Small Group Plan Materials and Downloads

Full Network PPO

• Evidence of Coverage – Full Network Bronze HDHP PPO 7200/0% – English (PDF)
• Evidence of Coverage – Full Network Bronze HDHP PPO 7200/0% INF – English (PDF)
• Evidence of Coverage – Full Network Bronze PPO 5800/60 – English (PDF)
• Evidence of Coverage – Full Network Bronze PPO 5800/60 INF – English (PDF)
• Evidence of Coverage – Full Network Gold HDHP PPO 1700/20% – English (PDF)
• Evidence of Coverage – Full Network Gold HDHP PPO 1700/20% 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 1500/20 – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 1500/20 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 0/5 – English (PDF)
• Evidence of Coverage – Full Network Platinum PPO 0/5 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 Platinum PPO 0/15 – English (PDF)
• Evidence of Coverage – Full Network Platinum PPO 0/15 INF – English (PDF)
• Evidence of Coverage – Full Network Silver HDHP PPO 1700/50% – English (PDF)
• Evidence of Coverage – Full Network Silver HDHP PPO 1700/50% 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 2500/50 – English (PDF)
• Evidence of Coverage – Full Network Silver PPO 2500/50 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 Más

• 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 Gold $55 – English (PDF)
• Evidence of Coverage – Salud HMO y Más Gold $55 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 Platinum $35 – English (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $35 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)

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 Gold $55 – English (PDF)
• Evidence of Coverage – Full Network HMO Gold $55 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 Platinum $35 – English (PDF)
• Evidence of Coverage – Full Network HMO Platinum $35 INF – English (PDF)
• Evidence of Coverage – Full Network HMO Silver $55 – English (PDF)
• Evidence of Coverage – Full Network HMO Silver $55 INF – English (PDF)

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 Gold $55 – English (PDF)
• Evidence of Coverage – SmartCare HMO Gold $55 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 Platinum $35 – English (PDF)
• Evidence of Coverage – SmartCare HMO Platinum $35 INF – English (PDF)
• Evidence of Coverage – SmartCare HMO Silver $55 – English (PDF)
• Evidence of Coverage – SmartCare HMO Silver $55 INF – English (PDF)

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 Gold $55 – English (PDF)
• Evidence of Coverage – WholeCare HMO Gold $55 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 Platinum $35 – English (PDF)
• Evidence of Coverage – WholeCare HMO Platinum $35 INF – English (PDF)
• Evidence of Coverage – WholeCare HMO Silver $55 – English (PDF)
• Evidence of Coverage – WholeCare HMO Silver $55 INF – English (PDF)

Full Network PPO

• Evidence of Coverage – Full Network Bronze HDHP PPO 6650/0% – English (PDF)
• Evidence of Coverage – Full Network Bronze HDHP PPO 6650/0% + INF – English (PDF)
• Evidence of Coverage – Full Network Bronze PPO 5800/60 – English (PDF)
• Evidence of Coverage – Full Network Bronze PPO 5800/60 + INF – English (PDF)
• Evidence of Coverage – Full Network Gold HDHP PPO 1650/20% – English (PDF)
• Evidence of Coverage – Full Network Gold HDHP PPO 1650/20% + 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 1500/20 – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 1500/20 + 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 0/5 – English (PDF)
• Evidence of Coverage – Full Network Platinum PPO 0/5 + 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 1650/50% – English (PDF)
• Evidence of Coverage – Full Network Silver HDHP PPO 1650/50% + 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 2500/50 – English (PDF)
• Evidence of Coverage – Full Network Silver PPO 2500/50 + 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)

Full Network PPO (July 1, 2025 and after)

• Evidence of Coverage – Full Network Bronze HDHP PPO 6650/0% INF – English (PDF)
• Evidence of Coverage – Full Network Bronze PPO 5800/60 INF – English (PDF)
• Evidence of Coverage – Full Network Gold HDHP PPO 1650/20% INF – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 0/35 INF – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 1000/35 INF – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 1500/20 INF – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 350/25 INF – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 500/20 INF – English (PDF)
• Evidence of Coverage – Full Network Gold PPO 750/15 INF – English (PDF)
• Evidence of Coverage – Full Network Platinum PPO 0/15 INF – English (PDF)
• Evidence of Coverage – Full Network Platinum PPO 0/5 INF – English (PDF)
• Evidence of Coverage – Full Network Platinum PPO 250/15 INF – English (PDF)
• Evidence of Coverage – Full Network Silver HDHP PPO 1650/50% INF – English (PDF)
• Evidence of Coverage – Full Network Silver PPO 1700/50 INF – English (PDF)
• Evidence of Coverage – Full Network Silver PPO 2250/60 INF – English (PDF)
• Evidence of Coverage – Full Network Silver PPO 2500/50 INF – English (PDF)
• Evidence of Coverage – Full Network Silver PPO 2500/55 INF – English (PDF)

Salud HMO y Más

• 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 Gold $55 – English (PDF)
• Evidence of Coverage – Salud HMO y Más Gold $55 + 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 Platinum $35 – English (PDF)
• Evidence of Coverage – Salud HMO y Más Platinum $35 + 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)

Salud HMO y Más (July 1, 2025 and after)

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

Evidence of Coverage – Full Network HMO (July 1, 2025 and after)

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

Evidence of Coverage – SmartCare HMO (July 1, 2025 and after)

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

Evidence of Coverage – WholeCare HMO (July 1, 2025 and after)

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

CA Essential Rx Drug List - English (PDF)