of Coverage – SmartCare HMO Silver $50 + Child Dental (PDF)
• Evidence of Coverage – SmartCare HMO Silver $50 + Child Dental + INF (PDF)

WholeCare HMO

• Evidence of Coverage – WholeCare HMO Gold $30 + Child Dental (PDF)
• Evidence of Coverage – WholeCare HMO Gold $30 + Child Dental + INF (PDF)
• Evidence of Coverage – WholeCare HMO Gold $35 + Child Dental (PDF)
• Evidence of Coverage – WholeCare HMO Gold $35 + Child Dental + INF (PDF)
• Evidence of Coverage – WholeCare HMO Gold $40 + Child Dental (PDF)
• Evidence of Coverage – WholeCare HMO Gold $40 + Child Dental + INF (PDF)
• Evidence of Coverage – WholeCare HMO Gold $50 + Child Dental (PDF)
• Evidence of Coverage – WholeCare HMO Gold $50 + Child Dental + INF (PDF)
• Evidence of Coverage – WholeCare HMO Platinum $0 + Child Dental (PDF)
• Evidence of Coverage – WholeCare HMO Platinum $0 + Child Dental + INF (PDF)
• Evidence of Coverage – WholeCare HMO Platinum $10 + Child Dental (PDF)
• Evidence of Coverage – WholeCare HMO Platinum $10 + Child Dental + INF (PDF)
• Evidence of Coverage – WholeCare HMO Platinum $20 + Child Dental (PDF)
• Evidence of Coverage – WholeCare HMO Platinum $20 + Child Dental + INF (PDF)
• Evidence of Coverage – WholeCare HMO Platinum $30 + Child Dental (PDF)
• Evidence of Coverage – WholeCare HMO Platinum $30 + Child Dental + INF (PDF)
• Evidence of Coverage – WholeCare HMO HMO Silver $50 + Child Dental (PDF)
• Evidence of Coverage – WholeCare HMO Silver $50 + Child Dental + INF (PDF)

Full Network PPO

• Evidence of Coverage – Bronze 60 PPO 6300/65 + Child Dental (PDF)
• Evidence of Coverage – Bronze 60 PPO 6300/65 + Child Dental + INF (PDF)
• Evidence of Coverage – Bronze 60 HDHP PPO 7000/0% + Child Dental (PDF)
• Evidence of Coverage – Bronze 60 HDHP PPO 7000/0% + Child Dental + INF (PDF)
• Evidence of Coverage – Gold 80 PPO 350/25 + Child Dental (PDF)
• Evidence of Coverage – Gold 80 PPO 350/25 + Child Dental + INF (PDF)
• Evidence of Coverage – Gold 80 PPO 0/30 + Child Dental Alt (PDF)
• Evidence of Coverage – Gold 80 PPO 0/30 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – Gold 80 PPO 1000/30 + Child Dental Alt (PDF)
• Evidence of Coverage – Gold 80 PPO 1000/30 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – Platinum 90 PPO 0/15 + Child Dental (PDF)
• Evidence of Coverage – Platinum 90 PPO 0/15 + Child Dental + INF (PDF)
• Evidence of Coverage – Silver 70 PPO 2250/50 + Child Dental (PDF)
• Evidence of Coverage – Silver 70 PPO 2250/50 + Child Dental + INF (PDF)
• Evidence of Coverage – Silver 70 PPO 2250/55 + Child Dental Alt (PDF)
• Evidence of Coverage – Silver 70 PPO 2250/55 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – Silver 70 HDHP PPO 1400/40% + Child Dental Alt (PDF)
• Evidence of Coverage – Silver 70 HDHP PPO 1400/40% + Child Dental Alt + INF (PDF)

EnhancedCare PPO

• Evidence of Coverage – EnhancedCare Gold 80 PPO 1000/30 + Child Dental Alt (PDF)
• Evidence of Coverage – EnhancedCare Gold 80 PPO 1000/30 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – EnhancedCare Gold 80 Value PPO 750/15 + Child Dental Alt (PDF)
• Evidence of Coverage – EnhancedCare Gold 80 Value PPO 750/15 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – EnhancedCare Gold 80 PPO 0/30 + Child Dental Alt (PDF)
• Evidence of Coverage – EnhancedCare Gold 80 PPO 0/30 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – EnhancedCare Gold 80 PPO 500/20 + Child Dental Alt (PDF)
• Evidence of Coverage – EnhancedCare Gold 80 PPO 500/20 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – EnhancedCare Gold 80 PPO 1500/0 + Child Dental Alt (PDF)
• Evidence of Coverage – EnhancedCare Gold 80 PPO 1500/0 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – EnhancedCare Platinum 90 PPO 250/15 + Child Dental Alt (PDF)
• Evidence of Coverage – EnhancedCare Platinum 90 PPO 250/15 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – EnhancedCare Silver 70 PPO 2250/55 + Child Dental Alt (PDF)
• Evidence of Coverage – EnhancedCare Silver 70 PPO 2250/55 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – EnhancedCare Silver 70 Value PPO 1700/50 + Child Dental Alt (PDF)
• Evidence of Coverage – EnhancedCare Silver 70 Value PPO 1700/50 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – EnhancedCare Silver 70 HDHP PPO 1400/40% + Child Dental Alt (PDF)
• Evidence of Coverage – EnhancedCare Silver 70 HDHP PPO 1400/40% + Child Dental Alt + INF (PDF)

Full Network PPO

• Evidence of Coverage – Bronze 60 PPO 6300/65 + Child Dental (PDF)
• Evidence of Coverage – Bronze 60 PPO 6300/65 + Child Dental + INF (PDF)
• Evidence of Coverage – Bronze 60 HDHP PPO 7000/0% + Child Dental (PDF)
• Evidence of Coverage – Bronze 60 HDHP PPO 7000/0% + Child Dental + INF (PDF)
• Evidence of Coverage – Gold 80 PPO 350/25 + Child Dental (PDF)
• Evidence of Coverage – Gold 80 PPO 350/25 + Child Dental + INF (PDF)
• Evidence of Coverage – Gold 80 PPO 1000/30 + Child Dental Alt (PDF)
• Evidence of Coverage – Gold 80 PPO 1000/30 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – Gold 80 Value PPO 750/15 + Child Dental Alt (PDF)
• Evidence of Coverage – Gold 80 Value PPO 750/15 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – Gold 80 PPO 0/30 + Child Dental Alt (PDF)
• Evidence of Coverage – Gold 80 PPO 0/30 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – Gold 80 PPO 500/20 + Child Dental Alt (PDF)
• Evidence of Coverage – Gold 80 PPO 500/20 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – Gold 80 PPO 1500/0 + Child Dental Alt (PDF)
• Evidence of Coverage – Gold 80 PPO 1500/0 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – Platinum 90 PPO 0/15 + Child Dental (PDF)
• Evidence of Coverage – Platinum 90 PPO 0/15 + Child Dental + INF (PDF)
• Evidence of Coverage – Platinum 90 PPO 250/15 + Child Dental Alt (PDF)
• Evidence of Coverage – Platinum 90 PPO 250/15 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – Silver 70 PPO 2250/50 + Child Dental (PDF)
• Evidence of Coverage – Silver 70 PPO 2250/50 + Child Dental + INF (PDF)
• Evidence of Coverage – Silver 70 PPO 2250/55 + Child Dental Alt (PDF)
• Evidence of Coverage – Silver 70 PPO 2250/55 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – Silver 70 Value PPO 1700/50 + Child Dental Alt (PDF)
• Evidence of Coverage – Silver 70 Value PPO 1700/50 + Child Dental Alt + INF (PDF)
• Evidence of Coverage – Silver 70 HDHP PPO 1400/40% + Child Dental Alt (PDF)
• Evidence of Coverage – Silver 70 HDHP PPO 1400/40% + Child Dental Alt + INF (PDF)

Salud HMO y Más

• Evidence of Coverage – Salud HMO y Más Gold $30 + Child Dental (PDF)
• Evidence of Coverage – Salud HMO y Más Gold $30 + Child Dental + INF (PDF)
• Evidence of Coverage – Salud HMO y Más Gold $35 + Child Dental (PDF)
• Evidence of Coverage – Salud HMO y Más Gold $35 + Child Dental + INF (PDF)
• Evidence of Coverage – Salud HMO y Más Gold $40 + Child Dental (PDF)
• Evidence of Coverage – Salud HMO y Más Gold $40 + Child Dental + INF (PDF)
• Evidence of Coverage – Salud HMO y Más Gold $50 + Child Dental (PDF)
• Evidence of Coverage – Salud HMO y Más Gold $50 + Child Dental + INF (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $0 + Child Dental + INF (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $0 + Child Dental + INF (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $10 + Child Dental (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $10 + Child Dental + INF (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $20 + Child Dental (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $20 + Child Dental + INF (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $30 + Child Dental (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $30 + Child Dental + INF (PDF)
• Evidence of Coverage – Salud HMO y Más Silver $50 + Child Dental (PDF)
• Evidence of Coverage – Salud HMO y Más Silver $50 + Child Dental + INF (PDF)

PureCare HSP

• Evidence Of Coverage – Health Net PureCare Bronze 60 HSP 6300/65 + Child Dental (PDF)
• Evidence Of Coverage – Health Net PureCare Bronze 60 HSP 6300/65 + Child Dental + INF (PDF)
• Evidence Of Coverage – Health Net PureCare Gold 80 HSP 350/25 + Child Dental (PDF)
• Evidence Of Coverage – Health Net PureCare Gold 80 HSP 350/25 + Child Dental + INF (PDF)
• Evidence Of Coverage – Health Net PureCare Platinum 90 HSP 0/15 + Child Dental (PDF)
• Evidence Of Coverage – Health Net PureCare Platinum 90 HSP 0/15 + Child Dental + INF (PDF)
• Evidence Of Coverage – Health Net PureCare Silver 70 HSP 2250/50 + Child Dental (PDF)
• Evidence Of Coverage – Health Net PureCare Silver 70 HSP 2250/50 + Child Dental + INF (PDF)

CA Essential Rx Drug List - English (PDF)