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All documents are in PDF format. 
2019 Plan Materials
Brochures
- Plan choices by location (PDF) (IFP on- and off-exchange)
- IEX Sales Brochure - English (PDF)
- IEX CommunityCare HMO Sales Brochure (PDF)
- IEX EnhancedCare PPO Sales Brochure (PDF)
- IEX PureCare HSP Sales Brochure (PDF)
- IEX PureCare One EPO Sales Brochure (PDF)
- Self-Referring Made Easy flyer (PDF)
- Heal - doctor house calls (PDF) (for PPO and EnhancedCare PPO plans only)
- Heal - doctor house calls - Spanish (PDF) (for PPO and EnhancedCare PPO plans only)
2019 CommunityCare HMO Plan Overviews
- Platinum 90 CommunityCare HMO (PDF)
- Gold 80 CommunityCare HMO (PDF)
- Silver 70 CommunityCare HMO (PDF)
CommunityCare HMO Silver Cost-Sharing Reduction Plan Overviews
- Silver 73 CommunityCare HMO CSR (PDF)
- Silver 87 CommunityCare HMO CSR (PDF)
- Silver 94 CommunityCare HMO CSR (PDF)
2019 PureCare HSP Plan Overviews
2019 PureCare One EPO Plan Overviews
- Platinum 90 PureCare One EPO (PDF)
- Gold 80 PureCare One EPO (PDF)
- Silver 70 PureCare One EPO (PDF)
- Silver 73 PureCare One EPO (PDF)
- Silver 87 PureCare One EPO (PDF)
- Silver 94 PureCare One EPO (PDF)
- Bronze 60 PureCare One EPO (PDF)
- Minimum Coverage PureCare One EPO (PDF)
2019 EnhancedCare PPO Plan Overviews
- Platinum 90 EnhancedCare PPO (PDF)
- Gold 80 EnhancedCare PPO (PDF)
- Silver 70 EnhancedCare PPO (PDF)
- Silver 73 EnhancedCare PPO (PDF)
- Silver 87 EnhancedCare PPO (PDF)
- Silver 94 EnhancedCare PPO (PDF)
- Bronze 60 EnhancedCare PPO (PDF)
- Bronze 60 HDHP EnhancedCare PPO (PDF)
- Minimum Coverage EnhancedCare PPO (PDF)
2019 Disclosures
- CommunityCare HMO and PureCare HSP Disclosure for Covered California - English (PDF)
- PureCare One EPO Disclosure for Covered California - English (PDF)
- PureCare One EPO Disclosure for Covered California - Spanish (PDF)
- PureCare One EPO Disclosure for Covered California - Chinese (PDF)
- PureCare One EPO Disclosure for Covered California - Korean (PDF)
- EnhancedCare PPO Disclosure for Covered California - English (PDF)
- EnhancedCare PPO Disclosure for Covered California - Spanish (PDF)
- EnhancedCare PPO Disclosure for Covered California - Chinese (PDF)
- EnhancedCare PPO Disclosure for Covered California - Korean (PDF)
Brochures
- Plan choices by location (PDF) (IFP on- and off-exchange)
- Sales Brochure (PDF)
- Self-Referring Made Easy flyer (PDF)
- Heal - doctor house calls (PDF) (for PPO and EnhancedCare PPO plans only)
- Heal - doctor house calls - Spanish (PDF) (for PPO and EnhancedCare PPO plans only)
Individual & Family Plans (IFP) Enrollment Applications - Effective January 1, 2019
- IFP CommunityCare HMO Enrollment Application - English (PDF)
- IFP PureCare HSP Enrollment Application - English (PDF)
- IFP PureCare One EPO Enrollment Application - English (PDF)
- IFP PPO Enrollment Application - English (PDF)
- IFP EnhancedCare PPO Enrollment Application - English (PDF)
- Hardship Exemption Form
*Please choose the document from the third bullet under "Step 1: Identify the correct form for you." - Rate Guide (1/2019) (PDF)
- 2019 Desktopper (PDF)
2019 CommunityCare HMO Plan Overviews
- Platinum 90 CommunityCare HMO (PDF)
- Gold 80 CommunityCare HMO (PDF)
- Silver 70 Off Exchange CommunityCare HMO (PDF)
2019 PureCare HSP Plan Overviews
2019 PureCare One EPO Plan Overviews
- Platinum 90 PureCare One EPO (PDF)
- Gold 80 PureCare One EPO (PDF)
- Silver 70 Off Exchange PureCare One EPO (PDF)
- Bronze 60 PureCare One EPO (PDF)
- Minimum Coverage PureCare One EPO (PDF)
2019 PPO Plan Overviews
- Platinum 90 PPO (PDF)
- Gold 80 PPO (PDF)
- Silver 70 PPO (PDF)
- Bronze 60 PPO (PDF)
- Minimum Coverage PPO (PDF)
2019 EnhancedCare PPO Plan Overviews
- Platinum 90 EnhancedCare PPO (PDF)
- Gold 80 EnhancedCare PPO (PDF)
- Silver 70 Off Exchange EnhancedCare PPO (PDF)
- Bronze 60 EnhancedCare PPO (PDF)
- Bronze 60 HDHP EnhancedCare PPO (PDF)
- Minimum Coverage EnhancedCare PPO (PDF)
- Gold Value EnhancedCare PPO (PDF)
- Silver Value EnhancedCare PPO (PDF)
2019 Disclosures
- CommunityCare HMO and PureCare HSP Disclosure - English (PDF)
- PureCare One EPO Disclosure - English (PDF)
- PureCare One EPO Disclosure - Spanish (PDF)
- PureCare One EPO Disclosure - Chinese (PDF)
- PureCare One EPO Disclosure - Korean (PDF)
- PPO Disclosure - English (PDF)
- PPO Disclosure - Spanish (PDF)
- PPO Disclosure - Chinese (PDF)
- PPO Disclosure - Korean (PDF)
- EnhancedCare PPO Disclosure - English (PDF)
- EnhancedCare PPO Disclosure - Spanish (PDF)
- EnhancedCare PPO Disclosure - Chinese (PDF)
- EnhancedCare PPO Disclosure - Korean (PDF)
Dental and Vision
Evidence of Coverage for CommunityCare HMO Covered California Plans
- Platinum 90 CommunityCare HMO (PDF)
- Gold 80 CommunityCare HMO (PDF)
- Silver 70 CommunityCare HMO (PDF)
- Silver 73 (CSR) CommunityCare HMO (PDF)
- Silver 87 (CSR) CommunityCare HMO (PDF)
- Silver 94 (CSR) CommunityCare HMO (PDF)
Covered California Evidence of Coverage for PureCare HSP PureCare Plans
Covered California Policies for PureCare One EPO Plans
- Platinum 90 PureCare One EPO (PDF)
- Gold 80 PureCare One EPO (PDF)
- Silver 70 PureCare One EPO (PDF)
- Silver 73 (CSR) PureCare One EPO (PDF)
- Silver 87 (CSR) PureCare One EPO (PDF)
- Silver 94 (CSR) PureCare One EPO (PDF)
- Bronze 60 PureCare One EPO (PDF)
- Minimum Coverage PureCare One EPO (PDF)
Covered California Policies for EnhancedCare PPO Plans
- Platinum 90 EnhancedCare PPO (PDF)
- Gold 80 EnhancedCare PPO (PDF)
- Silver 70 EnhancedCare PPO (PDF)
- Silver 73 (CSR) EnhancedCare PPO (PDF)
- Silver 87 (CSR) EnhancedCare PPO (PDF)
- Silver 94 (CSR) EnhancedCare PPO (PDF)
- Bronze 60 EnhancedCare PPO (PDF)
- Bronze 60 HDHP EnhancedCare PPO (PDF)
- Minimum Coverage EnhancedCare PPO (PDF)
Evidence of Coverage for CommunityCare HMO Plans (off Marketplace)
- Platinum 90 CommunityCare HMO (PDF)
- Platinum 90 CommunityCare HMO Plus with Dental and Vision (PDF)
- Gold 80 CommunityCare HMO (PDF)
- Gold 80 CommunityCare HMO Plus with Dental and Vision (PDF)
- Silver 70 Off Exchange CommunityCare HMO (PDF)
- Silver 70 Off Exchange CommunityCare HMO Plus with Dental and Vision (PDF)
Evidence of Coverage for HSP PureCare Plans (off Marketplace)
- Bronze 60 PureCare HSP (PDF)
- Bronze 60 PureCare HSP Plus with Dental and Vision (PDF)
- Minimum Coverage PureCare HSP (PDF)
- Minimum Coverage PureCare HSP Plus with Dental and Vision (PDF)
Policies for EPO PureCare One Plans (off Marketplace)
- Platinum 90 EPO (PDF)
- Platinum 90 EPO with Dental and Vision (PDF)
- Gold 80 EPO (PDF)
- Gold 80 EPO with Dental and Vision (PDF)
- Silver 70 Off Exchange EPO (PDF)
- Silver 70 Off Exchange EPO with Dental and Vision (PDF)
- Bronze 60 EPO (PDF)
- Bronze 60 EPO with Dental and Vision (PDF)
- Minimum Coverage EPO (PDF)
- Minimum Coverage EPO with Dental and Vision (PDF)
Policies for PPO Plans (off Marketplace)
- Platinum 90 PPO (PDF)
- Platinum 90 PPO with Dental and Vision (PDF)
- Gold 80 PPO (PDF)
- Gold 80 PPO with Dental and Vision (PDF)
- Silver 70 PPO (PDF)
- Silver 70 PPO with Dental and Vision (PDF)
- Bronze 60 PPO (PDF)
- Bronze 60 PPO with Dental and Vision (PDF)
- Minimum Coverage PPO (PDF)
- Minimum Coverage PPO with Dental and Vision (PDF)
Policies for EnhancedCare PPO Plans (off Marketplace)
- Platinum 90 EnhancedCare PPO (PDF)
- Platinum 90 EnhancedCare PPO with Dental and Vision (PDF)
- Gold 80 EnhancedCare PPO (PDF)
- Gold 80 EnhancedCare PPO with Dental and Vision (PDF)
- Gold Value EnhancedCare PPO (PDF)
- Gold Value EnhancedCare PPO with Dental and Vision (PDF)
- Silver 70 Off Exchange EnhancedCare PPO (PDF)
- Silver 70 Off Exchange EnhancedCare PPO with Dental and Vision (PDF)
- Silver Value EnhancedCare PPO (PDF)
- Silver Value EnhancedCare PPO with Dental and Vision (PDF)
- Bronze 60 EnhancedCare PPO (PDF)
- Bronze 60 EnhancedCare PPO with Dental and Vision (PDF)
- Bronze 60 HDHP EnhancedCare PPO (PDF)
- Bronze 60 HDHP EnhancedCare PPO with Dental and Vision (PDF)
- Minimum Coverage EnhancedCare PPO (PDF)
- Minimum Coverage EnhancedCare PPO with Dental and Vision (PDF)
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.
2018 Plan Materials
Only available if you qualify for Special Enrollment Period
Brochures
- Plan choices by location (PDF) (IFP on- and off-exchange)
- Sales Brochure - English (PDF) | Sales Brochure - Spanish (PDF) | Sales Brochure - Chinese (PDF)
- Self-Referring Made Easy flyer (PDF)
- Heal - doctor house calls (PDF) (for PPO and EnhancedCare PPO plans only)
- Heal - doctor house calls - Spanish (PDF) (for PPO and EnhancedCare PPO plans only)
2018 CommunityCare HMO Plan Overviews
- Platinum 90 CommunityCare HMO (PDF)
- Gold 80 CommunityCare HMO (PDF)
- Silver 70 CommunityCare HMO (PDF)
CommunityCare HMO Silver Cost-Sharing Reduction Plan Overviews
- Silver 73 CommunityCare HMO CSR (PDF)
- Silver 87 CommunityCare HMO CSR (PDF)
- Silver 94 CommunityCare HMO CSR (PDF)
2018 PureCare HSP Plan Overviews
2018 PureCare One EPO Plan Overviews
- Platinum 90 PureCare One EPO (PDF)
- Gold 80 PureCare One EPO (PDF)
- Silver 70 PureCare One EPO (PDF)
- Silver 73 PureCare One EPO (PDF)
- Silver 87 PureCare One EPO (PDF)
- Silver 94 PureCare One EPO (PDF)
- Bronze 60 PureCare One EPO (PDF)
- Minimum Coverage PureCare One EPO (PDF)
2018 EnhancedCare PPO Plan Overviews
- Platinum 90 EnhancedCare PPO (PDF)
- Gold 80 EnhancedCare PPO
- Silver 70 EnhancedCare PPO (PDF)
- Silver 73 EnhancedCare PPO (PDF)
- Silver 87 EnhancedCare PPO (PDF)
- Silver 94 EnhancedCare PPO (PDF)
- Bronze 60 EnhancedCare PPO (PDF)
- Minimum Coverage EnhancedCare PPO (PDF)
2018 Disclosures
CommunityCare HMO and PureCare HSP Disclosure for Covered California
- CommunityCare HMO and PureCare HSP Disclosure for Covered California - English (PDF)
- CommunityCare HMO and PureCare HSP Disclosure for Covered California - Spanish (PDF)
- CommunityCare HMO and PureCare HSP Disclosure for Covered California - Chinese (PDF)
- CommunityCare HMO and PureCare HSP Disclosure for Covered California - Korean (PDF)
PureCare One EPO Disclosure for Covered California
- PureCare One EPO Disclosure for Covered California - English (PDF)
- PureCare One EPO Disclosure for Covered California - Spanish (PDF)
- PureCare One EPO Disclosure for Covered California - Chinese (PDF)
- PureCare One EPO Disclosure for Covered California - Korean (PDF)
EnhancedCare PPO Disclosure for Covered California
Brochures
- Plan choices by location (PDF) (IFP on- and off-exchange)
- Sales Brochure (PDF)
- Meet EnhancedCare PPO Brochure (PDF)
- Ins and Outs of the EnhancedCare PPO Network (PDF)
- Self-Referring Made Easy flyer (PDF)
- Heal - doctor house calls (PDF) (for PPO and EnhancedCare PPO plans only)
- Heal - doctor house calls - Spanish (PDF) (for PPO and EnhancedCare PPO plans only)
Individual & Family Plans (IFP) Enrollment Applications - Effective January 1, 2018
Open Enrollment for 2018 has ended. You may qualify for a Special Enrollment Period. Learn More
- IFP CommunityCare HMO Enrollment Application - English (PDF)
- IFP CommunityCare HMO Enrollment Application - Spanish (PDF)
- IFP CommunityCare HMO Enrollment Application - Chinese (PDF)
- IFP CommunityCare HMO Enrollment Application - Korean (PDF)
- IFP PureCare HSP Enrollment Application - English (PDF)
- IFP PureCare HSP Enrollment Application - Spanish (PDF)
- IFP PureCare HSP Enrollment Application - Chinese (PDF)
- IFP PureCare HSP Enrollment Application - Korean (PDF)
- IFP PureCare One EPO Enrollment Application - English (PDF)
- IFP PureCare One EPO Enrollment Application - Spanish (PDF)
- IFP PureCare One EPO Enrollment Application - Chinese (PDF)
- IFP PureCare One EPO Enrollment Application - Korean (PDF)
- IFP PPO Enrollment Application - English (PDF)
- IFP PPO Enrollment Application - Spanish (PDF)
- IFP PPO Enrollment Application - Chinese (PDF)
- IFP PPO Enrollment Application - Korean (PDF)
- IFP EnhancedCare PPO Enrollment Application - English (PDF)
- IFP EnhancedCare PPO Enrollment Application - Spanis (PDF)
- IFP EnhancedCare PPO Enrollment Application - Chinese (PDF)
- IFP EnhancedCare PPO Enrollment Application - Korean (PDF)
- Hardship Exemption Form (PDF)
- Rate Guide (1/2018) (PDF)
- 2018 Desktopper (PDF)
CommunityCare HMO Plan Overviews
- Platinum 90 CommunityCare HMO (PDF)
- Gold 80 CommunityCare HMO (PDF)
- Silver 70 Off Exchange CommunityCare HMO (PDF)
PureCare HSP Plan Overviews
PureCare One EPO Plan Overviews
- Platinum 90 PureCare One EPO (PDF)
- Gold 80 PureCare One EPO (PDF)
- Silver 70 Off Exchange PureCare One EPO (PDF)
- Bronze 60 PureCare One EPO (PDF)
- Minimum Coverage PureCare One EPO (PDF)
PPO Plan Overviews
- Platinum 90 PPO (PDF)
- Gold 80 PPO (PDF)
- Silver 70 PPO (PDF)
- Bronze 60 PPO (PDF)
- Minimum Coverage PPO (PDF)
EnhancedCare PPO Plan Overviews
- Platinum 90 EnhancedCare PPO (PDF)
- Gold 80 EnhancedCare PPO (PDF)
- Silver 70 Off Exchange EnhancedCare PPO (PDF)
- Bronze 60 EnhancedCare PPO (PDF)
- Minimum Coverage EnhancedCare PPO (PDF)
- Gold Value EnhancedCare PPO (PDF)
- Silver Value EnhancedCare PPO (PDF)
2018 Disclosures
CommunityCare HMO and PureCare HSP Disclosure
- CommunityCare HMO and PureCare HSP Disclosure - English (PDF)
- CommunityCare HMO and PureCare HSP Disclosure - Spanish (PDF)
- CommunityCare HMO and PureCare HSP Disclosure - Chinese (PDF)
- CommunityCare HMO and PureCare HSP Disclosure - Korean (PDF)
PureCare One EPO Disclosure
- PureCare One EPO Disclosure - English (PDF)
- PureCare One EPO Disclosure - Spanish (PDF)
- PureCare One EPO Disclosure - Chinese (PDF)
- PureCare One EPO Disclosure - Korean (PDF)
PPO Disclosure
- PPO Disclosure - English (PDF)
- PPO Disclosure - Spanish (PDF)
- PPO Disclosure - Chinese (PDF)
- PPO Disclosure - Korean (PDF)
EnhancedCare PPO Disclosure
- EnhancedCare PPO Disclosure - English (PDF)
- EnhancedCare PPO Disclosure - Spanish (PDF)
- EnhancedCare PPO Disclosure - Chinese (PDF)
- EnhancedCare PPO Disclosure - Korean (PDF)
Dental and Vision
Evidence of Coverage for CommunityCare HMO Covered California Plans
- Platinum 90 CommunityCare HMO (PDF)
- Gold 80 CommunityCare HMO (PDF)
- Silver 70 CommunityCare HMO (PDF)
- Silver 73 (CSR) CommunityCare HMO (PDF)
- Silver 87 (CSR) CommunityCare HMO (PDF)
- Silver 94 (CSR) CommunityCare HMO (PDF)
Covered California Evidence of Coverage for PureCare HSP PureCare Plans
Covered California Policies for PureCare One EPO Plans
- Platinum 90 PureCare One EPO (PDF)
- Gold 80 PureCare One EPO (PDF)
- Silver 70 PureCare One EPO (PDF)
- Silver 73 (CSR) PureCare One EPO (PDF)
- Silver 87 (CSR) PureCare One EPO (PDF)
- Silver 94 (CSR) PureCare One EPO (PDF)
- Bronze 60 PureCare One EPO (PDF)
- Minimum Coverage PureCare One EPO (PDF)
Covered California Policies for EnhancedCare PPO Plans
Evidence of Coverage for CommunityCare HMO Plans (off Marketplace)
- Platinum 90 CommunityCare HMO (PDF)
- Platinum 90 CommunityCare HMO Plus with Dental and Vision (PDF)
- Gold 80 CommunityCare HMO (PDF)
- Gold 80 CommunityCare HMO Plus with Dental and Vision (PDF)
- Silver 70 Off Exchange CommunityCare HMO (PDF)
- Silver 70 Off Exchange CommunityCare HMO Plus with Dental and Vision (PDF)
Evidence of Coverage for HSP PureCare Plans (off Marketplace)
- Bronze 60 PureCare HSP (PDF)
- Bronze 60 PureCare HSP Plus with Dental and Vision (PDF)
- Minimum Coverage PureCare HSP (PDF)
- Minimum Coverage PureCare HSP Plus with Dental and Vision (PDF)
Policies for EPO PureCare One Plans (off Marketplace)
- Platinum 90 EPO (PDF)
- Platinum 90 EPO with Dental and Vision (PDF)
- Gold 80 EPO (PDF)
- Gold 80 EPO with Dental and Vision (PDF)
- Silver 70 Off Exchange EPO (PDF)
- Silver 70 Off Exchange EPO with Dental and Vision (PDF)
- Bronze 60 EPO (PDF)
- Bronze 60 EPO with Dental and Vision (PDF)
- Minimum Coverage EPO (PDF)
- Minimum Coverage EPO with Dental and Vision (PDF)
Policies for PPO Plans (off Marketplace)
- Platinum 90 PPO (PDF)
- Platinum 90 PPO with Dental and Vision (PDF)
- Gold 80 PPO (PDF)
- Gold 80 PPO with Dental and Vision (PDF)
- Silver 70 PPO (PDF)
- Silver 70 PPO with Dental and Vision (PDF)
- Bronze 60 PPO (PDF)
- Bronze 60 PPO with Dental and Vision (PDF)
- Minimum Coverage PPO (PDF)
- Minimum Coverage PPO with Dental and Vision (PDF)
Policies for EnhancedCare PPO Plans (off Marketplace)
- Platinum 90 EnhancedCare PPO (PDF)
- Platinum 90 EnhancedCare PPO with Dental and Vision (PDF)
- Gold 80 EnhancedCare PPO (PDF)
- Gold 80 EnhancedCare PPO with Dental and Vision (PDF)
- Gold Value EnhancedCare PPO (PDF)
- Gold Value EnhancedCare PPO with Dental and Vision (PDF)
- Silver 70 Off Exchange EnhancedCare PPO (PDF)
- Silver 70 Off Exchange EnhancedCare PPO with Dental and Vision (PDF)
- Silver Value EnhancedCare PPO (PDF)
- Silver Value EnhancedCare PPO with Dental and Vision (PDF)
- Bronze 60 EnhancedCare PPO (PDF)
- Bronze 60 EnhancedCare PPO with Dental and Vision (PDF)
- Minimum Coverage EnhancedCare PPO (PDF)
- Minimum Coverage EnhancedCare PPO with Dental and Vision (PDF)
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.