Plan Materials
Want to learn more about a specific plan? Here you'll find all the details about your Health Net coverage choices to find the plan that fits your needs.
All documents are in PDF format. 
Materials & Forms
Brochures
- 2020 – Plan choices by location (PDF) (IFP on- and off-exchange)
- 2020 – IEX Sales Brochure (PDF)
- 2020 – IEX CommunityCare HMO Sales Brochure (PDF)
- 2020 – IEX EnhancedCare PPO Sales Brochure (PDF)
- 2020 – IEX PureCare HSP Sales Brochure (PDF)
- 2020 – IEX PureCare One EPO Sales Brochure (PDF)
- 2020 – Heal - doctor house calls (PDF) (for PPO and EnhancedCare PPO plans only)
2020 Disclosures
HMO/HSP
2020 – CommunityCare HMO and PureCare HSP Disclosure for Covered California - English (PDF)
EPO
2020 – PureCare One EPO Disclosure for Covered California - English (PDF)
EnhancedCare PPO
2020 – EnhancedCare PPO Disclosure for Covered California - English (PDF)
Brochures
- 2020 – Plan choices by location (PDF) (IFP on- and off-exchange)
- 2020 – Sales Brochure (PDF)
Enrollment Tools
Individual & Family Plans (IFP) Enrollment Applications - Effective January 1, 2020
CommunityCare HMO
- 2020 – IFP CommunityCare HMO Enrollment Application – English (PDF)
- 2020 – IFP CommunityCare HMO Enrollment Application – Spanish (PDF)
- 2020 – IFP CommunityCare HMO Enrollment Application – Chinese (PDF)
- 2020 – IFP CommunityCare HMO Enrollment Application – Korean (PDF)
- 2020 – IFP CommunityCare HMO Enrollment Application – Vietnamese (PDF)
PureCare HSP
- 2020 – IFP PureCare HSP Enrollment Application – English (PDF)
- 2020 – IFP PureCare HSP Enrollment Application – Spanish (PDF)
- 2020 – IFP PureCare HSP Enrollment Application – Chinese (PDF)
- 2020 – IFP PureCare HSP Enrollment Application – Korean (PDF)
- 2020 – IFP PureCare HSP Enrollment Application – Vietnamese (PDF)
PureCare EPO
- 2020 – IFP PureCare One EPO Enrollment Application – English (PDF)
- 2020 – IFP PureCare One EPO Enrollment Application – Spanish (PDF)
- 2020 – IFP PureCare One EPO Enrollment Application – Chinese (PDF)
- 2020 – IFP PureCare One EPO Enrollment Application – Korean (PDF)
- 2020 – IFP PureCare One EPO Enrollment Application – Vietnamese (PDF)
PPO
- 2020 – IFP PPO Enrollment Application – English (PDF)
- 2020 – IFP PPO Enrollment Application – Spanish (PDF)
- 2020 – IFP PPO Enrollment Application – Chinese (PDF)
- 2020 – IFP PPO Enrollment Application – Korean (PDF)
- 2020 – IFP PPO Enrollment Application – Vietnamese (PDF)
EnhancedCare PPO
- 2020 – IFP EnhancedCare PPO Enrollment Application – English (PDF)
- 2020 – IFP EnhancedCare PPO Enrollment Application – Spanish (PDF)
- 2020 – IFP EnhancedCare PPO Enrollment Application – Chinese (PDF)
- 2020 – IFP EnhancedCare PPO Enrollment Application – Korean (PDF)
- 2020 – IFP EnhancedCare PPO Enrollment Application – Vietnamese (PDF)
2020 Disclosures
HMO/HSP
EPO
PPO
EnhancedCare PPO
Dental and Vision
- 2020 – Adult Dental and Vision Coverage with HMO and HSP Health Plans (PDF)
- 2020 – Adult Dental and Vision Coverage with PPO and EPO Health Plans (PDF)
- 2020 – Pediatric Dental/Vision (HMO/HSP) (PDF)
- 2020 – Pediatric Dental/Vision (PPO) (PDF)
- 2020 – Pediatric Dental/Vision (EPO/EnhancedCare PPO) (PDF)
Brochures
- 2019 – Plan choices by location (PDF) (IFP on- and off-exchange)
- 2019 – IEX Sales Brochure - English (PDF)
- 2019 – IEX Sales Brochure - Spanish (PDF)
- 2019 – IEX Sales Brochure - Chinese (PDF)
- 2019 – IEX CommunityCare HMO Sales Brochure (PDF)
- 2019 – IEX EnhancedCare PPO Sales Brochure (PDF)
- 2019 – IEX PureCare HSP Sales Brochure (PDF)
- 2019 – IEX PureCare One EPO Sales Brochure (PDF)
- 2019 – Heal - doctor house calls (PDF) (for PPO and EnhancedCare PPO plans only)
2019 CommunityCare HMO Plan Overviews
- 2019 – Platinum 90 CommunityCare HMO (PDF)
- 2019 – Gold 80 CommunityCare HMO (PDF)
- 2019 – Silver 70 CommunityCare HMO (PDF)
CommunityCare HMO Silver Cost-Sharing Reduction Plan Overviews
- 2019 – Silver 73 CommunityCare HMO CSR (PDF)
- 2019 – Silver 87 CommunityCare HMO CSR (PDF)
- 2019 – Silver 94 CommunityCare HMO CSR (PDF)
2019 PureCare HSP Plan Overviews
2019 PureCare One EPO Plan Overviews
- 2019 – Platinum 90 PureCare One EPO (PDF)
- 2019 – Gold 80 PureCare One EPO (PDF)
- 2019 – Silver 70 PureCare One EPO (PDF)
- 2019 – Silver 73 PureCare One EPO (PDF)
- 2019 – Silver 87 PureCare One EPO (PDF)
- 2019 – Silver 94 PureCare One EPO (PDF)
- 2019 – Bronze 60 PureCare One EPO (PDF)
- 2019 – Minimum Coverage PureCare One EPO (PDF)
2019 EnhancedCare PPO Plan Overviews
- 2019 – Platinum 90 EnhancedCare PPO (PDF)
- 2019 – Gold 80 EnhancedCare PPO (PDF)
- 2019 – Silver 70 EnhancedCare PPO (PDF)
- 2019 – Silver 73 EnhancedCare PPO (PDF)
- 2019 – Silver 87 EnhancedCare PPO (PDF)
- 2019 – Silver 94 EnhancedCare PPO (PDF)
- 2019 – Bronze 60 EnhancedCare PPO (PDF)
- 2019 – Bronze 60 HDHP EnhancedCare PPO (PDF)
- 2019 – Minimum Coverage EnhancedCare PPO (PDF)
2019 Disclosures
HMO/HSP
- 2019 – CommunityCare HMO and PureCare HSP Disclosure for Covered California - English (PDF)
- 2019 – CommunityCare HMO and PureCare HSP Disclosure for Covered California - Spanish (PDF)
- 2019 – CommunityCare HMO and PureCare HSP Disclosure for Covered California - Chinese (PDF)
- 2019 – CommunityCare HMO and PureCare HSP Disclosure for Covered California - Korean (PDF)
- 2019 – CommunityCare HMO and PureCare HSP Disclosure for Covered California - Vietnamese (PDF)
EPO
- 2019 – PureCare One EPO Disclosure for Covered California - English (PDF)
- 2019 – PureCare One EPO Disclosure for Covered California - Spanish (PDF)
- 2019 – PureCare One EPO Disclosure for Covered California - Chinese (PDF)
- 2019 – PureCare One EPO Disclosure for Covered California - Korean (PDF)
- 2019 – PureCare One EPO Disclosure for Covered California - Vietnamese (PDF)
EnhancedCare PPO
- 2019 – EnhancedCare PPO Disclosure for Covered California - English (PDF)
- 2019 – EnhancedCare PPO Disclosure for Covered California - Spanish (PDF)
- 2019 – EnhancedCare PPO Disclosure for Covered California - Chinese (PDF)
- 2019 – EnhancedCare PPO Disclosure for Covered California - Korean (PDF)
- 2019 – EnhancedCare PPO Disclosure for Covered California - Vietnamese (PDF)
Brochures
- 2019 – Plan choices by location (PDF) (IFP on- and off-exchange)
- 2019 – Sales Brochure (PDF)
- 2019 – Heal - doctor house calls (PDF) (for PPO and EnhancedCare PPO plans only)
Enrollment Tools
- Hardship Exemption Form (external website)
*Please choose the document from the third bullet under "Step 1: Identify the correct form for you." - 2019 – Rate Guide (1/2019) (PDF)
- 2019 – 2019 Desktopper (PDF)
Individual & Family Plans (IFP) Enrollment Applications - Effective January 1, 2019
HMO
- 2019 – IFP CommunityCare HMO Enrollment Application - English (PDF)
- 2019 – IFP CommunityCare HMO Enrollment Application - Spanish (PDF)
- 2019 – IFP CommunityCare HMO Enrollment Application - Chinese (PDF)
- 2019 – IFP CommunityCare HMO Enrollment Application - Korean (PDF)
- 2019 – IFP CommunityCare HMO Enrollment Application - Vietnamese (PDF)
HSP
- 2019 – IFP PureCare HSP Enrollment Application - English (PDF)
- 2019 – IFP PureCare HSP Enrollment Application - Spanish (PDF)
- 2019 – IFP PureCare HSP Enrollment Application - Chinese (PDF)
- 2019 – IFP PureCare HSP Enrollment Application - Korean (PDF)
- 2019 – IFP PureCare HSP Enrollment Application - Vietnamese (PDF)
EPO
- 2019 – IFP PureCare One EPO Enrollment Application - English (PDF)
- 2019 – IFP PureCare One EPO Enrollment Application - Spanish (PDF)
- 2019 – IFP PureCare One EPO Enrollment Application - Chinese (PDF)
- 2019 – IFP PureCare One EPO Enrollment Application - Korean (PDF)
- 2019 – IFP PureCare One EPO Enrollment Application - Vietnamese (PDF)
PPO
- 2019 – IFP PPO Enrollment Application - English (PDF)
- 2019 – IFP PPO Enrollment Application - Spanish (PDF)
- 2019 – IFP PPO Enrollment Application - Chinese (PDF)
- 2019 – IFP PPO Enrollment Application - Korean (PDF)
- 2019 – IFP PPO Enrollment Application - Vietnamese (PDF)
EnhancedCare PPO
- 2019 – IFP EnhancedCare PPO Enrollment Application - English (PDF)
- 2019 – IFP EnhancedCare PPO Enrollment Application - Spanish (PDF)
- 2019 – IFP EnhancedCare PPO Enrollment Application - Chinese (PDF)
- 2019 – IFP EnhancedCare PPO Enrollment Application - Korean (PDF)
- 2019 – IFP EnhancedCare PPO Enrollment Application - Vietnamese (PDF)
2019 CommunityCare HMO Plan Overviews
- 2019 – Platinum 90 CommunityCare HMO (PDF)
- 2019 – Gold 80 CommunityCare HMO (PDF)
- 2019 – Silver 70 Off Exchange CommunityCare HMO (PDF)
2019 PureCare HSP Plan Overviews
2019 PureCare One EPO Plan Overviews
- 2019 – Platinum 90 PureCare One EPO (PDF)
- 2019 – Gold 80 PureCare One EPO (PDF)
- 2019 – Silver 70 Off Exchange PureCare One EPO (PDF)
- 2019 – Bronze 60 PureCare One EPO (PDF)
- 2019 – Minimum Coverage PureCare One EPO (PDF)
2019 PPO Plan Overviews
- 2019 – Platinum 90 PPO (PDF)
- 2019 – Gold 80 PPO (PDF)
- 2019 – Silver 70 PPO (PDF)
- 2019 – Bronze 60 PPO (PDF)
- 2019 – Minimum Coverage PPO (PDF)
2019 EnhancedCare PPO Plan Overviews
- 2019 – Platinum 90 EnhancedCare PPO (PDF)
- 2019 – Gold 80 EnhancedCare PPO (PDF)
- 2019 – Silver 70 Off Exchange EnhancedCare PPO (PDF)
- 2019 – Bronze 60 EnhancedCare PPO (PDF)
- 2019 – Bronze 60 HDHP EnhancedCare PPO (PDF)
- 2019 – Minimum Coverage EnhancedCare PPO (PDF)
- 2019 – Gold Value EnhancedCare PPO (PDF)
- 2019 – Silver Value EnhancedCare PPO (PDF)
2019 Disclosures
HMO/HSP
- 2019 – CommunityCare HMO and PureCare HSP Disclosure - English (PDF)
- 2019 – CommunityCare HMO and PureCare HSP Disclosure - Spanish (PDF)
- 2019 – CommunityCare HMO and PureCare HSP Disclosure - Chinese (PDF)
- 2019 – CommunityCare HMO and PureCare HSP Disclosure - Korean (PDF)
- 2019 – CommunityCare HMO and PureCare HSP Disclosure - Vietnamese (PDF)
EPO
- 2019 – PureCare One EPO Disclosure - English (PDF)
- 2019 – PureCare One EPO Disclosure - Spanish (PDF)
- 2019 – PureCare One EPO Disclosure - Chinese (PDF)
- 2019 – PureCare One EPO Disclosure - Korean (PDF)
- 2019 – PureCare One EPO Disclosure - Vietnamese (PDF)
PPO
- 2019 – PPO Disclosure - English (PDF)
- 2019 – PPO Disclosure - Spanish (PDF)
- 2019 – PPO Disclosure - Chinese (PDF)
- 2019 – PPO Disclosure - Korean (PDF)
- 2019 – PPO Disclosure - Vietnamese (PDF)
EnhancedCare PPO
- 2019 – EnhancedCare PPO Disclosure - English (PDF)
- 2019 – EnhancedCare PPO Disclosure - Spanish (PDF)
- 2019 – EnhancedCare PPO Disclosure - Chinese (PDF)
- 2019 – EnhancedCare PPO Disclosure - Korean (PDF)
- 2019 – EnhancedCare PPO Disclosure - Vietnamese (PDF)
Dental and Vision
- 2019 – Adult Dental and Vision Coverage with HMO and HSP Health Plans (PDF)
- 2019 – Adult Dental and Vision Coverage with PPO and EPO Health Plans (PDF)
- 2019 – Pediatric Dental/Vision (HMO/HSP) (PDF)
- 2019 – Pediatric Dental/Vision (PPO) (PDF)
- 2019 – Pediatric Dental/Vision (EPO/EnhancedCare PPO) (PDF)
Summary of Benefits and Coverage (SBC)
CommunityCare HMO
- 2020 – Platinum 90 CommunityCare HMO SBC – English (PDF)
- 2020 – Gold 80 CommunityCare HMO SBC – English (PDF)
- 2020 – Silver 70 CommunityCare HMO SBC – English (PDF)
- 2020 – Silver 73 CommunityCare HMO SBC – English (PDF)
- 2020 – Silver 87 CommunityCare HMO SBC – English (PDF)
- 2020 – Silver 94 CommunityCare HMO SBC – English (PDF)
EnhancedCare PPO
- 2020 – Platinum 90 EnhancedCare PPO SBC – English (PDF)
- 2020 – Gold 80 EnhancedCare PPO SBC – English (PDF)
- 2020 – Silver 70 EnhancedCare PPO SBC – English (PDF)
- 2020 – Bronze 60 EnhancedCare PPO SBC – English (PDF)
- 2020 – Bronze 60 HDHP EnhancedCare PPO SBC – English (PDF)
- 2020 – Silver 73 EnhancedCare PPO SBC – English (PDF)
- 2020 – Silver 87 EnhancedCare PPO SBC – English (PDF)
- 2020 – Silver 94 EnhancedCare PPO SBC – English (PDF)
- 2020 – Minimum Coverage EnhancedCare PPO SBC – English (PDF)
PureCare One EPO
- 2020 – Platinum 90 PureCare One EPO SBC – English (PDF)
- 2020 – Gold 80 PureCare One EPO SBC – English (PDF)
- 2020 – Silver 70 PureCare One EPO SBC – English (PDF)
- 2020 – Bronze 60 PureCare One EPO SBC – English (PDF)
- 2020 – Silver 73 PureCare One EPO SBC – English (PDF)
- 2020 – Silver 87 PureCare One EPO SBC – English (PDF)
- 2020 – Silver 94 PureCare One EPO SBC – English (PDF)
- 2020 – Minimum Coverage PureCare One EPO SBC – English (PDF)
PureCare HSP
CommunityCare HMO
- 2020 – Platinum 90 CommunityCare HMO SBC – English (PDF)
- 2020 – Gold 80 CommunityCare HMO SBC – English (PDF)
- 2020 – Silver 70 CommunityCare HMO SBC – English (PDF)
EnhancedCare PPO
- 2020 – Platinum 90 EnhancedCare PPO SBC – English (PDF)
- 2020 – Gold 80 EnhancedCare PPO SBC – English (PDF)
- 2020 – Silver 70 EnhancedCare PPO SBC – English (PDF)
- 2020 – Bronze 60 EnhancedCare PPO SBC – English (PDF)
- 2020 – Bronze 60 HDHP EnhancedCare PPO SBC – English (PDF)
- 2020 – Gold Value EnhancedCare PPO SBC – English (PDF)
- 2020 – Silver Value EnhancedCare PPO SBC – English (PDF)
- 2020 – Minimum Coverage EnhancedCare PPO SBC – English (PDF)
PPO
- 2020 – Platinum 90 PPO SBC – English (PDF)
- 2020 – Gold PPO SBC – English (PDF)
- 2020 – Silver 70 PPO SBC – English (PDF)
- 2020 – Bronze 60 PPO SBC – English (PDF)
- 2020 – Minimum Coverage PPO SBC – English (PDF)
PureCare One EPO
- 2020 – Platinum 90 PureCare One EPO SBC – English (PDF)
- 2020 – Gold 80 PureCare One EPO SBC – English (PDF)
- 2020 – Silver 70 PureCare One EPO SBC – English (PDF)
- 2020 – Bronze 60 PureCare One EPO SBC – English (PDF)
- 2020 – Minimum Coverage PureCare One EPO SBC – English (PDF)
PureCare HSP
CommunityCare HMO AI-AN
- 2020 – Platinum 90 CommunityCare HMO AI-AN SBC – English (PDF)
- 2020 – Gold 80 CommunityCare HMO AI-AN SBC – English (PDF)
- 2020 – Silver 70 CommunityCare HMO AI-AN SBC – English (PDF)
- 2020 – $0 Cost Share CommunityCare HMO AI-AN – English (PDF)
EnhancedCare PPO AI-AN
- 2020 – Platinum 90 EnhancedCare PPO AI-AN SBC – English (PDF)
- 2020 – Gold 80 EnhancedCare PPO AI-AN SBC – English (PDF)
- 2020 – Silver 70 EnhancedCare PPO AI-AN SBC – English (PDF)
- 2020 – Bronze 60 EnhancedCare PPO AI-AN SBC – English (PDF)
- 2020 – Bronze 60 HDHP EnhancedCare PPO AI-AN SBC – English (PDF)
- 2020 – $0 Cost Share EnhancedCare PPO AI-AN – English (PDF)
PureCare One EPO AI-AN
- 2020 – Platinum 90 PureCare One EPO AI-AN SBC – English (PDF)
- 2020 – Gold 80 PureCare One EPO AI-AN SBC – English (PDF)
- 2020 – Silver 70 PureCare One EPO AI-AN SBC – English (PDF)
- 2020 – Bronze 60 PureCare One EPO AI-AN SBC – English (PDF)
- 2020 – $0 Cost Share PureCare One EPO AI-AN – English (PDF)
PureCare HSP AI-AN
CommunityCare HMO
- 2019 – Platinum 90 CommunityCare HMO SBC – English (PDF)
- 2019 – Platinum 90 CommunityCare HMO SBC – Spanish (PDF)
- 2019 – Platinum 90 CommunityCare HMO SBC – Chinese (PDF)
- 2019 – Platinum 90 CommunityCare HMO SBC – Korean (PDF)
- 2019 – Gold 80 CommunityCare HMO SBC – English (PDF)
- 2019 – Gold 80 CommunityCare HMO SBC – Spanish (PDF)
- 2019 – Gold 80 CommunityCare HMO SBC – Chinese (PDF)
- 2019 – Gold 80 CommunityCare HMO SBC – Korean (PDF)
- 2019 – Silver 70 CommunityCare HMO SBC – English (PDF)
- 2019 – Silver 70 CommunityCare HMO SBC – Spanish (PDF)
- 2019 – Silver 70 CommunityCare HMO SBC – Chinese (PDF)
- 2019 – Silver 70 CommunityCare HMO SBC – Korean (PDF)
- 2019 – Silver 73 CommunityCare HMO SBC – English (PDF)
- 2019 – Silver 73 CommunityCare HMO SBC – Spanish (PDF)
- 2019 – Silver 73 CommunityCare HMO SBC – Chinese (PDF)
- 2019 – Silver 73 CommunityCare HMO SBC – Korean (PDF)
- 2019 – Silver 87 CommunityCare HMO SBC – English (PDF)
- 2019 – Silver 87 CommunityCare HMO SBC – Spanish (PDF)
- 2019 – Silver 87 CommunityCare HMO SBC – Chinese (PDF)
- 2019 – Silver 87 CommunityCare HMO SBC – Korean (PDF)
- 2019 – Silver 94 CommunityCare HMO SBC – English (PDF)
- 2019 – Silver 94 CommunityCare HMO SBC – Spanish (PDF)
- 2019 – Silver 94 CommunityCare HMO SBC – Chinese (PDF)
- 2019 – Silver 94 CommunityCare HMO SBC – Korean (PDF)
EnhancedCare PPO
- 2019 – Platinum 90 EnhancedCare PPO SBC – English (PDF)
- 2019 – Platinum 90 EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Platinum 90 EnhancedCare PPO SBC – Chinese (PDF)
- 2019 – Platinum 90 EnhancedCare PPO SBC – Korean (PDF)
- 2019 – Gold 80 EnhancedCare PPO SBC – English (PDF)
- 2019 – Gold 80 EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Gold 80 EnhancedCare PPO SBC – Chinese (PDF)
- 2019 – Gold 80 EnhancedCare PPO SBC – Korean (PDF)
- 2019 – Silver 70 EnhancedCare PPO SBC – English (PDF)
- 2019 – Silver 70 EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Silver 70 EnhancedCare PPO SBC – Chinese (PDF)
- 2019 – Silver 70 EnhancedCare PPO SBC – Korean (PDF)
- 2019 – Bronze 60 EnhancedCare PPO SBC – English (PDF)
- 2019 – Bronze 60 EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Bronze 60 EnhancedCare PPO SBC – Chinese (PDF)
- 2019 – Bronze 60 EnhancedCare PPO SBC – Korean (PDF)
- 2019 – Bronze 60 HDHP EnhancedCare PPO SBC – English (PDF)
- 2019 – Bronze 60 HDHP EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Bronze 60 HDHP EnhancedCare PPO SBC – Chinese (PDF)
- 2019 – Bronze 60 HDHP EnhancedCare PPO SBC – Korean (PDF)
- 2019 – Silver 73 EnhancedCare PPO SBC – English (PDF)
- 2019 – Silver 73 EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Silver 73 EnhancedCare PPO SBC – Chinese (PDF)
- 2019 – Silver 73 EnhancedCare PPO SBC – Korean (PDF)
- 2019 – Silver 87 EnhancedCare PPO SBC – English (PDF)
- 2019 – Silver 87 EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Silver 87 EnhancedCare PPO SBC – Chinese (PDF)
- 2019 – Silver 87 EnhancedCare PPO SBC – Korean (PDF)
- 2019 – Silver 94 EnhancedCare PPO SBC – English (PDF)
- 2019 – Silver 94 EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Silver 94 EnhancedCare PPO SBC – Chinese (PDF)
- 2019 – Silver 94 EnhancedCare PPO SBC – Korean (PDF)
- 2019 – Minimum Coverage EnhancedCare PPO SBC – English (PDF)
- 2019 – Minimum Coverage EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Minimum Coverage EnhancedCare PPO SBC – Chinese (PDF)
- 2019 – Minimum Coverage EnhancedCare PPO SBC – Korean (PDF)
PureCare One EPO
- 2019 – Platinum 90 PureCare One EPO SBC – English (PDF)
- 2019 – Platinum 90 PureCare One EPO SBC – Spanish (PDF)
- 2019 – Platinum 90 PureCare One EPO SBC – Chinese (PDF)
- 2019 – Platinum 90 PureCare One EPO SBC – Korean (PDF)
- 2019 – Gold 80 PureCare One EPO SBC – English (PDF)
- 2019 – Gold 80 PureCare One EPO SBC – Spanish (PDF)
- 2019 – Gold 80 PureCare One EPO SBC – Chinese (PDF)
- 2019 – Gold 80 PureCare One EPO SBC – Korean (PDF)
- 2019 – Silver 70 PureCare One EPO SBC – English (PDF)
- 2019 – Silver 70 PureCare One EPO SBC – Spanish (PDF)
- 2019 – Silver 70 PureCare One EPO SBC – Chinese (PDF)
- 2019 – Silver 70 PureCare One EPO SBC – Korean (PDF)
- 2019 – Bronze 60 PureCare One EPO SBC – English (PDF)
- 2019 – Bronze 60 PureCare One EPO SBC – Spanish (PDF)
- 2019 – Bronze 60 PureCare One EPO SBC – Chinese (PDF)
- 2019 – Bronze 60 PureCare One EPO SBC – Korean (PDF)
- 2019 – Silver 73 PureCare One EPO SBC – English (PDF)
- 2019 – Silver 73 PureCare One EPO SBC – Spanish (PDF)
- 2019 – Silver 73 PureCare One EPO SBC – Chinese (PDF)
- 2019 – Silver 73 PureCare One EPO SBC – Korean (PDF)
- 2019 – Silver 87 PureCare One EPO SBC – English (PDF)
- 2019 – Silver 87 PureCare One EPO SBC – Spanish (PDF)
- 2019 – Silver 87 PureCare One EPO SBC – Chinese (PDF)
- 2019 – Silver 87 PureCare One EPO SBC – Korean (PDF)
- 2019 – Silver 94 PureCare One EPO SBC – English (PDF)
- 2019 – Silver 94 PureCare One EPO SBC – Spanish (PDF)
- 2019 – Silver 94 PureCare One EPO SBC – Chinese (PDF)
- 2019 – Silver 94 PureCare One EPO SBC – Korean (PDF)
- 2019 – Minimum Coverage PureCare One EPO SBC – English (PDF)
- 2019 – Minimum Coverage PureCare One EPO SBC – Spanish (PDF)
- 2019 – Minimum Coverage PureCare One EPO SBC – Chinese (PDF)
- 2019 – Minimum Coverage PureCare One EPO SBC – Korean (PDF)
PureCare HSP
- 2019 – Bronze 60 PureCare HSP SBC – English (PDF)
- 2019 – Bronze 60 PureCare HSP SBC – Spanish (PDF)
- 2019 – Bronze 60 PureCare HSP SBC – Chinese (PDF)
- 2019 – Bronze 60 PureCare HSP SBC – Korean (PDF)
- 2019 – Minimum Coverage PureCare HSP SBC – English (PDF)
- 2019 – Minimum Coverage PureCare HSP SBC – Spanish (PDF)
- 2019 – Minimum Coverage PureCare HSP SBC – Chinese (PDF)
- 2019 – Minimum Coverage PureCare HSP SBC – Korean (PDF)
CommunityCare HMO
- 2019 – Platinum 90 CommunityCare HMO SBC – English (PDF)
- 2019 – Platinum 90 CommunityCare HMO SBC – Spanish (PDF)
- 2019 – Platinum 90 CommunityCare HMO SBC – Chinese (PDF)
- 2019 – Platinum 90 CommunityCare HMO SBC – Korean (PDF)
- 2019 – Gold 80 CommunityCare HMO SBC – English (PDF)
- 2019 – Gold 80 CommunityCare HMO SBC – Spanish (PDF)
- 2019 – Gold 80 CommunityCare HMO SBC – Chinese (PDF)
- 2019 – Gold 80 CommunityCare HMO SBC – Korean (PDF)
- 2019 – Silver 70 CommunityCare HMO SBC – English (PDF)
- 2019 – Silver 70 CommunityCare HMO SBC – Spanish (PDF)
- 2019 – Silver 70 CommunityCare HMO SBC – Chinese (PDF)
- 2019 – Silver 70 CommunityCare HMO SBC – Korean (PDF)
EnhancedCare PPO
- 2019 – Platinum 90 EnhancedCare PPO SBC – English (PDF)
- 2019 – Platinum 90 EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Platinum 90 EnhancedCare PPO SBC – Chinese (PDF)
- 2019 – Platinum 90 EnhancedCare PPO SBC – Korean (PDF)
- 2019 – Gold 80 EnhancedCare PPO SBC – English (PDF)
- 2019 – Gold 80 EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Gold 80 EnhancedCare PPO SBC – Chinese (PDF)
- 2019 – Gold 80 EnhancedCare PPO SBC – Korean (PDF)
- 2019 – Silver 70 EnhancedCare PPO SBC – English (PDF)
- 2019 – Silver 70 EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Silver 70 EnhancedCare PPO SBC – Chinese (PDF)
- 2019 – Silver 70 EnhancedCare PPO SBC – Korean (PDF)
- 2019 – Bronze 60 EnhancedCare PPO SBC – English (PDF)
- 2019 – Bronze 60 EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Bronze 60 EnhancedCare PPO SBC – Chinese (PDF)
- 2019 – Bronze 60 EnhancedCare PPO SBC – Korean (PDF)
- 2019 – Bronze 60 HDHP EnhancedCare PPO SBC – English (PDF)
- 2019 – Bronze 60 HDHP EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Bronze 60 HDHP EnhancedCare PPO SBC – Chinese (PDF)
- 2019 – Bronze 60 HDHP EnhancedCare PPO SBC – Korean (PDF)
- 2019 – Gold Value EnhancedCare PPO SBC – English (PDF)
- 2019 – Gold Value EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Gold Value EnhancedCare PPO SBC – Chinese (PDF)
- 2019 – Gold Value EnhancedCare PPO SBC – Korean (PDF)
- 2019 – Silver Value EnhancedCare PPO SBC – English (PDF)
- 2019 – Silver Value EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Silver Value EnhancedCare PPO SBC – Chinese (PDF)
- 2019 – Silver Value EnhancedCare PPO SBC – Korean (PDF)
- 2019 – Minimum Coverage EnhancedCare PPO SBC – English (PDF)
- 2019 – Minimum Coverage EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Minimum Coverage EnhancedCare PPO SBC – Chinese (PDF)
- 2019 – Minimum Coverage EnhancedCare PPO SBC – Korean (PDF)
PPO
- 2019 – Platinum 90 PPO SBC – English (PDF)
- 2019 – Platinum 90 PPO SBC – Spanish (PDF)
- 2019 – Platinum 90 PPO SBC – Chinese (PDF)
- 2019 – Platinum 90 PPO SBC – Korean (PDF)
- 2019 – Gold PPO SBC – English (PDF)
- 2019 – Gold 80 PPO SBC – Spanish (PDF)
- 2019 – Gold 80 PPO SBC – Chinese (PDF)
- 2019 – Gold 80 PPO SBC – Korean (PDF)
- 2019 – Silver 70 PPO SBC – English (PDF)
- 2019 – Silver 70 PPO SBC – Spanish (PDF)
- 2019 – Silver 70 PPO SBC – Chinese (PDF)
- 2019 – Silver 70 PPO SBC – Korean (PDF)
- 2019 – Bronze 60 PPO SBC – English (PDF)
- 2019 – Bronze 60 PPO SBC – Spanish (PDF)
- 2019 – Bronze 60 PPO SBC – Chinese (PDF)
- 2019 – Bronze 60 PPO SBC – Korean (PDF)
- 2019 – Minimum Coverage PPO SBC – English (PDF)
- 2019 – Minimum Coverage PPO SBC – Spanish (PDF)
- 2019 – Minimum Coverage PPO SBC – Chinese (PDF)
- 2019 – Minimum Coverage PPO SBC – Korean (PDF)
PureCare One EPO
- 2019 – Platinum 90 PureCare One EPO SBC – English (PDF)
- 2019 – Platinum 90 PureCare One EPO SBC – Spanish (PDF)
- 2019 – Platinum 90 PureCare One EPO SBC – Chinese (PDF)
- 2019 – Platinum 90 PureCare One EPO SBC – Korean (PDF)
- 2019 – Gold 80 PureCare One EPO SBC – English (PDF)
- 2019 – Gold 80 PureCare One EPO SBC – Spanish (PDF)
- 2019 – Gold 80 PureCare One EPO SBC – Chinese (PDF)
- 2019 – Gold 80 PureCare One EPO SBC – Korean (PDF)
- 2019 – Silver 70 PureCare One EPO SBC – English (PDF)
- 2019 – Silver 70 PureCare One EPO SBC – Spanish (PDF)
- 2019 – Silver 70 PureCare One EPO SBC – Chinese (PDF)
- 2019 – Silver 70 PureCare One EPO SBC – Korean (PDF)
- 2019 – Bronze 60 PureCare One EPO SBC – English (PDF)
- 2019 – Bronze 60 PureCare One EPO SBC – Spanish (PDF)
- 2019 – Bronze 60 PureCare One EPO SBC – Chinese (PDF)
- 2019 – Bronze 60 PureCare One EPO SBC – Korean (PDF)
- 2019 – Minimum Coverage PureCare One EPO SBC – English (PDF)
- 2019 – Minimum Coverage PureCare One EPO SBC – Spanish (PDF)
- 2019 – Minimum Coverage PureCare One EPO SBC – Chinese (PDF)
- 2019 – Minimum Coverage PureCare One EPO SBC – Korean (PDF)
PureCare HSP
- 2019 – Bronze 60 PureCare HSP SBC – English (PDF)
- 2019 – Bronze 60 PureCare HSP SBC – Spanish (PDF)
- 2019 – Bronze 60 PureCare HSP SBC – Chinese (PDF)
- 2019 – Bronze 60 PureCare HSP SBC – Korean (PDF)
- 2019 – Minimum Coverage PureCare HSP SBC – English (PDF)
- 2019 – Minimum Coverage PureCare HSP SBC – Spanish (PDF)
- 2019 – Minimum Coverage PureCare HSP SBC – Chinese (PDF)
- 2019 – Minimum Coverage PureCare HSP SBC – Korean (PDF)
CommunityCare HMO AI-AN
- 2019 – Platinum 90 CommunityCare HMO SBC – English (PDF)
- 2019 – Platinum 90 CommunityCare HMO SBC – Spanish (PDF)
- 2019 – Platinum 90 CommunityCare HMO SBC – Chinese (PDF)
- 2019 – Platinum 90 CommunityCare HMO SBC – Korean (PDF)
- 2019 – Gold 80 CommunityCare HMO SBC – English (PDF)
- 2019 – Gold 80 CommunityCare HMO SBC – Spanish (PDF)
- 2019 – Gold 80 CommunityCare HMO SBC – Chinese (PDF)
- 2019 – Gold 80 CommunityCare HMO SBC – Korean (PDF)
- 2019 – Silver 70 CommunityCare HMO SBC – English (PDF)
- 2019 – Silver 70 CommunityCare HMO SBC – Spanish (PDF)
- 2019 – Silver 70 CommunityCare HMO SBC – Chinese (PDF)
- 2019 – Silver 70 CommunityCare HMO SBC – Korean (PDF)
- 2019 – $0 Cost Share CommunityCare HMO AI-AN – English (PDF)
- 2019 – $0 Cost Share CommunityCare HMO AI-AN – Spanish (PDF)
- 2019 – $0 Cost Share CommunityCare HMO AI-AN – Chinese (PDF)
- 2019 – $0 Cost Share CommunityCare HMO AI-AN – Korean (PDF)
EnhancedCare PPO AI-AN
- 2019 – Platinum 90 EnhancedCare PPO AI-AN SBC – English (PDF)
- 2019 – Platinum 90 EnhancedCare PPO SBC – Spanish (PDF)
- 2019 – Platinum 90 EnhancedCare PPO AI-AN SBC – Chinese (PDF)
- 2019 – Platinum 90 EnhancedCare PPO AI-AN SBC – Korean (PDF)
- 2019 – Gold 80 EnhancedCare PPO AI-AN SBC – English (PDF)
- 2019 – Gold 80 EnhancedCare PPO AI-AN SBC – Spanish (PDF)
- 2019 – Gold 80 EnhancedCare PPO AI-AN SBC – Chinese (PDF)
- 2019 – Gold 80 EnhancedCare PPO AI-AN SBC – Korean (PDF)
- 2019 – Silver 70 EnhancedCare PPO AI-AN SBC – English (PDF)
- 2019 – Silver 70 EnhancedCare PPO AI-AN SBC – Spanish (PDF)
- 2019 – Silver 70 EnhancedCare PPO AI-AN SBC – Chinese (PDF)
- 2019 – Silver 70 EnhancedCare PPO AI-AN SBC – Korean (PDF)
- 2019 – Bronze 60 EnhancedCare PPO AI-AN SBC – English (PDF)
- 2019 – Bronze 60 EnhancedCare PPO AI-AN SBC – Spanish (PDF)
- 2019 – Bronze 60 EnhancedCare PPO AI-AN SBC – Chinese (PDF)
- 2019 – Bronze 60 EnhancedCare PPO AI-AN SBC – Korean (PDF)
- 2019 – Bronze 60 HDHP EnhancedCare PPO AI-AN SBC – English (PDF)
- 2019 – Bronze 60 HDHP EnhancedCare PPO AI-AN SBC – Spanish (PDF)
- 2019 – Bronze 60 HDHP EnhancedCare PPO AI-AN SBC – Chinese (PDF)
- 2019 – Bronze 60 HDHP EnhancedCare PPO AI-AN SBC – Korean (PDF)
- 2019 – $0 Cost Share EnhancedCare PPO AI-AN – English (PDF)
- 2019 – $0 Cost Share EnhancedCare PPO AI-AN – Spanish (PDF)
- 2019 – $0 Cost Share EnhancedCare PPO AI-AN – Chinese (PDF)
- 2019 – $0 Cost Share EnhancedCare PPO AI-AN – Korean (PDF)
PureCare One EPO AI-AN
- 2019 – Platinum 90 PureCare One EPO AI-AN SBC – English (PDF)
- 2019 – Platinum 90 PureCare One EPO AI-AN SBC – Spanish (PDF)
- 2019 – Platinum 90 PureCare One EPO AI-AN SBC – Chinese (PDF)
- 2019 – Platinum 90 PureCare One EPO AI-AN SBC – Korean (PDF)
- 2019 – Gold 80 PureCare One EPO AI-AN SBC – English (PDF)
- 2019 – Gold 80 PureCare One EPO AI-AN SBC – Spanish (PDF)
- 2019 – Gold 80 PureCare One EPO AI-AN SBC – Chinese (PDF)
- 2019 – Gold 80 PureCare One EPO AI-AN SBC – Korean (PDF)
- 2019 – Silver 70 PureCare One EPO AI-AN SBC – English (PDF)
- 2019 – Silver 70 PureCare One EPO AI-AN SBC – Spanish (PDF)
- 2019 – Silver 70 PureCare One EPO AI-AN SBC – Chinese (PDF)
- 2019 – Silver 70 PureCare One EPO AI-AN SBC – Korean (PDF)
- 2019 – Bronze 60 PureCare One EPO AI-AN SBC – English (PDF)
- 2019 – Bronze 60 PureCare One EPO AI-AN SBC – Spanish (PDF)
- 2019 – Bronze 60 PureCare One EPO AI-AN SBC – Chinese (PDF)
- 2019 – Bronze 60 PureCare One EPO AI-AN SBC – Korean (PDF)
- 2019 – $0 Cost Share PureCare One EPO AI-AN – English (PDF)
- 2019 – $0 Cost Share PureCare One EPO AI-AN – Spanish (PDF)
- 2019 – $0 Cost Share PureCare One EPO AI-AN – Chinese (PDF)
- 2019 – $0 Cost Share PureCare One EPO AI-AN – Korean (PDF)
PureCare HSP AI-AN
- 2019 – Bronze 60 PureCare HSP AI-AN SBC – English (PDF)
- 2019 – Bronze 60 PureCare HSP AI-AN SBC – Spanish (PDF)
- 2019 – Bronze 60 PureCare HSP AI-AN SBC – Chinese (PDF)
- 2019 – Bronze 60 PureCare HSP AI-AN SBC – Korean (PDF)
- 2019 – $0 Cost Share PureCare HSP AI-AN – English (PDF)
- 2019 – $0 Cost Share PureCare HSP AI-AN – Spanish (PDF)
- 2019 – $0 Cost Share PureCare HSP AI-AN – Chinese (PDF)
- 2019 – $0 Cost Share PureCare HSP AI-AN – Korean (PDF)
Looking for a Summary of Benefits and Coverage for a specific plan? Use our SBC Search Tool
Plan Contract and Evidence of Coverage/Policies
Evidence of Coverage for CommunityCare HMO Covered California Plans
- 2019 – Platinum 90 CommunityCare HMO (PDF)
- 2019 – Gold 80 CommunityCare HMO (PDF)
- 2019 – Silver 70 CommunityCare HMO (PDF)
- 2019 – Silver 73 (CSR) CommunityCare HMO (PDF)
- 2019 – Silver 87 (CSR) CommunityCare HMO (PDF)
- 2019 – Silver 94 (CSR) CommunityCare HMO (PDF)
Covered California Evidence of Coverage for PureCare HSP PureCare Plans
Covered California Policies for PureCare One EPO Plans
- 2019 – Platinum 90 PureCare One EPO (PDF)
- 2019 – Gold 80 PureCare One EPO (PDF)
- 2019 – Silver 70 PureCare One EPO (PDF)
- 2019 – Silver 73 (CSR) PureCare One EPO (PDF)
- 2019 – Silver 87 (CSR) PureCare One EPO (PDF)
- 2019 – Silver 94 (CSR) PureCare One EPO (PDF)
- 2019 – Bronze 60 PureCare One EPO (PDF)
- 2019 – Minimum Coverage PureCare One EPO (PDF)
Covered California Policies for EnhancedCare PPO Plans
- 2019 – Platinum 90 EnhancedCare PPO (PDF)
- 2019 – Gold 80 EnhancedCare PPO (PDF)
- 2019 – Silver 70 EnhancedCare PPO (PDF)
- 2019 – Silver 73 (CSR) EnhancedCare PPO (PDF)
- 2019 – Silver 87 (CSR) EnhancedCare PPO (PDF)
- 2019 – Silver 94 (CSR) EnhancedCare PPO (PDF)
- 2019 – Bronze 60 EnhancedCare PPO (PDF)
- 2019 – Bronze 60 HDHP EnhancedCare PPO (PDF)
- 2019 – Minimum Coverage EnhancedCare PPO (PDF)
Evidence of Coverage for CommunityCare HMO Plans (off Marketplace)
- 2019 – Platinum 90 CommunityCare HMO (PDF)
- 2019 – Platinum 90 CommunityCare HMO Plus with Dental and Vision (PDF)
- 2019 – Gold 80 CommunityCare HMO (PDF)
- 2019 – Gold 80 CommunityCare HMO Plus with Dental and Vision (PDF)
- 2019 – Silver 70 Off Exchange CommunityCare HMO (PDF)
- 2019 – Silver 70 Off Exchange CommunityCare HMO Plus with Dental and Vision (PDF)
Evidence of Coverage for HSP PureCare Plans (off Marketplace)
- 2019 – Bronze 60 PureCare HSP (PDF)
- 2019 – Bronze 60 PureCare HSP Plus with Dental and Vision (PDF)
- 2019 – Minimum Coverage PureCare HSP (PDF)
- 2019 – Minimum Coverage PureCare HSP Plus with Dental and Vision (PDF)
Policies for EPO PureCare One Plans (off Marketplace)
- 2019 – Platinum 90 EPO (PDF)
- 2019 – Platinum 90 EPO with Dental and Vision (PDF)
- 2019 – Gold 80 EPO (PDF)
- 2019 – Gold 80 EPO with Dental and Vision (PDF)
- 2019 – Silver 70 Off Exchange EPO (PDF)
- 2019 – Silver 70 Off Exchange EPO with Dental and Vision (PDF)
- 2019 – Bronze 60 EPO (PDF)
- 2019 – Bronze 60 EPO with Dental and Vision (PDF)
- 2019 – Minimum Coverage EPO (PDF)
- 2019 – Minimum Coverage EPO with Dental and Vision (PDF)
Policies for PPO Plans (off Marketplace)
- 2019 – Platinum 90 PPO (PDF)
- 2019 – Platinum 90 PPO with Dental and Vision (PDF)
- 2019 – Gold 80 PPO (PDF)
- 2019 – Gold 80 PPO with Dental and Vision (PDF)
- 2019 – Silver 70 PPO (PDF)
- 2019 – Silver 70 PPO with Dental and Vision (PDF)
- 2019 – Bronze 60 PPO (PDF)
- 2019 – Bronze 60 PPO with Dental and Vision (PDF)
- 2019 – Minimum Coverage PPO (PDF)
- 2019 – Minimum Coverage PPO with Dental and Vision (PDF)
Policies for EnhancedCare PPO Plans (off Marketplace)
- 2019 – Platinum 90 EnhancedCare PPO (PDF)
- 2019 – Platinum 90 EnhancedCare PPO with Dental and Vision (PDF)
- 2019 – Gold 80 EnhancedCare PPO (PDF)
- 2019 – Gold 80 EnhancedCare PPO with Dental and Vision (PDF)
- 2019 – Gold Value EnhancedCare PPO (PDF)
- 2019 – Gold Value EnhancedCare PPO with Dental and Vision (PDF)
- 2019 – Silver 70 Off Exchange EnhancedCare PPO (PDF)
- 2019 – Silver 70 Off Exchange EnhancedCare PPO with Dental and Vision (PDF)
- 2019 – Silver Value EnhancedCare PPO (PDF)
- 2019 – Silver Value EnhancedCare PPO with Dental and Vision (PDF)
- 2019 – Bronze 60 EnhancedCare PPO (PDF)
- 2019 – Bronze 60 EnhancedCare PPO with Dental and Vision (PDF)
- 2019 – Bronze 60 HDHP EnhancedCare PPO (PDF)
- 2019 – Bronze 60 HDHP EnhancedCare PPO with Dental and Vision (PDF)
- 2019 – Minimum Coverage EnhancedCare PPO (PDF)
- 2019 – Minimum Coverage EnhancedCare PPO with Dental and Vision (PDF)
Other Documents
Compliance Forms
- Authorization for Disclosure of Protected Health Information - English (PDF)
- Authorization for Disclosure of Protected Health Information - Spanish (PDF)
- Authorization for Disclosure of Protected Health Information - Chinese (PDF)
- Authorization for Disclosure of Protected Health Information - Korean (PDF)
- Glossary of Health Coverage and Medical Terms - English (PDF)
- Glossary of Health Coverage and Medical Terms - Spanish (PDF)
- Glossary of Health Coverage and Medical Terms - Chinese (PDF)
- Glossary of Health Coverage and Medical Terms - Korean (PDF)
- Glossary of Health Coverage and Medical Terms - Navajo (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. Please log in to request a hardcopy of the document by mail.