Small Business Health Insurance, Plans, Forms, Applications, Rate Guides, RAF, Anthem Blue Cross Blue Shield Aetna California Choice Health Net Kaiser PacifiCare Sharp UHC in California

Small Group Health Insurance (2-50 employees) - California
This page gives you immediate access to small group health insurance plans, plan descriptions, forms, applications, rate guides, raf, underwriting guidelines, employer handbooks, group admin manuals, dental, vision, life, disibility and other specialty product information from all of the major health insurance carriers in California.
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Group Medical Carriers (CA):	Aetna \| Anthem Blue Cross \| Blue Shield \| California Choice \| Health Net \| Independence American \| HSA California \| Kaiser \| Kaiser Choice Solution \| SeeChange \| Sharp \| UHC / PacifiCare \| Western Health Advantage
Dental Carriers (CA):	Aetna \| Anthem Blue Cross \| Blue Shield \| New Dental Choice \| PacifiCare \| Premier Access \| UHC
Disability Carriers (CA):	American Fidelity \| The Hartford \| The Standard \| Unum
HSA Administration (CA):	First Horizon \| Health Equity \| HSA Bank \| Sterling HSA
Life Carriers (CA):	Aetna \| American Fidelity \| Anthem Blue Cross \| Blue Shield \| The Hartford \| The Standard \| UHC \| Unum
Specialty Products (CA):	Ceridian \| coPower \| Satori
Supplemental & Voluntary (CA):	Aflac \| American Fidelity \| Colonial
Vision Carriers (CA):	Aetna \| Anthem Blue Cross \| Blue Shield \| UHC \| VSP
Wellness At Work (CA):	My Wellchoice+

view / hide Aetna Details
		Rate Guide Effective: 4-1-2012 to 6-30-2012

Applications & Forms..... Group Medical Dental Life Insurance Vision

Aetna Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out pocket max	In-Network Office visits (AD = after deductible)
MC HSA HDHP $2,000 80/50	4-2012	PPO	2000 indiv / 4000 family	5500 indiv / 11000 family	20% co-ins AD	$20 $40 Integrated with medical ded	20% coIns 20% / $0 InP Hosp 20% / $0 OutP Hosp 20% / $0 OutP Facility AD
MC HSA HDHP $3,000 90/50	4-2012	PPO	3000 indiv / 6000 family	5500 indiv / 11000 family	10% co-ins AD	$20 $40 Integrated with medical ded	10% coIns 10% / $0 InP Hosp 10% / $0 OutP Hosp 10% / $0 OutP Facility AD
MC HSA HDHP $3,500 80/50	4-2012	PPO	3500 indiv / 7000 family	4500 indiv / 9000 family	20% co-ins AD	$20 $40 Integrated with medical ded	20% coIns 20% / $0 InP Hosp 20% / $0 OutP Hosp 20% / $0 OutP Facility AD
Aetna HRA / PPO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
MC HRA HDHP $3,000 70/50 New	4-2012	PPO	3000 indiv / 6000 family	4500 indiv / 9000 family	$30 copay deductible waived	$20 $40 Integrated with Medical Ded	30% coIns 30% / $0 InP Hosp 30% / $0 OutP Hosp 30% / $0 OutP Facility AD
Aetna PPO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
MC 10,000 100/50	4-2010 ???	PPO	10000 indiv / 10000 family	0 / 0 ??? ask steve about this	$20 copay deductible waived	$20 $40 $250 ded	0% coIns 0% / $0 InP Hosp 0% / $0 OutP Hosp AD
MC 7,500 75/50 New	4-2012	PPO	7500 indiv / 7500 family	10000 indiv / 10000 family	$30 copay deductible waived	$20 $40 $0 ded	25% coIns 25% / $0 InP Hosp 25% / $0 OutP Hosp 25% / $0 OutP Facility AD
MC 4,500 60/50 New	4-2012	PPO	4500 indiv / 2 mem max	8500 indiv / 2 member max	$40 copay deductible waived	$20 $40 $250 ded	40% coIns 40% / $0 InP Hosp 40% / $250 OutP Hosp 40% / $150 OutP Facility AD
MC 3,500 65/50	4-2012	PPO	3500 indiv / 2 mem max	8500 indiv / 2 member max	$35 copay deductible waived	$20 $40 $250 ded	35% coIns 35% / $0 InP Hosp 35% / $250 OutP Hosp 35% / $150 OutP Facility AD
MC 2,500 75/50	4-2012	PPO	2500 indiv / 2 mem max	7500 indiv / 2 mem max	$25 copay deductible waived	$20 $40 $250 ded	25% coIns 25% / $0 InP Hosp 25% / $250 OutP Hosp 25% / $150 OutP Facility AD
MC $2,000 80/50/50	4-2012	PPO	2000 indiv / 2 mem max	7000 indiv / 2 member max	$25 copay deductible waived	$20 $40 $250 ded	20% coIns 20% / $0 InP Hosp 30% / $0 OutP Hosp 20% / $0 OutP Facility AD
MC $1,250 80/50/50	4-2012	PPO	1250 indiv / 2 mem max	6250 indiv / 2 member max	$25 copay deductible waived	$15 $40 $250 ded	20% coIns 20% / $0 InP Hosp 30% / $0 OutP Hosp 20% / $0 OutP Facility AD
MC $1,000 70/50	4-2012	PPO	1000 indiv / 2 mem max	6000 indiv / 2 member max	$25 copay deductible waived	$15 / $40 / AD	30% coIns 30% / $0 InP Hosp 40% / $250 OutP Hosp 30% / $150 OutP Facility AD
MC Value $2,250 60/50 New	4-2012	PPO	2250 indiv / 3 mem max	7250 indiv / 3 mem max	$40 copay deductible waived	$20 Not Covered AD	40% coIns 40% / $750 InP Hosp 40% / $250 OutP Hosp 40% / $150 OutP Facility AD
MC Value $3,750 50/50 New	4-2012	PPO	3750 indiv / 3 mem max	8750 indiv / 3 mem max	$50 copay deductible waived	$20 Not Covered AD	50% coIns 50% / $750 InP Hosp 50% / $250 OutP Hosp 50% / $150 OutP Facility AD
Aetna PPO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
PPO $750 80/60	4-2012	PPO	750 indiv / 2 mem max	5250 indiv / 2 mem max	$20 copay deductible waived	$15 $40 AD	20% coIns 20% / $250 InP Hosp 30% / $250 OutP Hosp 20% / $150 OutP Facility AD
MC $750 80/50/50	4-2012	PPO	750 indiv / 2 mem max	5750 indiv / 2 mem max	$25 copay deductible waived	$15 $40 $250 ded	20% coIns 20% / $0 InP Hosp 30% / $0 OutP Hosp 20% / $0 OutP Facility AD
MC $500 80/60	4-2012	PPO	500 indiv / 2 mem max	4500 indiv / 2 member max	$35 copay deductible waived	$15 $40 AD	20% coIns 20% / $0 InP Hosp 30% / $150 OutP Hosp 20% / $0 OutP Facility AD
MC $250 80/60	4-2012	PPO	250 indiv / 2 mem max	3750 indiv / 2 member max	$20 copay ded waived	$15 $40 AD	20% coIns AD 20% AD / $0 InP Hosp 30% AD / $0 OutP Hosp 20% ded waived / $0 OutP Facility
MC $250 90/70	4-2012	PPO	250 indiv / 2 mem max	3250 indiv / 2 member max	$20 copay deductible waived	$15 $25 AD	10% coIns AD 10% AD / $0 InP Hosp 20% AD / $0 OutP Hosp 10% ded waived / $0 OutP Facility
Indemnity	4-2012	PPO	500 indiv / 2 mem max	4000 indiv / 2 member max	20% co-ins AD	$10 $25 150 $ded	20% coIns 20% / $250 InP Hosp 30% / $250 OutP Hosp 20% / $0 OutP Facility AD
Aetna HMO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
HMO Coinsurance 70%	4-2012	HMO	0 / 0	3500 indiv / 7000 family	$40 copay	$20 $40 $0 ded	30% coIns 30% / $0 InP Hosp 40% / $0 OutP Hosp 30% / $0 OutP Facility
HMO Coinsurance 60% New	4-2012	HMO	0 / 0	3500 indiv / 7000 family	$40 copay	$20 $40 $200 ded	40% coIns 40% / $0 InP Hosp 50% / $0 OutP Hosp 40% / $0 OutP Facility
HMO Deductible $1,000 70%	4-2012	HMO	1000 indiv / 2000 family	3500 indiv / 7000 family ????? ask steve if adding ded	$40 copay deductible waived	$20 $40 $0 ded	30% coIns 30% / $0 InP Hosp 30% / $0 OutP Hosp 30% / $0 OutP Facility AD
HMO Deductible $1,500 70% New	4-2012	HMO	1500 indiv / 3000 family	3500 indiv / 7000 family ???? ask steve if adding ded	$40 copay deductible waived	$20 $40 $200 ded	30% coIns 30% / $0 InP Hosp 30% / $0 OutP Hosp 30% / $0 OutP Facility AD
HMO $50	4-2012	HMO	0 / 0	4000 indiv / 8000 family	$50 copay	$15 / $35 / $0 ded	0% coIns 0% / $1000 InP Hosp up to 3 days per admit 0% / $500 OutP Hosp 0% / $250 OutP Facility
HMO $40	4-2012	HMO	0 / 0	3500 indiv / 7000 family	$40 copay	$15 / $35 / $0 ded	0% coIns 0% / $750 InP Hosp per day up to 3 days per admit 0% / $400 OutP Hosp 0% / $200 OutP Facility
HMO $30	4-2012	HMO	0 / 0	3000 indiv / 6000 family	$30 copay	$15 $35 $0 ded	0% coIns 0% / $500 InP Hosp per day up to 3 days per admit 0% / $300 OutP Hosp 0% / $150 OutP Facility
HMO $20	4-2012	HMO	0 / 0	2500 indiv / 5000 family	$20 copay	$15 $35 $0 ded	0% coIns 0% / $200 InP Hosp per day up to 3 days per admit 0% / $250 OutP Hosp 0% / $100 OutP Facility
Aetna HMO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
HMO $10	4-2012	HMO	0 / 0	1500 indiv / 3000 family	$10 copay	$15 $35 $0 ded	0% coIns 0% / $100 InP Hosp 0% / $100 OutP Hosp 0% / $0 OutP Facility
Value Network* HMO $40/$50	4-2012	HMO	0 / 0	3500 indiv / 7000 family	$40 copay	$20 $40 $150 ded	0% coIns 0% / $800 InP Hosp per day up to 3 days per admit 0% / $500 OutP Hosp 0% / $400 OutP Facility
Value Network* HMO $30/$40	4-2012	HMO	0 / 0	3000 indiv / 6000 family	$30 copay	$20 $40 $150 ded	0% coIns 0% / $600 InP Hosp per day up to 3 days per admit 0% / $400 OutP Hosp 0% / $300 OutP Facility
Value Network* HMO $20/$30	4-2012	HMO	0 / 0	2500 indiv / 5000 family	$20 copay	$20 $40 $150 ded	0% coIns 0% / $400 InP Hosp per day up to 3 days per admit 0% / $300 OutP Hosp 0% / $200 OutP Facility
Value Network* HMO $10/$20	4-2012	HMO	0 / 0	2000 indiv / 4000 family	$10 copay	$20 $40 $150 ded	0% coIns 0% / $100 InP Hosp per day up to 3 days per admit 0% / $200 OutP Hosp 0% / $100 OutP Facility.
Vitalidad HMO $10	10-2010	HMO	0 / 0	2000 indiv / 4000 family	$0	$10 $10 0 $ded	0% coIns 0% / $100 InP Hosp per day up to $700 per admit 0% / $0 OutP Hosp
Vitalidad Plus California con Aetna HMO $30/$10	10-2010	HMO	0 / 0	3000 indiv / 6000 family	$30 copay	$15 $35 $0 ded	0% coIns 0% / $600 InP Hosp per day up to 3 days per admit 0% / $300 OutP Hosp 0% / $150 OutP Facility
Vitalidad Plus California con Aetna HMO $10/$5	10-2010	HMO	0 / 0	2000 indiv / 4000 family	$10 copay	$15 $35 $0 ded	0% coIns 0% / $100 InP Hosp per day up to 3 days per admit 0% / $100 OutP Hosp 0% / $50 OutP Facility
Aetna HMO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
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		Rate Guides: EE 7-2012 EC 7-2012 BeneFits 7-2012

Applications & Forms..... Group Medical Dental Life Insurance Vision					Provider Networks: California National
Group Admin Manual:		Underwriting Guidelines:			Employer Handbook:

Anthem Blue Cross HSA Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Lumenos HSA 3500 (80/50) *	7-2012	PPO	3500 / 7000 aggregate	5000 / 10000 aggregate	20% co-ins AD	$10 $60 AD	20% coIns 20% / $0 InP 20% / $0 OutP AD
Lumenos HSA 2500 (80/50)	7-2012	PPO	2500 / 5000 aggregate	5000 / 10000 aggregate	20% co-ins AD	$10 $30	20% coIns 20% / $0 InP 20% / $0 OutP AD
Lumenos HSA 1500	10-2010	PPO	1500 / 3000 aggregate	3000 / 6000 aggregate	20% co-ins AD	$10 $30 AD	20% coIns 20% / $0 InP 20% / $0 OutP AD
Lumenos HSA 1500 (80/50)	7-2012	PPO	1500 / 3000 aggregate	3000 / 6000 aggregate	20% co-ins AD	$10 $30	20% coIns 20% / $0 InP 20% / $0 OutP AD
Anthem Blue Cross HIA Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Lumenos® HIA Plus 500 changed to PPO 1500 $35 Copay New	7-2012	PPO	HIA Plus 500 2000 / 4000 aggregate Health Incentive Plan Allocation 500 / 1000 aggregate PPO 1500 $35 1500 / 3000 Health Incentive Plan Allocation does not apply to this new plan. Unused HIA Plus dollars will not roll over upon transition to new plan.	HIA Plus 500 5000 / 10000 aggregate PPO 1500 $35 5000 / 10000 Once payments reach $10,000 per mem, mem pays nothing for covered expenses for the remainder of the year.	HIA Plus 500 40% co-ins AD PPO 1500 $35 $35 copay	HIA Plus 500 $10 $30 AD PPO 1500 $35 $10 $30 $250 ded	HIA Plus 500 40% coIns 40% / $0 InP 40% / $0 OutP AD PPO 1500 $35 40% coIns 40% / $0 InP 50% / $0 (up to maximum Anthem payment of $380 per admit, plus all excess charges). OutP AD
Lumenos® HIA Plus 750 changed to PPO 1000 $25 Copay New	7-2012	PPO	HIA Plus 750 1500 / 3000 aggregate Health Incentive Plan Allocation 750 / 1500 aggregate PPO 1000 $25 1000 / 2000 Health Incentive Plan Allocation does not apply to this new plan. Unused HIA Plus dollars will not roll over upon transition to new plan.	HIA Plus 750 5000 / 10000 aggregate PPO 1000 $25 5000 / 10000 Once payments reach $10,000 per mem, mem pays nothing for covered expenses for the remainder of the year.	HIA Plus 750 25% co-ins AD PPO 1000 $25 $25 copay	HIA Plus 750 $10 $30 AD PPO 1000 $25 $10 $30 $250 ded	HIA Plus 750 25% coIns 25% / $0 InP 25% / $0 OutP AD PPO 1000 $25 30% coIns 30% / $0 inP 30% / $0 outP (up to maximum Anthem payment of $380 per admit, plus all excess charges). OutP AD
Anthem Blue Cross EPO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
High Deductible EPO	2-2011	PPO	2000 / 4000 aggregate	3100 / 5700 aggregate	20% co-ins AD	$10 $25 AD	20% coIns 20% / $0 InP 20% / $0 OutP AD
Anthem Blue Cross HRA Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Lumenos HRA 5000C	7-2012	PPO	5000 / 10000	7000 / 14000	$30	$10 $30	20% coIns 20% / $0 InP 20% / $0 OutP
Lumenos HRA 5000D	7-2012	PPO	5000 / 10000	7000 / 14000	20%	$10 $30	20% coIns 20% / $0 InP 20% / $0 OutP
Lumenos HRA 3000C	7-2012	PPO	3000 / 6000	5000 / 10000	$20 copay	$10 $30	20% coIns 20% / $0 InP 20% / $0 OutP
Lumenos HRA 3000D	10-2011	PPO	3000 / 6000	5000 / 10000	20%	$10 $30	20% coIns 20% / $0 InP 20% / $0 OutP
Anthem Blue Cross ACO PPO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
ACO 20	7-2012	PPO	ACO Providers None PPO Providers 750 / 2250	ACO Providers 4000 / 8000 PPO Providers 5750 / 12250	ACO $20 PPO $55	PPO Providers Only $10 $30 $150 ded	ACO Providers 20% coIns 0% / $1000 InP * 20% / $500 OutP PPO Providers 20% coIns 20% / $0 InP 20% / $0 OutP AD
ACO 30 *	7-2012	PPO	ACO Providers None PPO Providers 1500 / 4500	ACO Providers 5000 / 10000 PPO Providers 7500 / 16500	ACO $30 PPO $55	PPO Providers Only $10 $30 $150 ded	ACO Providers 30% coIns 0% / $1500 InP 30% / $750 OutP PPO Providers 30% coIns 30% / $0 InP 30% / $0 OutP AD
Anthem Blue Cross Solution PPO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Solution 2500 PPO *	7-2012	PPO	2500 / 5000	6000 / 12000	$30 copay	$10 $45 $500 ded	30% coIns 30% / $0 InP 30% / $0 OutP AD
Solution 3500 PPO *	7-2012	PPO	3500 / 7000	6500 / 13000	$40 copay	$10 $45 $500 ded	40% coIns 40% / $0 InP 40% / $0 OutP AD
Solution 3500 PPO (No Contraceptive) NEW	7-2012	PPO	3500 / 7000	6500 / 13000	$40 copay	$10 $45 $500 ded	40% coIns 40% / $0 InP 40% / $0 OutP AD
Solution 5000 PPO *	7-2012	PPO	5000 / 10000	8000 / 16000	$45 copay	$10 $45 $500 ded	45% coIns 45% / $0 InP 45% / $0 OutP AD
Anthem Blue Cross PPO Copay Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
PPO $40 Copay	7-2012	PPO	750 / 1500	5000 / 10000	40 copay	$10 $30 $150 ded	40% coIns 40% / $0 InP 40% / $0 OutP AD
PPO $30 Copay	7-2012	PPO	500 / 1000	4500 / 9000	$30 copay	$10 $30 $150 ded	30% coIns 30% / $0 InP 30% / $0 OutP AD
PPO $20 Copay	7-2012	PPO	250 / 500	4000 / 8000	$20 copay	$10 $30 $150 ded	20% coIns 20% / $0 InP 20% / $0 OutP AD
Anthem Blue Cross PPO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
PPO 1000 / $25	7-2012	PPO	1000 / 2000	5000 / 10000	$25 copay	$10 $30 $250 ded	30% coIns 30% / $0 InP 30% / $0 OutP AD
PPO 1500 / $35	7-2012	PPO	1500 / 3000	5000 / 10000	$35 copay	$10 $30 $250 ded	40% coIns 40% / $0 InP 40% / $0 OutP AD
PPO 2000 / $45	7-2012	PPO	2000 / 4000	5000 / 10000	$45 copay	$10 $30 $250 ded	40% coIns 40% / $0 InP 40% / $0 OutP AD
Anthem Blue Cross GenRX PPO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
PPO $45 Copay GenRx	7-2012	PPO	750 / 1500	5000 / 10000	$45 copay	$10 na $0 ded	45% coIns 45% / $0 InP 45% / $0 OutP AD
PPO $35 Copay GenRx	10-2011	PPO	500 / 1000	4500 / 9000	$35 copay	$10 na 0 $ded	35% coIns 35% / $0 InP 35% / $0 OutP AD
PPO $25 Copay GenRx	7-2012	PPO	250 / 500	4000 / 8000	$25 copay	$10 na $0 ded	25% coIns 25% / $0 InP 25% / $0 OutP AD
Anthem Blue Cross Premier PPO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Premier PPO $30 Copay *	7-2012	PPO	500 / 1000	4000 / 8000	$30 copay	$10 $25 $0 ded	30% coIns 30% / $0 InP 30% / $0 OutP AD
Premier PPO $20 Copay	7-2012	PPO	250 / 500	3500 / 7000	$20 copay	$10 $30 $0 ded	20% coIns 20% / $0 InP 20% / $0 OutP AD
Premier PPO $10 Copay	7-2012	PPO	250 / 500	3000 / 6000	$10 copay	$10 $30 $0 ded	10% coIns 10% / $0 InP 10% / $0 OutP AD
Anthem Blue Cross Elements Hospital PPO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Elements Hospital	10-2011	PPO	2000 / 4000	5000 / 10000	na	$10 na	30% coIns 30% / $0 InP 30% / $0 OutP AD
Elements Hospital Plus *	7-2012	PPO	1500 / 3000	5000 / 10000	50% co-ins	$10 na No Ded	30% coIns 30% / $0 InP 30% / $0 OutP AD
Elements Hospital Preferred	7-2012	PPO	1250 / 2500	5000 / 10000	50% co-ins	$10 $35 $250 ded	20% coIns 20% / $0 InP 20% / $0 OutP AD
Anthem Blue Cross Hospital Benefits PPO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Hospital Benefits	10-2011	PPO	2000 / 4000	5000 / 10000	na	$15 n/a	30% coIns 30% / $0 InP 30% / $0 OutP AD
Hospital Benefits Plus	7-2012	PPO	1500 / 3000	5000 / 10000	50% co-ins	$15 n/a	30% coIns 30% / $0 InP 30% / $0 OutP AD
Hospital Benefits Preferred	10-2011	PPO	1250 / 2500	5000 / 10000	50% co-ins	$15 n/a	30% coIns 30% / $0 InP 30% / $0 OutP
Anthem Blue Cross Saver HMO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Saver 20 HMO	7-2012	HMO	0 / 0	2500 / 5000 aggregate	$20 copay	$10 $30 $150 ded	0% coIns 0% / $0 InP 0% / $300 OutP
Saver 30 HMO	7-2012	HMO	0 / 0	3500 / 7000 aggregate	$30 copay	$10 $30 $150 ded	0% coIns 0% / $0 InP 0% / $500 OutP
Saver 40 HMO	7-2012	HMO	0 / 0	4000 / 8000 aggregate	$40 copay	$10 $30 $250 ded	0% coIns 0% / $0 InP 0% / $500 OutP
Anthem Blue Cross Saver Select Network HMO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Saver 20 HMO (Select Network)	7-2012	HMO	0 / 0	2500 / 5000 aggregate	$20 copay	$10 $30 $150 ded	0% coIns 0% / $0 InP 0% / $300 OutP
Saver 30 HMO (Select Network)	7-2012	HMO	0 / 0	3500 / 7000 aggregate	$30 copay	$10 $30 $150 ded	0% coIns 0% / $0 InP 0% / $500 OutP
Saver 40 HMO (Select Network)	10-2011	HMO	0 / 0	4000 / 8000 aggregate	$40 copay	$10 $30 250 $ded	0% coIns 0% / $0 InP 0% / $500 OutP
Anthem Blue Cross Classic HMO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Classic 20 HMO	7-2012	HMO	0 / 0	2000 / 4000 aggregate	$20 copay	$10 $30 $150 ded	0% coIns 0% / $0 InP 20% / $0 OutP
Classic 30 HMO	7-2012	HMO	0 / 0	3000 / 6000 aggregate	$30 copay	$10 $30 $150 ded	0% coIns 0% / $0 InP 20% / $0 OutP
Classic 30 HMO (no contraceptive) New Plan	7-2012	HMO	0 / 0	3000 / 6000 aggregate	$30 copay	$10 $30 $150 ded	0% coIns 0% / $0 InP 20% / $0 OutP
Classic 40 HMO	7-2012	HMO	0 / 0	3500 / 7000 aggregate	$40 copay	$10 $30 $250 ded	0% coIns 0% / $0 InP 30% / $0 OutP
Anthem Blue Cross Classic Select Network HMO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Classic 20 HMO (Select Network)	7-2012	HMO	0 / 0	2000 / 4000 aggregate	$20 copay	$10 $30 $150 ded	0% coIns 0% / $0 InP 20% / $0 OutP
Classic 30 HMO (Select Network) *	7-2012	HMO	0 / 0	3000 / 6000 aggregate	$30 copay	$10 $60 $150 ded	0% coIns 0% / $0 InP 20% / $0 OutP
Classic 40 HMO (Select Network)	7-2012	HMO	0 / 0	3500 / 7000 aggregate	$40 copay	$10 $30 $250 ded	0% coIns 0% / $0 InP 30% / $0 OutP
Anthem Blue Cross HMO Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
HMO $25 100%	7-2012	HMO	0 / 0	2000 / 4000 aggregate	$25 copay	$10 $30 $150 ded	0% coIns 0% / $0 InP 0% / $0 OutP
HMO $10 100%	7-2012	HMO	0 / 0	1750 / 3500 aggregate	$10 copay	$10 $30 $150 ded	0% coIns 0% / $0 InP 0% / $0 OutP
Anthem Blue Cross HMO Select Network Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
HMO $25 100% (Select Network) *	7-2012	HMO	0 / 0	2000 / 4000 aggregate	$25 copay	$10 $30 $150 ded	0% coIns 0% / $0 InP 0% / $0 OutP
HMO $10 100% (Select Network)	7-2012	HMO	0 / 0	1750 / 3500 aggregate	$10 copay	$10 $30 $150 ded	0% coIns 0% / $0 InP 0% / $0 OutP
Anthem Blue Cross HMO Select Network Plans	Effective	Network	In-Network (Ded Sgl/Fam)	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
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				Rate Guide Eff: 7-2012

Applications & Forms..... Group Medical Dental Life Insurance Vision					Provider Networks: California National
Group Admin Manual:		Underwriting Guidelines:				Employer Handbook:
Blue Shield Plans	Effective	Network	In-Network Deductible (Sgl / Fam)	In-Network Out of Pocket Max (Sgl / Fam)	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
	Effective	Network	In-Network Deductible (Sgl / Fam)	In-Network Out of Pocket Max (Sgl / Fam)	In-Network Office visits (AD = after deductible)
Base PPO 30	7-2012	PPO	3000 / 6000	5000 / 10000	$30 visit	$10 $30 $300 ded	30% coIns 30% / $0 InP 30% / $0 OutP AD
Base PPO 40	7-2012	PPO	4000 / 8000	6000 / 12000	$40 visit	$10 $30 $300 ded	40% coIns 40% / $0 InP 40% / $0 OutP AD
Base PPO 50	7-2012	PPO	5000 / 10000	7000 / 14000	$50 visit	$10 $30 $300 ded	50% coIns 50% / $0 InP 50% / $0 OutP AD
Blue Shield Enhanced PPO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Enhanced PPO 15 New	7-2012	PPO	500 / 1000	3000 / 6000	$15 visit	$10 $30 $300 ded	25% coIns 25% / $0 InP 25% / $0 OutP AD
Enhanced PPO 25 New	7-2012	PPO	500 / 1000	3000 / 6000	$25 visit	$10 $30 $0 ded	25% coIns 25% / $0 InP 25% / $0 OutP AD
Enhanced PPO 30 New	7-2012	PPO	1500 / 3000	5000 / 10000	$30 visit	$10 $30 $300 ded	40% coIns 40% / $0 InP 40% / $0 OutP AD
Enhanced PPO 35 New	7-2012	PPO	1500 / 3000	5000 / 10000	$35 visit	$10 $30 $300 ded	45% coIns 45% / $0 InP 45% / $0 OutP AD
Enhanced PPO 40 New	7-2012	PPO	2000 / 4000	6000 / 12000	$40 visit	$10 $30 $300 ded	50% coIns 50% / $0 InP 50% / $0 OutP AD
Enhanced PPO 45 New	7-2012	PPO	2000 / 4000	6000 / 12000	$45 visit	$10 $30 $300 ded	50% coIns 50% / $0 InP 50% / $0 OutP AD
Blue Shield Premier PPO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Premier PPO 5 New	7-2012	PPO	250 / 500	1500 / 2500	$5 visit	$10 $30 $0 ded	5% coIns 5% / $0 InP 5% / $0 OutP AD
Premier PPO 15 New	7-2012	PPO	250 / 500	2000 / 4000	$15 visit	$10 $30 $0 ded	15% coIns 15% / $0 InP 15% / $0 OutP AD
Premier PPO 20 New	7-2012	PPO	500 / 1000	3000 / 6000	$20 visit	$10 $30 $0 ded	20% coIns 20% / $0 InP 20% / $0 OutP AD
Premier PPO 25 New	7-2012	PPO	500 / 1000	3000 / 6000	$25 visit	$10 $30 $0 ded	25% coIns 25% / $0 InP 25% / $0 OutP AD
Premier PPO 35 New	7-2012	PPO	750 / 1500	4000 / 8000	$35 visit	$10 $30 $0 ded	35% coIns 35% / $0 InP 35% / $0 OutP AD
Premier PPO 45 New	7-2012	PPO	1000 / 2000	5000 / 10000	$45 visit	$10 $30 $0 ded	45% coIns 45% / $0 InP 45% / $0 OutP AD
Blue Shield Sheild Spectrum PPO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Shield Spectrum PPO 2500 Value	7-2012	PPO	2500 / 5000	5500 / 11000	$45 copay 3 visits before meeting ded, subsequent visits are subject to ded	$15 $30 $250 ded	35% AD coIns 35% / $1000 AD InP 35% / $500 per surgery AD OutP
Shield Spectrum PPO 1500 Value	7-2012	PPO	1500 / 3000	4500 / 9000	$30 copay 3 visits before meeting ded, subsequent visits are subject to ded	$15 $30 or 30% $250 ded	30% AD coIns 30% / $1000 per year AD InP 30% / $500 per surgery AD OutP
Shield Spectrum PPO 1000 Value	7-2012	PPO	1000 / 2000	4000 / 8000	$20 copay 3 visits before meeting ded, subsequent visits are subject to ded	$15 $30 or 30% $250 ded	30% AD coIns 30% / $500 AD InP 30% / $250 per surgery AD OutP
Shield Spectrum PPO 750 Value	7-2012	PPO	750 / 1500	4000 / 8000	$15 copay 3 visits before meeting ded, subsequent visits are subject to ded	$15 $30 or 30% $250 ded	30% AD coIns 30% / $500 AD InP 30% / $250 per surgery AD OutP
Blue Shield Simple Savings PPO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Simple Savings 2500 / 5000	7-2012	HMO HSA	2500 / 5000	3500 / 7000	20% co-ins	$10 $30 AD	20% coIns 20% / $0 InP 20% / $0 OutP AD
Simple Savings 3400 / 6800	7-2012	HMO HSA	3400 / 6800	4250 / 8500	20% co-ins	$10 $30 AD	20% coIns 20% / $0 InP 20% / $0 OutP AD
Simple Savings 3500 / 7000	7-2012	HMO HSA	3500 / 7000	4500 / 9000	20% co-ins	$10 $30 AD	20% coIns 20% / $0 InP 20% / $0 OutP AD
Simple Savings 4500 / 9000	7-2012	HMO HSA	4500 / 9000	5500 / 11000	20% co-ins	$10 $30 AD	20% coIns 20% / $0 InP 20% / $0 OutP AD
Simple Savings 5500 / 11000	7-2012	HMO HSA	5500 / 11000	5950 / 11900	0% co-ins	$10 $30 AD	0% coIns 0% / $0 InP 0% / $0 OutP AD
Blue Shield Access+ HMO Enhanced Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Access+ HMO Enhanced 15	7-2012	HMO	0 / 0	2000 / 4000	$15 copay	$10 $30 $300 ded	15% coIns 15% / $0 InP 15% / $0 OutP
Access+ HMO Enhanced 25	7-2012	HMO	0 / 0	3000 / 6000	$25 copay	$10 $30 $300 ded	25% coIns 25% / $0 InP 25% / $0 OutP
Access+ HMO Enhanced 35	7-2012	HMO	0 / 0	4000 / 8000	$35 copay	$10 $30 $300 ded	35% coIns 35% / $0 InP 35% / $0 OutP
Access+ HMO Enhanced 40	7-2012	HMO	0 / 0	4500 / 9000	$40 copay	$10 $30 $300 ded	40% coIns 40% / $0 InP 40% / $0 OutP
Access+ HMO Enhanced 45	7-2012	HMO	0 / 0	5000 / 10000	$45 copay	$10 $30 $300 ded	45% coIns 45% / $0 InP 45% / $0 OutP
Blue Shield Access+ HMO Premier Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Access+ HMO Premier Plan 15	7-2012	HMO	0 / 0	1500 / 3000	$15 copay	$10 $30 $0 ded	0% coIns 0% / $150 per day, 3 days max per admit InP 0% / $150 per surgery OutP
Access+ HMO Premier Plan 25	7-2012	HMO	0 / 0	2500 / 5000	$25 copay	$10 $30 $0 ded	0% coIns 0% / $250 per day, 3 days max per admit InP 0% / $300 per surgery OutP
Access+ HMO Premier Plan 35	7-2012	HMO	0 / 0	3500 / 7000	$35 copay	$10 $30 $0 ded	0% coIns 0% / $350 per day, 3 days max per admit InP 0% / $750 per surgery OutP
Access+ HMO Premier Plan 45	1-2012	HMO	0 / 0	4500 / 9000	$45 copay	$10 $30 $0 ded	0% coIns 0% / $450 InP 0% / $1000 OutP
Blue Shield Local Access+ HMO Enhanced Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Local Access+ HMO Enhanced 15	7-2012	HMO	0 / 0	2000 / 4000	$15 copay	$10 $30 $300 ded	15% coIns 15% / $0 InP 15% / $0 OutP
Local Access+ HMO Enhanced 25	7-2012	HMO	0 / 0	3000 / 6000	$25 copay	$10 $30 $300 ded	25% coIns 25% / $0 InP 25% / $0 OutP
Local Access+ HMO Enhanced 35	7-2012	HMO	0 / 0	4000 / 8000	$35 copay	$10 $30 $300 ded	35% coIns 35% / $0 InP 35% / $0 OutP
Local Access+ HMO Enhanced 45	7-2012	HMO	0 / 0	5000 / 10000	$45 copay	$10 $30 $300 ded	45% coIns 45% / $0 InP 45% / $0 OutP
Blue Shield Local Access+ HMO Premier Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Local Access+ HMO Premier 15	7-2012	HMO	0 / 0	1500 / 3000	$15 copay	$10 $30 $0 ded	0% coIns 0% / $150 per day, 3 days max per admit InP 0% / $150 surgery OutP
Local Access+ HMO Premier 25	7-2012	HMO	0 / 0	2500 / 5000	$25 copay	$10 $30 $0 ded	0% coIns 0% / $250 per day, 3 days max per admit InP 0% / $300 surgery OutP
Local Access+ HMO Premier 35	1-2012	HMO	0 / 0	3500 / 7000	$35 copay	$10 $30 $0 ded	0% coIns 0% / $350 per day, 3 days max per admit InP 0% / $750 surgery OutP
Local Access+ HMO Premier 45	7-2012	HMO	0 / 0	4500 / 9000	$45 copay	$10 $30 $0 ded	0% coIns 0% / $450 per day, 3 days max per admit InP 0% / $1000 surgery OutP
Blue Shield HMO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Access Baja® HMO Plan 10	7-2012	HMO	0 / 0	1000 / 2000	$10 copay	$10 $10 $0 ded	0% coIns 0% / $100 per day, 10 days per calendar year InP 0% / $50 OutP
Blue Shield HMO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
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	Rate Guide Effective: 7-1-2012 to 12-1-2012

Applications & Forms..... Group Medical						Provider Networks
Group Admin Manual:		Underwriting Guidelines:				Employer Handbook:
California Choice Plans		Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
		Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)
CalChoice PPO 750		1-2012	PPO	750 / 2250 aggregate	4000 indiv / 8000 family	$35 copay	$15 $30 $150 ded	20% coIns 20% / $500 InP 20% / $500 OutP
CalChoice PPO 750 GenRx		1-2012	PPO	750 / 2250 aggregate	4500 indiv / 9000 family	$35 copay	$15 not covered	35% coIns 35% / $500 InP 35% / $500 OutP
CalChoice PPO 1000		1-2012	PPO	1000 / 3000 aggregate	5000 indiv/ 10000 family	$40 copay	$15 $30 $200 ded	30% coIns 30% / $1000 InP 30% / $500 OutP
CalChoice PPO 1000 GenRx		1-2012	PPO	1000 / 3000 aggregate	5000 indiv/ 10000 family	$45 copay	$15 not covered	45% coIns 45% / $500 InP 45% / $500 OutP
CalChoice PPO 1500 New		7-2012	PPO	1500 / 4500 aggregate	5000 / 10000	$40 copay	$15 $35 $500 ded	30% coIns 30% / $1000 InP 30% / $500 OutP
CalChoice PPO 1750 GenRx New		7-2012	PPO	1750 / 5200 aggregate	6000 / 12000	$45 copay	$15 not covered	45% coIns 45% / $1000 InP 45% / $500 OutP
CalChoice PPO 3000		1-2012	PPO	3000 / 9000 aggregate	7000 indiv/ 14000 family	$30 copay	$15 $30 $250 ded	30% coIns 30% / $1000 InP 30% / $500 OutP
CalChoice PPO 4000		1-2012	PPO	4000 / 10000 aggregate	7000 indiv/ 14000 family	$40 copay	$15 $30 $250 ded	40% coIns 40% / $500 InP 40% / $500 OutP
CalChoice PPO 2400		1-2010	PPO	2400 / 7200 aggregate	5000 indiv / 10000 family	$40 copay	$15 $30 250 $ded	0% 30% / $500 30% / $500
California Choice Active Choice & HSA Plans		Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Active Choice 500		1-2010	PPO	0 / 0	5000 / 10000 First Dollar Coverage $500 / $1000	0% up to $500 ind / $1,000 family	$15 $30 $500 ded	25% 25% / $500 25% / $400
CalChoice HSA 1500		1-2010	HSA	1500 / 3000 aggregate	2800 / 5600	20% AD	$15 $30 AD	20% 20% / $0 20% / $0 AD
CalChoice HSA 2400		1-2010	HSA	2400 / 4800 aggregate	3200 / 5800	20% AD	$15 $30 AD	20% 20% / $0 20% / $0 AD
CalChoice HSA 2500 (3V7) Participating Health Plans: Health Net		7-09	HSA	2500 / 5000	5000 / 10000	$25 AD	$15 $30 AD	30% 30% / $0 30% / $0 AD
CalChoice HSA 3500 (3V6) Participating Health Plans: Health Net		7-09	HSA	3500 / 7000	5000 / 10000	$35 AD	$15 $30 AD	30% 30% / $0 30% / $0 AD
CalChoice HSA 4500 (3V5) Participating Health Plans: Health Net		7-09	HSA	4500 / 9000	5600 / 11200	$45 AD	$15 $30 AD	40% 40% / $0 40% / $0 AD
California Choice Lumenos HSA Plans		Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Lumenos HSA 1800		1-2012	PPO HSA	1800 / 3600	3000 indiv / 5500 family	20%	$15 $30	20% coIns 20% / $0 InP 20% / $0 OutP
Lumenos HSA 2500		1-2012	PPO HSA	2500 / 5000	4000 indiv / 6000 family	20%	$20 $30	20% coIns 20% / $0 InP 20% / $0 OutP
California Choice EOA Plans		Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Elect Open Access Participating Health Plans: Health Net		1-2012	HMO PPO	0 / 0	3000 indiv / 6000 two party / 7000 family	$25 copay HMO / $40 copay PPO	$15 $30 $100 ded	25% coIns 25% / $0 InP 25% / $0 OutP
EOA 25 Plus Participating Health Plans: Health Net		1-2012	HMO PPO	0 / 0	3000 indiv / 6000 two party / 7000 family	$25 copay HMO / $40 copay PPO	$15 $30 $100 ded	0% coIns 0% / $450 per day, max $1800 InP 0% / $400 OutP
EOA 40 Plus Participating Health Plans: Health Net		1-2012	HMO PPO	0 / 0	3500 indiv / 7000 two party / 8000 family	$40 copay HMO / $55 copay PPO	$20 $30 $200 ded	0% coIns 0% / $500 per day 0% / $500 OutP
California Choice HMO Plans		Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
CalChoice HMO 15 Participating Health Plans: Anthem Blue Cross, Health Net, Kaiser, Sharp, Western Health Advantage		1-2012	HMO	0 / 0	2000 indiv / 4000 family	$15 copay	$10 $20 $0 ded	0% 0% / $400 0% / $200
CalChoice HMO 25 Participating Health Plans: Anthem Blue Cross		1-2012	HMO	0 / 0	3000 indiv / 6000 family	$25 copay	$15 $30 $100 ded	0% 0% / $400 per day, max $1800 0% / $400
CalChoice HMO 25 Participating Health Plans: Health Net		1-2012	HMO	0 / 0	3000 indiv / 6000 family	$25 copay	$15 $30 $100 ded	0% 0% / $450 per day, max $1800 0% / $400
CalChoice HMO 25 Participating Health Plans: Kaiser Permanente		1-2012	HMO	0 / 0	2500 indiv / 5000 family	$25 copay	$10 $25 $0 ded	0% 0% / $400 0% / $300
CalChoice HMO 25 Participating Health Plans: Sharp		1-2012	HMO	0 / 0	2500 indiv / 5000 family	$25 copay	$15 $30 $100 ded	0% 0% / $400 per day, max $1200 0% / $400
CalChoice HMO 25 Participating Health Plans: Western Health Advantage		1-2012	HMO	0 / 0	2500 indiv / 5000 family	$25 copay	$15 $30 $100 ded	0% 0% / $400 per day, max $1200 0% / $300
CalChoice HMO 25 Value Participating Health Plans: Health Net		1-2012	HMO	0 / 0	3000 indiv / 6000 family	$25 copay	$15 $30 $100 ded	25% coIns 25% / $0 InP 25% / $0 OutP
CalChoice HMO 25 Value Participating Health Plans: Anthem Blue Cross		1-2012	HMO	1000 / 2000	3000 indiv / 6000 family	$25 copay	$15 $30 $200 ded	20% coIns 20% / $0 InP 20% / $0 OutP AD
Salud HMO y mas Participating Health Plans: Health Net		1-2012	HMO	0 / 0	2500 indiv / 5000 family	$25 copay	$15 $25 $0 ded	0% coIns 0% / $500 per day, max $1000 InP 0% / $300 OutP
California Choice HMO Plans		Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
CalChoice HMO 30 Participating Health Plans: Anthem Blue Cross		1-2012	HMO	0 / 0	3000 indiv / 6000 family	$30 copay	$15 $30 $150 ded	0% 0% / $450 per day, max $1800 0% / $400
CalChoice HMO 30 Participating Health Plans: Health Net		1-2012	HMO	0 / 0	3000 indiv / 6000 family	$30 copay	$15 $30 $150 ded	0% 0% / $450 per day, max $1800 0% / $400
CalChoice HMO 30 Participating Health Plans: Kaiser Permanente		1-2012	HMO	0 / 0	3000 indiv / 6000 family	$30 copay	$15 $30 $0 ded	0% 0% / $450 0% / $400
CalChoice HMO 30 Participating Health Plans: Sharp		1-2012	HMO	0 / 0	3000 indiv / 6000 family	$30 copay	$15 $30 $150 ded	0% 0% / $450 per day, max $1800 0% / $400
CalChoice HMO 30 Participating Health Plans: Western Health Advantage		1-2012	HMO	0 / 0	3000 indiv / 6000 family	$30 copay	$15 $30 $150 ded	0% 0% / $450 per day, max $1800 0% / $400
CalChoice HMO 30 Value Participating Health Plans: Health Net		1-2012	HMO	0 / 0	3500 indiv / 7000 family	$30 copay	$20 $30 $200 ded	30% 30% / $0 30% / $0
CalChoice HMO 40 Participating Health Plans: Anthem Blue Cross		1-2012	HMO	0 / 0	3500 indiv / 7000 family	$40 copay	$20 $30 $200 ded	0% 0% / $500 per day 0% / $500
CalChoice HMO 40 Participating Health Plans: Health Net		1-2012	HMO	0 / 0	3500 indiv / 7000 family	$40 copay	$20 $30 $200 ded	0% 0% / $500 per day 0% / $500
CalChoice HMO 40 Participating Health Plans: Kaiser Permanente		1-2012	HMO	0 / 0	3500 indiv / 7000 family	$40 copay	$15 $30 $0 ded	0% 0% / $500 per day 0% / $500
CalChoice HMO 40 Participating Health Plans: Sharp		1-2012	HMO	0 / 0	3500 indiv / 7000 family	$40 copay	$20 $30 $200 ded	0% 0% / $500 per day 0% / $500
CalChoice HMO 40 Participating Health Plans: Western Health Advantage		1-2012	HMO	0 / 0	3500 indiv / 7000 family	$40 copay	$20 $30 $200 ded	0% 0% / $500 per day 0% / $500
CalChoice HMO 40 Value Participating Health Plans: Health Net		1-2012	HMO	0 / 0	3500 indiv / 7000 family	$40 copay	$20 $30 $200 ded	40% 40% / $0 40% / $0
CalChoice HMO 40 Value Participating Health Plans: Anthem Blue Cross		1-2012	HMO	1500 / 3000	4000 indiv / 8000 family	$40 copay	$15 $30 $250 ded	30% 30% / $0 30% / $0 AD
CalChoice HMO 40 Value Participating Health Plans: Western Health Advantage		1-2012	HMO	2500 / 5000	5000 indiv / 10000 family	$40 copay	$20 $30 $250 ded	0% AD 0% / $500 per day AD 0% / $250
California Choice HMO Plans		Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
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		Rate Guide Effective: 5-2012 through 7-15-2012

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Health Net Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max Lifetime Max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max Lifetime Max	In-Network Office visits (AD = after deductible)
Value HSA 4500 (1FK)	10-2010	PPO	4500 / 9000	5950 / 11900	$40 copay AD	$15 $30 AD	50% 50% / $0 with $500 ded per calendar year 50% / $0 with $250 per calendar year
Value HSA 3500 (1FH)	10-2010	PPO	3500 / 7000	5000 / 10000	$30 copay AD	$15 $30 AD	30% AD 30% / $0 with $250 ded per calendar year 30% / $0 with $250 per calendar year
Value HSA 2500 (1FF)	10-2010	PPO	2500 / 5000	4000 / 8000	$20 copay AD	$15 $30 AD	20% AD 20% / $0 with $250 ded per calendar year 20% / $0 with $250 per calendar year
Value HSA 1500 (1FD)	10-2010	PPO	1500 / 3000	3000 / 6000	$10 copay AD	$10 $25 AD	20% 20% / $0 20% / $0 AD
Standard HSA 4000 (1FJ)	10-2010	PPO	4000 / 8000	5950 / 11900	0% co-ins AD	$10 $25 AD	0% 0% / $0 0% / $0 AD
Hn Options PPO HSA 4000 (1JQ)	10-2010	PPO	4000 / 8000	5000 / 10000	$35 copay AD	$15 $30 AD	40% AD 40% / $0 with $250 ded per calendar year 40% / $0 with $250 ded per calendar year
Hn Options PPO HSA 3000 (1JP)	10-2010	PPO	3000 / 6000	4000 / 8000	$25 copay AD	$15 $30 AD	30% AD 30% / $0 with $250 ded per calendar year 30% / $0 with $250 ded per calendar year
Health Net HRA Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
HRA 3000 (5UG)	3-2011	PPO	3000 / 6000	4000 / 8000	50% coIns AD	$10 $25 AD	20% 20% / $0 20% / $0 AD
HRA 5000 (5UH)	3-2011	PPO	5000 / 10000	6000 / 12000	50% coIns	$10 $25 AD	20% 20% / $0 20% / $0 AD
Health Net PPO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
PPO-45 Standard (5QF)	5-2012	PPO	1000 / 2000	6000 / 12000	$45 copay	$15 $30 $0 ded	45% 45% / $0 with $500 ded per calendar year 45% / $0 with $250 ded per calendar year
PPO 45 Value (5QC)	5-2012	PPO	1500 / 3000	8500 / 17000	$45 copay AD	$15 $30 $250 ded	50% coIns 50% / $0 with $500 ded per calendar year 50% / $0 with $250 ded per calendar year AD
PPO 40 Standard (1FR)	10-2010	PPO	500 / 1000	5500 / 11000	$40 copay AD	$15 $30 $0 ded	40% AD 40% / $0 with $500 ded per calendar year 40% / $0 with $250 ded per calendar year
PPO 40 Value (1FU)	10-2010	PPO	1500 / 3000	6500 / 13000	$40 copay AD	$15 $30 $250 ded	50% AD 50% / $0 with $500 ded per calendar year 50% / $0 with $250 ded per calendar year
PPO 35 Standard (5QG)	5-2012	PPO	750 / 1500	4750 / 9500	$35 copay	$15 $30 0 $ded	35% 35% / $0 with $250 ded per calendar year 35% / $0 with $250 ded per calendar year
PPO 35 Value (5QB)	5-2012	PPO	1250 / 2500	7250 / 14500	$35 copay AD	$15 $30 $200 ded	45% AD coIns 45% / $0 with $250 ded per calendar year 45% / $0 with $250 ded per calendar year
PPO 30 Standard (1FQ)	10-2010	PPO	500 / 1000	4000 / 8000	$30 copay AD	$15 $30 $0 ded	20% AD 20% / $0 with $250 ded per calendar year 20% / $0 with $250 ded per calendar year
PPO 30 Value (1FT)	10-2010	PPO	1500 / 3000	6000 / 12000	$30 copay AD	$15 $30 $200 ded	30% AD 30% / $0 with $250 ded per calendar year 30% / $0 with $250 ded per calendar year
PPO 25 Standard (5QD)	5-2012	PPO	500 / 1000	4000 / 8000	$25 copay AD	$15 $30 $0 ded	25% 25% / $0 with $250 ded per calendar year 25% / $0 with $250 ded per calendar year
PPO 25 Value (5QE)	5-2012	PPO	1000 / 2000	6000 / 12000	$25 copay AD	$15 $30 $150 ded	35% AD coIns 35% / $0 with $250 ded per calendar year 35% / $0 with $250 ded per calendar year
PPO 20 Standard (1FP)	10-2010	PPO	250 / 500	3250 / 6500	$20 copay AD	$15 $30 $0 ded	10% AD 10% / $0 with $250 ded per calendar year 10% / $0 with $250 ded per calendar year
PPO 20 Value (1FS)	10-2010	PPO	1250 / 2500	4750 / 9500	$20 copay AD	$15 $30 $150 ded	20% AD 20% / $0 with $250 ded per calendar year 20% / $0 with $250 ded per calendar year
PPO 15 Standard (5QH)	5-2012	PPO	250 / 500	3250 / 6500	$15 copay AD	$10 $25 $0 ded	15% AD coIns 15% / $0 with $250 ded per calendar year 15% / $0 AD
PPO 15 Value (5QJ)	5-2012	PPO	750 / 1500	4750 / 9500	$10 copay AD	$10 $25 $100 ded	25% AD coIns 25% / $0 with $250 ded per calendar year 25% / $0 AD
PPO 10 Standard (1FN)	10-2010	PPO	0 / 0	2500 / 5000	$10 copay	$10 $25 $0 ded	10% 10% / $0 10% / $0
PPO 10 Value (1KK)	10-2010	PPO	1000 / 2000	3500 / 7000	$10 copay AD	$10 $25 $100 ded	20% 20% / $0 20% / $0 AD
PPO 45 Advantage (5ZR)	9-2011	PPO	4000 / 8000	8000 / 16000	$45 copay AD	$15 $30 $250 ded	50% coIns 50% / $0 InP 50% / $0 OutP AD
PPO 35 Advantage (5ZQ)	9-2011	PPO	3000 / 6000	6500 / 13000	$35 copay AD	$15 $30 $250 ded	40% coIns 40% / $0 InP 40% / $0 OutP AD
Health Net Hn Options PPO Plans (EOA = Elect Open Access plan) (SN = Silver Network plan)	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Hn Options PPO 1750 (1JN)	10-2010	PPO	1750 / 3500	6750 / 13500	$35 copay AD	$15 $30 $200 ded	40% 40% / $0 with $250 ded per calendar year 40% / $0 with $250 ded per calendar year
Hn Options PPO 1500 (1JM)	10-2010	PPO	1500 / 3000	5500 / 11000	$25 copay AD	$15 $30 $200 ded	30% 30% / $0 with $250 ded per calendar year 30% / $0 with $250 ded per calendar year
Hn Options PPO 500 (9R4)	10-2010	PPO	500 / 1000	4500 / 9000	$35 copay AD	$15 $30 200 $ded	30% 30% / $0 with $250 ded per calendar year 30% / $0 with $250 ded per calendar year
Hn Options PPO 250 (1JK)	10-2010	PPO	250 / 500	3750 / 7500	$25 copay AD	$15 $30 150 $ded	20% AD 20% / $0 with $250 ded per calendar year 20% / $0 with $250 ded per calendar year
Hn OPTIONS EOA 35 (1JH) SN Hn OPTIONS EOA 35 (1JJ)	10-2010	HMO PPO	0 / 0	4000 / 8000	$35 HMO copay $50 PPO copay	$15 $30 $200 ded	30% coIns 30% / $0 InP 30% / $0 OutP
Hn OPTIONS EOA 25 (1JF) SN Hn OPTIONS EOA 25	10-2010	PPO	0 / 0	3000 / 6000	$25 copay	$15 $30 $150 ded	20% 20% / $0 20% / $0
Flex Net Indemnity (1KL)	11-2010	PPO	300 / 900	1500 / 4500	20% co-ins	20% 20% $75 ded	20% 20% / $0 20% / $0 AD
Health Net POS Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
POS 10 (1FB)	11-2010	PPO	250 / 500	3000 single / 2 per family	$20 copay AD	$10 $25 0 $ded	10% 10% / $0 with $250 ded per calendar year 10% / $0 with $250 ded per calendar year
POS 10 (1FB)	11-2010	HMO	0 / 0	1500 / 3000	$10 copay	$10 $25 0 $ded	0% 0% / $0 0% / $0
POS 20 (1FC)	11-2010	PPO	500 / 1000	3500 single / 2 per family	$30 copay AD	$15 $30 0 $ded	20% AD 20% / $0 with $250 ded per calendar year 20% / $0 with $250 ded per calendar year
POS 20 (1FC)	11-2010	HMO	0 / 0	2000 / 4000	$20 copay	$15 $30 0 $ded	0% 0% / $250 per day, 3 day max 0% / $250
Health Net Salud Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Salud PPO (1HW)	10-2010	PPO	100 single / 2 per family	2000 / 4000	$15 copay AD	$10 $35 0 $ded	20% AD 20% / $0 with $250 per admission ded 20% / $0 with $250 ded
Salud Mexico (1HX)	10-2010	HMO	0 / 0	1500 single / 3000 two-party / 4500 family	$5 copay	$5 $0 ded	0% 0% / $0 0% / $0
Salud HMO y Mas 35 (1KF)	10-2010	HMO	0 / 0	4000 / 8000	$35 copay	$10 $35 $250 ded	20% 0% / $500 per day, 4 day max 20% / $0
Salud HMO y Mas 25 (1HU)	10-2010	HMO	0 / 0	3500 / 7000	$25 copay	$10 $35 $250 ded	20% 0% / $250 per day, 4 day max 20% / $0
Salud HMO y Mas 15	10-2010	HMO	0 / 0	1500 single / 3000 two-party / 4500 family	$15 copay	$5 $15 $0 ded	20% 0% / $250 20% / $0
Salud con Health Net EPO (1HV)	10-2010	EPO HMO	0 / 0	1500 / 4500	$15 copay	$10 $35 $0 ded	20% 0% / $0 with $250 per admission ded 20% / $0
Health Net HMO EOA Standard Plans (EOA = Elect Open Access) (SN = Silver Network plan)	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
EOA Standard 10 - Plan 86Z SN EOA Standard 10 - Plan 7J7	5-2010	HMO	0 / 0	1500 / 3000	$10 copay	$10 $25 $ded	0% 0% / $0 0% / $0
EOA Standard 15 (5TB) SN EOA Standard 15 (BTH)	5-2012	HMO PPO	0 / 0	1500 / 3000	$15 HMO copay $30 PPO copay (12 visits per year)	$15 $30 $0 ded	0% coIns 0% / $250 per day, 3 day max InP 0% / $250 OutP
EOA Standard 20 - Plan 871 SN EOA Standard 20 - Plan 7J8	5-2010	HMO	0 / 0	2000 / 4000	$20 copay	$15 $30 $0 ded	0% 0% / $250 per day for a max of 3 days per admit 0% / $250
EOA Standard 25 (5TC) SN EOA Standard 25 (5TJ)	5-2012	HMO PPO	0 / 0	2000 / 4000	$20 HMO copay $30 PPO copay (12 visits per year)	$15 $30 $0 ded	0% coIns 0% / $500 per day, 3 day max InP 0% / $500 OutP
EOA Standard 30 - Plan 872 SN EOA Standard 30 - Plan 7J9	5-2010	HMO	0 / 0	3000 / 6000	$30 copay	$15 $30 $0 ded	0% 0% / $500 per day, 3 day max 0% / $500
EOA Standard 35 (5TD) SN EOA Standard 35 (5TK)	5-2012	HMO PPO	0 / 0	3000 / 6000	$35 HMO copay $50 PPO copay (12 visits per year)	$15 $30 $0 ded	0% coIns 0% / $750 per day, 3 day max InP 0% / $750 OutP
EOA Standard 40 - Plan 873 SN EOA Standard 40 - Plan 7K1	5-2010	HMO	0 / 0	4000 / 8000	$40 copay	$15 $30 $0 ded	0% 0% / $1000 per day for max of 3 days per admit 0% / $1000
EOA Standard 50 (5NX) SN EOA Standard 50 (5PL)	5-2012	HMO PPO	0 / 0	4500 / 9000	$50 HMO copay $65 PPO copay (12 visits per year)	$15 $30 $0 ded	0% coIns 0% / $1500 per day, 3 day max InP 0% / $1500 OutP
Health Net HMO EOA Value Plans (EOA = Elect Open Access) (SN = Silver Network plan)	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
EOA Value 10 - Plan 874 SN EOA Value 10 - Plan 7k2	5-2010	HMO	0 / 0	2000 / 4000	$10 copay	$10 $25 100 $ded	10% 10% / $0 10% / $0
EOA Value 20 - Plan 875 SN EOA Value 20 - Plan 7K3	5-2010	HMO	0 / 0	2500 / 5000	$20 copay	$15 $30 150 $ded	20% 20% / $0 20% / $0
EOA Value 30 - Plan 876 SN EOA Value 30 - Plan 7K4	5-2010	HMO	0 / 0	3500 / 7000	$30 copay	$15 $30 200 $ded	30% 30% / $0 30% / $0
SN EOA Value 35 - Plan 7K4	5-2010	HMO	0 / 0	3500 / 7000	$30 copay	$15 $30 200 $ded	30% 30% / $0 30% / $0
EOA Value 40 - Plan 877 SN EOA Value 40 - Plan 7K5	5-2010	HMO	0 / 0	4500 / 9000	$40 copay	$15 $30 250 $ded	40% 40% / $0 40% / $0
EOA Value 50 (5NW) SN EOA Value 50 (5PK)	5-2012	HMO PPO	0 / 0	5750 / 11500	$50 HMO copay $65 PPO copay (12 visits per year)	$15 $30 $250 ded	50% coIns 50% / $0 InP 50% / $0 OutP
Health Net HMO EOA Advantage Plans (EOA = Elect Open Access) (SN = Silver Network plan)	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Advantage EOA 25 - Plan 888 and SN Advantage EOA 25 - Plan S43	5-2010	HMO	0 / 0	1500 / 3000	$10 copay	$10 $25 0 $ded	0% 0% / $0 0% / $0
Advantage EOA 35 - Plan 888 and SN Advantage EOA 35 - Plan S43	5-2010	HMO	0 / 0	1500 / 3000	$10 copay	$10 $25 0 $ded	0% 0% / $0 0% / $0
Advantage EOA 45 - Plan 888 and SN Advantage EOA 45 - Plan S43	5-2010	HMO	0 / 0	2000 / 4000	$20 copay	$15 $30 0 $ded	0% 0% / $250 per day, max 3 days 0% / $250
Health Net HMO SmartCare Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
SmartCare HMO 10 Standard - Plan 6EQ	3-2012	HMO	0 / 0	1500 / 3000	$10 copay	$15 $40 $100 ded	0% coIns 0% / $250 3-day max InP Hosp 0% / $250 OutP Hosp
SmartCare HMO 20 Standard - Plan 6EP	3-2012	HMO	0 / 0	2500 / 5000	$20 copay	$15 $40 $150 ded	0% coIns 0% / $500 3-day max InP Hosp 0% / $500 OutP Hosp
SmartCare HMO 30 Standard - Plan 6EN	3-2012	HMO	0 / 0	3500 / 7000	$30 copay	$15 $40 $200 ded	0% coIns 0% / $750 3-day max InP Hosp 0% / $750 OutP Hosp
SmartCare HMO 40 Standard - Plan 6EM	3-2012	HMO	0 / 0	4500 / 9000	$40 copay	$15 $40 $250 ded	0% coIns 0% / $1000 3-day max InP Hosp 0% / $1000 OutP Hosp
SmartCare HMO 50 Standard - Plan 6EL	3-2012	HMO	0 / 0	5500 / 11000	$50 copay	$15 $40 $300 ded	0% coIns 0% / $1500 3-day max InP Hosp 0% / $1500 OutP Hosp
SmartCare HMO 50 Value - Plan 6EK	3-2012	HMO	0 / 0	5750 / 11500	$50 copay	$15 $40 $300 ded	0% coIns 50% / $0 InP Hosp 50% / $0 OutP Hosp
Health Net HMO Standard Plans (SN = Silver Network plan)	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
10 Standard HMO (1EJ) SN 10 Standard HMO (1FV)	3-2012	HMO	0 / 0	1500 / 3000	$10 copay	$10 $25 $0 ded	0% 0% / $0 0% / $0
15 Standard HMO (5SG) SN 15 Standard HMO (5SN) (5SU)	3-2012	HMO	0 / 0	1500 / 3000	$15 copay	$15 $30 $0 ded	0% coIns 0% / $250 per day, 3 day max InP 0% / $250 OutP
20 Standard HMO (1EK) SN 20 Standard HMO (1FW)	3-2012	HMO	0 / 0	2000 / 4000	$20 copay	$15 $30 0 $ded	0% 0% / $250 per day, max 3 days 0% / $250
25 Standard HMO (5SH) SN 25 Standard HMO (5SP) (5SV)	3-2012	HMO	0 / 0	2000 / 4000	$25 copay	$15 $30 $0 ded	0% 0% / $500 per day, max 3 days 0% / $500
30 Standard HMO (1EL) SN 30 Standard HMO (1FX)	3-2012	HMO	0 / 0	3000 / 6000	$30 copay	$15 $30 0 $ded	0% 0% / $500 per day, 3 day max 0% / $500
35 Standard HMO (5SJ) SN 35 Standard HMO (5SQ) (5SW)	3-2012	HMO	0 / 0	3000 / 6000	$35 copay	$15 $30 $0 ded	0% 0% / $750 per day, 3 day max 0% / $750
40 Standard HMO (1EM) SN 40 Standard HMO (1FY)	3-2012	HMO	0 / 0	4000 / 8000	$40 copay	$15 $30 0 $ded	0% 0% / $1000 per day 3 day max 0% / $1000
50 Standard HMO (5NS) SN 50 Standard HMO (5PB) (5PD)	3-2012	HMO	0 / 0	4500 / 9000	$50 copay	$15 $30 $0 ded	0% 0% / $1500 per day, 3 day max 0% / $1500
Health Net HMO Value Plans (SN = Silver Network plan)	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
10 Value HMO (1EN) SN 10 Value HMO (1FZ)	3-2012	HMO	0 / 0	2000 / 4000	$10 copay	$10 $25 $100 ded	10% 10% / $0 10% / $0
20 Value HMO (1EP) SN 20 Value HMO (1GB)	3-2012	HMO	0 / 0	2500 / 5000	$20 copay	$15 $30 $150 ded	20% 20% / $0 20% / $0
30 Value HMO (1EQ) SN 30 Value HMO (1GC)	3-2012	HMO	0 / 0	3500 / 7000	$30 copay	$15 $30 $200 ded	30% 30% / $0 30% / $0
40 Value HMO (1ER) SN 40 Value HMO (1GD)	3-2012	HMO	0 / 0	4500 / 9000	$40 copay	$15 $30 $250 ded	40% 40% / $0 40% / $0
50 Value HMO (5NT) SN 50 Value HMO (5PC) (5PE)	3-2012	HMO	0 / 0	5750 / 11500	$50 copay	$15 $30 $250 ded	50% 50% / $0 50% / $0
Health Net HMO Dual Network Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Standard HMO 20 - Dual Network (5NK)	3-2012	HMO	0 / 0	2000 / 4000	$20 copay	$15 $30 $0 ded	0% coIns 0% / $250 per day, 3 day max InP 0% / $250 OutP
Standard HMO 30 - Dual Network (5NL)	3-2012	HMO	0 / 0	3000 / 6000	$30 copay	$15 $30 $0 ded	0% 0% / $500 per day, 3 day max 0% / $500
Value HMO 30 - Dual Network (5NM)	3-2012	HMO	0 / 0	3500 / 7000	$30 copay	$15 $30 $200 ded	30% 30% / $0 30% / $0
Value HMO 40 - Dual Network (5NJ)	3-2012	HMO	0 / 0	4500 / 9000	$40 copay	$15 $30 $250 ded	40% 40% / $0 40% / $0
Health Net HMO Advantage Plans (SN = Silver Network plan)	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Advantage HMO 25 (1JZ) SN Advantage HMO 25 (1JV) (1JT)	10-2010	HMO	0 / 0	3000 / 6000	$25 copay	$15 $40 $200 ded	25% 25% / $0 25% / $0
Advantage HMO 35 (1KB) SN Advantage HMO 35 (1JW) (1JU)	10-2010	HMO	0 / 0	4000 / 8000	$35 copay	$15 $40 $250 ded	35% 35% / $0 35% / $0
Advantage HMO 45 (1JY) SN Advantage HMO 45 (1JR) (1JS)	10-2010	HMO	0 / 0	5000 / 10000	$45 copay	$15 $40 $300 ded	45% 45% / $0 45% / $0
Health Net HMO Plans (SN = Silver Network plan)	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Hn Options HMO 35 (1JC) SN Hn Options HMO 35 (1JD) (1JE)	10-2010	HMO	0 / 0	4000 / 8000	$35 copay	$15 $30 $200 ded	30% 30% / $0 30% / $0
Hn Options HMO 25 (1HY) SN Hn Options HMO 25 (1HZ) (1JB)	10-2010	HMO	0 / 0	3000 / 6000	$25 copay	$15 $30 $150 ded	20% 20% / $0 20% / $0
Health Net HMO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
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Applications & Forms..... Group Medical						Provider Networks
Group Admin Manual:		Underwriting Guidelines:				Employer Handbook:
HSA California Plans		Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)

PPO 2500 (HSA) Participating Health Plans: Health Net		2-2011	PPO	2500 / 5000	5000 indiv/ 10000 family	$25 copay AD	$15 $30 AD	30% coIns 30% / $0 plus $250 ded applies InP 30% / $0 plus $250 ded applies OutP AD
PPO 3500 (HSA) Participating Health Plans: Health Net		2-2011	PPO	3500 / 7000	5000 indiv/ 10000 family	$35 copay AD	$15 $30 AD	30% coIns 30% / $0 plus $250 ded applies InP 30% / $0 plus $250 ded applies OutP AD
PPO 4500 (HSA) Participating Health Plans: Health Net		2-2011	PPO	4500 / 9000	5600 indiv/ 11200 family	$45 copay AD	$15 $30 AD	40% coIns 40% / $0 plus $250 ded applies InP 40% / $0 plus $250 ded applies OutP AD
HSA California HMO/HSA Plans		Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
HMO 2200 (HSA) Participating Health Plans: Kaiser		2-2011	HMO	2200 / 4400	4500 indiv / 9000 family	$20 copay AD	$10 $20 AD	25% coIns 25% / $0 InP 25% / $0 OutP AD
HMO 2600 (HSA) Participating Health Plans: Kaiser		2-2011	HMO	2600 / 5200	5600 indiv/ 11200 family	$30 copay AD	$10 $30 AD	30% coIns 30% / $0 InP 30% / $0 OutP AD
HMO 1800 (HSA) Participating Health Plans: Western Health Advantage		2-2011	HMO	1800 / 3600	1800 indiv / 3600 family	$0 copay AD	$0 $0 AD	0% coIns 0% / $0 InP 0% / $0 OutP AD
HMO 2800B (HSA) Participating Health Plans: Western Health Advantage		2-2011	HMO	2800 / 5600	4000 indiv/ 8000 family	$40 copay AD	$10 $30 AD	0% coIns 0% / $500 day InP 0% / $250 OutP
HSA California HMO/HSA Plans		Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
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		Rate Guide Eff: 4-2012

Applications & Forms..... Group Medical					Provider Networks
Group Admin Manual:		Underwriting Guidelines:			Employer Handbook:
Independence American HRA Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max Lifetime Max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
HRA $3K/1K	7-2011	HRA	3000 / 6000	4000 / 8000 $5 million	20% co-ins	$10 $25 AD	20% 20% / $0 20% / $0 AD
HRA $3K/2K	7-2011	HRA	3000 / 6000	5000 / 10000 $5 million	20% co-ins	$10 $25 AD	20% 20% / $0 20% / $0 AD
HRA $4K/1K	7-2011	HRA	4000 / 8000	5000 / 10000 $5 million	20% co-ins	$10 $25 AD	20% 20% / $0 20% / $0 AD
HRA $4K/2K	7-2011	HRA	4000 / 8000	6000 / 12000 $5 million	20% co-ins	$10 $25 AD	20% 20% / $0 20% / $0 AD
HRA $5K/1K	7-2011	HRA	5000 / 10000	6000 / 12000 $5 million	20% co-ins	$10 $25 AD	20% 20% / $0 20% / $0 AD
Independence American HRA Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max Lifetime Max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
HRA $5K/2K	7-2011	HRA	5000 / 10000	7000 / 14000 $5 million	20% co-ins	$10 $25 AD	20% 20% / $0 20% / $0 AD
HRA $7,500/100percent	7-2011	HRA	7500 / 15000	0 / 0 $5 million	0% co-ins	$10 $25 AD	0% 0% / $0 0% / $0 AD
HRA $7,500/1K	7-2011	HRA	7500 / 15000	8500 / 17000 5 Million	20% co-ins	$10 $25 AD	20% 20% / $0 20% / $0 AD
HRA HYBRID $2,000	3-2011	HRA	2000 / 4000	4500 / 9000	20% co-ins	$15 $25 AD	20% 20% / $0 20% / $0 AD
HRA HYBRID $3,000	3-2011	HRA	3000 / 6000	5500 / 11000	20% co-ins	$15 $25 AD	20% 20% / $0 20% / $0 AD
Independence American HRA Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max Lifetime Max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
HRA HYBRID $3,500/500	7-2011	HRA	3500 / 7000	5500 / 11000	20% co-ins	$15 $25 AD	20% 20% / $0 20% / $0 AD
HRA HYBRID $3,500/1,000	7-2011	HRA	3500 / 7000	5500 / 11000	20% co-ins	$15 $25 AD	20% 20% / $0 20% / $0 AD
HRA HYBRID $5,000/500	3-2011	HRA	5000 / 10000	7000 / 14000	20% co-ins	$15 $25 AD	20% 20% / $0 20% / $0 AD
HRA HYBRID $5,000/1,000	7-2011	HRA	5000 / 10000	7000 / 14000	20% co-ins	$15 $25 AD	20% 20% / $0 20% / $0 AD
Independence American HRA Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
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		Rate Guide Eff: 6-2012 to 12-2012

Applications & Forms..... Group Medical Dental Life Insurance Vision					Provider Networks
Kaiser Sample Fee Charges: Southern CA Northern CA

Kaiser Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)
$0/2000 Deductible Plan with HSA	1-2012	HMO HSA	2000 / 4000 aggregate	3500 / 7000 aggregate None	$0 copay AD	$10 $30 AD	0% coIns 0% / $300 day InP 0% / $150 per procedure OutP AD
$0/2700 Deductible Plan with HSA	1-2012	HMO HSA	2700 / 5450 embedded	4500 / 9000 embedded None	$0% copay AD	$10 $30 AD	0% coIns 0% / $450 per day InP 0% / $250 per procedure OutP AD
$30/3000 Deductible Plan with HSA	1-2012	HMO HSA	3000 / 6000 embedded	5950 / 11900 embedded	$30 copay AD	$10 $30 AD	30% coIns 30% / $0 per admit InP 30% / $0 OutP AD
Kaiser HRA Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
$30/2500 Deductible Plan with HRA	1-2012	HMO HRA	2500 / 5000 embedded	5000 / 10000 embedded	$30 copay AD	$10 $30 $0 ded	20% coIns 20% / $0 per admit InP 20% / $0 OutP AD
$30/1500 Deductible Plan with HRA	1-2012	HMO HRA	1500 / 3000 embedded	3500 / 7000 embedded	$30 copay AD	$10 $30 $0 ded	20% coIns 20% / $0 per admit InP 20% / $0 OutP AD
Kaiser POS Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
$35 POS	1-2012	PPO	500 indiv / 1000 two / 1500 family embedded	3000 indiv / 6000 two / 9000 family embedded	$45 copay	$14 $40 $0 ded	30% coIns 30% / $0 InP 30% / $0 OutP AD
$35 POS	1-2012	HMO	3000 / 6000 embedded	3000 / 6000 embedded	$35 copay	$10 $35 $0 ded	0% coIns 0% / $200 per day InP 0% / $100 OutP
Kaiser PPO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
$40/1000	1-2012	PPO	1000 / 2000 embedded	5000 / 10000 embedded	$40 copay	$15 $35 $200 ded	30% coIns 30% / $0 InP 30% / $0 OutP AD
$40/2500 with HSA Option	1-2012	PPO	2500 / 5000	5000 / 10000	$40 copay	$15 $35 AD	30% coIns 30% / $0 InP 30% / $0 OutP AD
Kaiser HMO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
$30/1000 Deductible Plan	1-2012	HMO	1000 / 2000 embedded	3500 / 7000 embedded	$30 copay	$10 $35 $0 ded	0% coIns 0% / $500 day InP 0% / $250 per procedure OutP AD
$30/1500 Deductible Plan	1-2012	HMO	1500 / 3000 embedded	3500 / 7000 embedded	$30 copay	$10 $30 $0 ded	0% coIns 0% / $500 day InP 0% / $250 per procedure OutP AD
$40/2000 Deductible Plan	1-2012	HMO	2000 / 4000 embedded	4500 / 9000 embedded	$40 copay	$10 $35 $0 ded	30% coIns 30% / $0 InP 30% / $0 OutP AD
$40/3000 Deductible New	1-2012	HMO	3000 / 6000 embedded	6000 / 12000 embedded	$40 copay AD	$10 $35 $0 ded	30% coIns 30% / $0 InP 30% / $0 OutP AD
$50	1-2012	HMO	0 / 0	3500 / 7000	$50 copay	$10 $35 $250 ded	0% coIns 0% / $500 day InP 0% / $250 per procedure OutP
$30	1-2012	HMO	0 / 0	3000 / 6000	$30 copay	$10 $35 $250 ded	0% coIns 0% / $400 day InP 0% / $200 per procedure OutP
$20	1-2012	HMO	0 / 0	2500 / 5000	$20 copay	$10 $30 $0 ded	0% coIns 0% / $300 day InP 0% / $150 per procedure OutP
$15	1-2012	HMO	0 / 0	2500 / 5000	$15 copay	$10 $25 $0 ded	0% coIns 0% / $200 day InP 0% / $100 per procedure OutP
$5	1-2012	HMO	0 / 0	1500 / 3000	$5 copay	$5 $15 $0 ded	0% coIns 0% / $0 InP 0% / $5 per procedure OutP
Kaiser HMO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
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		Rate Guide Eff: 7-1-2012 to 12-1-2012

Applications & Forms..... Group Medical					Provider Networks

Kaiser Choice Solution Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)
HDHP 1900	7-2012	HSA	1900 / 3800	3400 / 6800	$0 AD	$10 $30 AD	0% coIns 0% / $300 per day InP 0% / $150 per procedure OutP AD
HDHP 2700	7-2012	HSA	2700 / 5400	5000 / 10000	$30 AD	$10 $30 AD	20% coIns 20% / $0 per admission InP 20% / $0 OutP AD
Kaiser Choice Solution POS Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
POS 20 / $1000 PPO	7-2012	PPO	1000 / 3000	3000 / 9000	$30 copay	$20 $40 $250 ded	20% coIns 20% / $0 after 250 ded per admit InP 20% / $0 OutP AD
POS 20 / $1000 HMO	7-2012	HMO	0 / 0	1500 / 3000	$20 copay	$10 $30 $0 ded	0% coIns 0% / $250 per admit InP 0% / $100 per procedure OutP
Kaiser Choice Solution PPO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
PPO 30/$500	7-2012	PPO	500 / 1500	2000 / 6000	$30 copay	$15 $40 $250 ded	20% coIns 20% / $0 after $250 ded per admit InP 20% / $0 OutP AD
Kaiser Choice Solution HMO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
HMO 10	7-2012	HMO	0 / 0	1500 / 3000	$10 copay	$10 $20 $0 ded	0% coIns 0% / $200 per day InP 0% / $100 per procedure OutP
HMO 20 / 1000	7-2012	HMO	1000 / 2000	3500 / 7000	$20 copay	$10 $30 $0 ded	20% coIns 20% / $0 InP 20% / $0 OutP AD
HMO 30	7-2012	HMO	0 / 0	3000 / 6000	$30 copay	$10 $30 $100 ded	0% coIns 0% / $400 per day InP 0% / $250 per procedure OutP
HMO 40 / 2800 New	7-2012	HMO	2800 / 5600	5600 / 11200	$40 copay	$10 $35 $0 ded	30% coIns 30% / $0 InP 30% / $0 OutP AD
Kaiser Choice Solution HMO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
VIEW DISCONTINUED KAISER CHOICE SOLUTION PLANS - None Available view / hide Kaiser Choice Solution Details

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		Rate Guide Eff: 5-1-2012

Applications & Forms..... Group Medical					Provider Networks

SeeChange Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoIns / InP / OutP / AD (AD = after deductible)
	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)
HSA 3000	5-2012	HSA	3000 / 6000	5000 / 10000 Enhanced 4000 / 8000	20% co-ins Enhanced 0% coIns	$10 $35 AD	20% / 20% / 20% / AD Enhanced 0% / 0% / 0% / AD
HSA 4000	5-2012	HSA	4000 / 8000	5500 / 11000 Enhanced 5000 / 10000	20% co-ins Enhanced 0% coIns	$10 $35 AD	20% / 20% / 20% / AD Enhanced 0% / 0% / 0% / AD
HSA 5000	5-2012	HSA	5000 / 10000	5950 / 11900 Enhanced 5500 / 11000	20% co-ins Enhanced 0% coIns	$10 $35 AD	20% / 20% / 20% / AD Enhanced 0% / 0% / 0% / AD
SeeChange HRA Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoIns / InP / OutP / AD (AD = after deductible)
HRA 5000 *	5-2012	HRA	5000 / 10000	9000 / 18000	$40 copay 3 visits	$10 $50 $500 ind ded $1000 fam ded	20% / 20% / 20% / AD
SeeChange PPO No Deductible Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoIns / InP / OutP / AD (AD = after deductible)
No Deductible 3.0 *	5-2012	PPO	0 / 0	4000 / 8000 Enhanced 3000 / 6000	30% co-ins Enhanced 20% coIns	$10 $35 $200 ind ded $400 fam ded	30% / 30% / 30% / AD Enhanced 20% / 20% / 20% / AD
No Deductible 6.0	5-2012	PPO	0 / 0	8000 / 16000 Enhanced 6000 / 12000	40% co-ins Enhanced 30% coIns	$10 $35 $200 ind ded $400 fam ded	40% / 40% / 40% / AD Enhanced 30% / 30% / 30% / AD
No Deductible 9.0	5-2012	PPO	0 / 0	12000 / 24000 Enhanced 9000 / 18000	40% co-ins Enhanced 30% coIns	$10 $35 $200 ind ded $400 fam ded	40% / 40% / 40% / AD Enhanced 30% / 30% / 30% / AD
SeeChange PPO Deluxe Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoIns / InP / OutP / AD (AD = after deductible)
Deluxe 500 Copay	5-2012	PPO	500 / 1000	1500 / 3000	$25 copay	$10 $35 $200 ind ded $400 fam ded	20% / 20% / 20% / AD
Deluxe 1000 Copay	5-2012	PPO	1000 / 2000	3000 / 6000	$25 copay	$10 $35 $200 ind ded $400 fam ded	20% / 20% / 20% / AD
Deluxe 2000 Copay	5-2012	PPO	2000 / 4000	4000 / 8000	$25 copay	$10 $35 $200 ind ded $400 fam ded	20% / 20% / 20% / AD
Deluxe 3000 Copay	5-2012	PPO	3000 / 6000	5000 / 10000	$25 copay	$10 $35 $200 ind ded $400 fam ded	20% / 20% / 20% / AD
Deluxe 4000 Copay	5-2012	PPO	4000 / 8000	6000 / 12000	$25 copay	$10 $35 $200 ind ded $400 fam ded	20% / 20% / 20% / AD
SeeChange PPO Classic & Select Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoIns / InP / OutP / AD (AD = after deductible)
Classic 2200	5-2012	PPO	2200 / 4400	4400 / 8800 Enhanced 2200 / 4400	20% co-ins Enhanced 0% coIns	$10 $35 $200 ind ded $400 fam ded	20% / 20% / 20% / AD Enhanced 0% / 0% / 0% / AD
Classic 3500	5-2012	PPO	3500 / 7000	5000 / 10000 Enhanced 3500 / 7000	30% co-ins Enhanced 0% coIns	$10 $35 $200 ind ded $400 fam ded	30% / 30% / 30% / AD Enhanced 0% / 0% / 0% / AD
Classic 5000	5-2012	PPO	5000 / 10000	7000 / 14000 Enhanced 5000 / 10000	40% co-ins Enhanced 0% coIns	$10 $35 $200 ind ded $400 fam ded	40% / 40% / 40% / AD Enhanced 0% / 0% / 0% / AD
Select 8000	5-2012	PPO	8000 / 16000	10000 / 20000	$40 copay 3 visits	$10 $50 $500 ind ded $1000 fam ded	10% / 10% / 10% / AD
Select 10000	5-2012	PPO	10000 / 20000	10000 / 20000	$40 copay 3 visits	$10 $50 $500 ind ded $1000 fam ded	0% / 0% / 0% / AD
SeeChange PPO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoIns / InP / OutP / AD (AD = after deductible)
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		Rate Guide Effective 3-2012

Applications & Forms..... Group Medical Dental Life Insurance Vision					Provider Networks

Sharp Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)
PPO $20/500 Companion Plan	7-09	PPO	500/1000	2000/4000	$20 copay AD	$10 $30 150 $ded	20% 20% / $0 20% / $0 AD
PPO $30/1000 Companion Plan	7-09	PPO	1000/2000	3000/6000	$30 copay AD	$10 $30 150 $ded	20% 20% / $0 20% / $0 AD
Sharp HSA Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
HSA Compatible	5-09	HSA	2500/5000	2500/5000	0% co-ins AD	$10 $30 0 $ded	20% 20% / $0 20% / $0 AD
Sharp HMO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
10/10/0	10-07	HMO	0 / 0	1500 / 3000	$10 copay	$10 $20 0 $ded	0% 0% / $0 0% / $0
10/10/100 - 3 Day Max	10-2010	HMO	0 / 0	2000 / 4000	$10 copay	$10 $20 0 $ded	0% 0% / $100 per admit (3 day max) 0% / $100 per procedure
15/15/250 - 3 Day Max	10-2010	HMO	0 / 0	2000 / 4000	$15 copay	$15 $35 0 $ded	0% 0% / $250 per admit (3 day max) 0% / $250 per procedure
20/30/500 - 3 Day Max	10-2010	HMO	0 / 0	2500 / 5000	$20 copay	$20 $35 0 $ded	0% 0% / $500 per admit (3 day max) 0% / $500 per procedure
20/40/1000	10-2010	HMO	0 / 0	3500 / 7000	$20 copay	$15 $35 0 $ded	0% 0% / $1000 per admit 0% / $500 per procedure
30/40/1000	10-2010	HMO	0 / 0	3500 / 7000	$30 copay	$20 $35 0 $ded	0% 0% / $1000 per admit 0% / $500 per procedure
30/40/750/day	10-2010	HMO	0 / 0	4000 / 8000	$30 copay	$20 $35 0 $ded	0% 0% / $750 per day 0% / $750 per procedure
40/40/750/day	10-2010	HMO	0 / 0	4000 / 8000	$40 copay	$20 $35 0 $ded	0% 0% / $750 per day 0% / $750 per procedure
1000ded/30/40	10-2010	HMO	1000 / 2000	3500 / 7000	$30 copay	$20 $35 $150 ded	30% 30% / $0 30% / $0 AD
1500ded/40/40	4-2010	HMO	1500 / 3000	4000 / 8000	$40 copay	$20 $35 $150 ded	40% 40% / $0 40% / $0 AD
Sharp HMO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
CalChoice 15	8-07	HMO	0 / 0	2000 / 4000	$15 copay	$10 $20 0 $ded	0% 0% / $400 per admit 0% / $200 per procedure
CalChoice 25	8-07	HMO	0 / 0	2500 / 5000	$25 copay	$15 $30 0 $ded	0% 0% / $400 per day 0% / $300 per procedure
CalChoice 30	8-07	HMO	0 / 0	3000 / 6000	$30 copay	$15 $30 0 $ded	0% 0% / $450 per day 0% / $400 per procedure
CalChoice 40	8-07	HMO	0 / 0	3500 / 7000	$40 copay	$20 $30 0 $ded	0% 0% / $500 per day 0% / $500 per procedure
Sharp HMO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
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		Rate Guide Effective: 4-1-2012

Applications & Forms..... Group Medical Dental Life Insurance Vision					Provider Networks

UHC HSA Choice Plus Definity Plans Uses separate rx pdf	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)
Choice Plus Definity HSA 1500/80%	2-2011	PPO	1500 / 3000	3000 / 6000	20% co-ins AD	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	20% coIns 20% / $0 InP 20% / $0 OutP
Choice Plus Definity HSA 2000/100%	2-2011	PPO	2000 / 4000	4000 / 8000	0% co-ins AD	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	0% coIns 0% / $0 InP 0% / $0 OutP
Choice Plus Definity HSA 2000/90% (6ZJ) New	11-2011	PPO	2000 / 4000	4000 / 8000	10% co-ins AD	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	10% coIns 10% / $0 InP 10% / $0 OutP AD
Choice Plus Definity HSA 3000/80%	2-2011	PPO	3000 / 6000	5000 / 10000	20% co-ins AD	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	20% coIns 20% / $0 InP 20% / $0 OutP
Choice Plus Definity HSA 3000/100%	2-2011	PPO	3000 / 6000	5000 / 10000	0% co-ins AD	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	0% coIns 0% / $0 InP 0% / $0 OutP
Choice Plus Definity HSA 3000/90% (6ZK) New	11-2011	PPO	3000 / 6000	5000 / 10000	10% co-ins AD	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	10% coIns 10% / $0 InP 10% / $0 OutP AD
Choice Plus Definity HSA 3000/80%	2-2011	PPO	3000 / 6000	5000 / 10000	20% co-ins AD	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	20% coIns 20% / $0 InP 20% / $0 OutP
Choice Plus Definity HSA 4000/80%	2-2011	PPO	4000 / 8000	5000 / 10000	20% co-ins AD	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	20% coIns 20% / $0 InP 20% / $0 OutP
UHC HSA SignatureValue Alliance Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
SV Alliance HSA 90% / 1500ded (CB-6) New	5-2012	HMO	1500 / 3000	3000 / 6000	10% copay AD	$10 $30 AD	10% coIns 10% / $0 InP 10% / $0 OutP AD
SV Alliance HSA 80% / 2000ded (CB-7) New	5-2012	HMO	2000 / 4000	4000 / 8000	20% copay AD	$10 $30 AD	20% coIns 20% / $0 InP 20% / $0 OutP AD
SV Alliance HSA 80% / 3000ded (CB-8) New	5-2012	HMO	3000 / 6000	6000 / 12000	20% copay AD	$10 $30 AD	20% coIns 20% / $0 InP 20% / $0 OutP AD
UHC HRA Choice Plus Definity Plans Uses separate rx pdf	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Choice Plus Definity HRA 1500/80%	2-2011	PPO	1500 / 3000 Embedded	6000 / 12000	20% co-ins AD	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	20% coIns 20% / $0 InP 20% / $0 OutP
Choice Plus Definity HRA 2000/70%	2-2011	PPO	2000 / 4000 Embedded	5000 / 10000	30% co-ins AD	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	30% coIns 30% / $0 InP 30% / $0 OutP
Choice Plus Definity HRA 2500/80%	2-2011	PPO	2500 / 5000 Embedded	6000 / 12000	20% co-ins AD	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	20% coIns 20% / $0 InP 20% / $0 OutP
Choice Plus Definity HRA 3000/70% Plan	2-2011	PPO	3000 / 6000 Embedded	6000 / 12000	30% co-ins AD	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	30% coIns 30% / $0 InP 30% / $0 OutP
Choice Plus Definity HRA 7500/75% New	5-2012	PPO	7500 / 15000 Embedded	10000 / 20000	25% coIns AD	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	25% coIns 25% / $0 per occurrence ded of $1500 and AD InP 25% / $0 per occurrence ded of $500 and AD OutP
UHC HRA SignatureValue Alliance Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
SV Alliance HRA 30-45 / 90% 1500ded (CC-Q) New	5-2012	HMO	1500 / 3000	4000 / 8000	$30 copay	$20 $35 $150 ded	10% coIns 10% / $0 InP 10% / $0 OutP AD
SV Alliance HRA 35-50 / 80% 2000ded (CC-R) New	5-2012	HMO	2000 / 4000	5000 / 10000	$35 copay	$20 $35 $150 ded	20% coIns 20% / $0 InP 20% / $0 OutP AD
SV Alliance HRA 40-55 / 70% 3000 ded (CC-S) New	5-2012	HMO	3000 / 6000	6000 / 12000	$40 copay	$20 $35 $150 ded	30% coIns 30% / $0 InP 30% / $0 OutP AD
UHC PPO Non Differential Plan Uses separate rx pdf	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Non Differential PPO 2000/80% Plan 6H-F (6HF)	2-2011	PPO	2000 / 6000 Embedded	4000 / 12000	20% co-ins AD	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	20% coIns 20% / $0 InP 20% / $0 OutP
UHC PPO Choice Plus Balanced Uses separate rx pdf	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services (CoIns / InP CoIns / InP Copay / OutP CoIns / OutP Copay) (AD = after deductible)
Choice Plus Balanced 20/3000/90%	2-2011	PPO	3000 / 9000 Embedded	6000 / 12000	$20 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	10% coIns 10% / $0 InP 10% / $0 OutP
Choice Plus Balanced 30/1000/80%	2-2011	PPO	1000 / 3000 embedded	5000 / 10000	$30 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	20% coIns 20% / $0 InP 20% / $0 OutP
Choice Plus Balanced 30/2500/80% Plan	2-2011	PPO	2500 / 7500 embedded	4500 / 9000	$30 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	20% coIns 20% / $0 InP 20% / $0 OutP
Choice Plus Balanced 30/3000/70% (6ZC)	11-2011	PPO	3000 / 6000	8000 / 16000	$30 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	30% AD coIns 30% / $0 per occurence ded of $500 and AD InP 30% / $0 per occurence ded of $250 and AD OutP
Choice Plus Balanced 40/1000/50% (6ZA)	11-2011	PPO	1000 / 3000	6000 / 13000	$40 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	50% AD coIns 50% / $0 per occurence ded of $500 and AD InP 50% / $0 per occurence ded of $250 and AD OutP
Choice Plus Balanced 40/1000/70%	2-2011	PPO	1000 / 3000 embedded	5000 / 10000	$40 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	30% coIns 30% / $0 InP 30% / $0 OutP
Choice Plus Balanced 40/1500/70% (J3J)	7-2011	PPO	1500 / 4500	5000 / 10000	$40 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	30% coIns 30% / $0 InP 30% / $0 OutP AD
Choice Plus Balanced 40/2000/50% (6ZB)	11-2011	PPO	2000 / 6000	8000 / 18000	$40 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	50% AD coIns 50% / $0 per occurence ded of $500 and AD InP 50% / $0 per occurence ded of $250 and AD OutP
Choice Plus Balanced 40/4000/60% (6ZD) New	11-2011	PPO	4000 / 8000	10000 / 20000	$40 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	40% AD coIns 40% / $0 per occurrence ded of $500 and AD InP 40% / $0 per occurrence ded of $250 and AD OutP
Choice Plus Balanced 40/7500/75% (CC4) New	5-2012	PPO	7500 / 15000 embedded	17500 / 35000	$40 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	25% AD coIns 25% / $0 per occurrence ded of $1500 and AD InP 25% / $0 per occurrence ded of $500 and AD OutP
Choice Plus Balanced 50/5000/50% (6ZE) New	11-2011	PPO	5000 / 10000	12000 / 24000	$50 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	50% AD coIns 50% / $0 per occurrence ded of $500 and AD InP 50% / $0 per occurrence ded of $250 and AD OutP
UHC PPO Choice Plus Balanced Value Uses separate rx pdf	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Choice Plus Balanced Value 30/1000/80% Plan 5E-P (D6M)	2-2011	PPO	1000 / 3000	4000 / 8000	$30 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	20% coIns 20% / $500 InP 20% / $250 OutP
Choice Plus Balanced Value 40/1000/50% Plan 5E-Q (D6O)	2-2011	PPO	1000 / 3000	5000 / 10000	$40 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	50% coIns 50% / $500 InP 50% / $250 OutP
Choice Plus Balanced Value 40/1000/70% (6ZG)	11-2011	PPO	1000 / 3000	6000 / 13000	$40 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	30% AD coIns 30% / $0 per occurrence ded of $1000 and AD InP 30% / $0 per occurrence ded of $500 and AD OutP
Choice Plus Balanced Value 40/1500/70% (6ZH)	11-2011	PPO	1500 / 4500	6500 / 14500	$40 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	30% AD coIns 30% / $0 per occurrence ded of $1000 and AD InP 30% / $0 per occurrence ded of $500 and AD OutP
Choice Plus Balanced Value 40/2000/50% (6ZF)	11-2011	PPO	2000 / 6000	8000 / 18000	$40 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	50% AD coIns 50% / $0 per occurrence ded of $1000 and AD InP 50% / $0 per occurrence ded of $500 and AD OutP
Choice Plus Balanced Value 40/5000/70% (6ZI) New	11-2011	PPO	5000 / 10000	15000 / 30000	$40 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	30% AD coIns 30% / $0 per occurrence ded of $1000 and AD InP 30% / $0 per occurrence ded of $500 and AD OutP
UHC PPO Choice Plus Traditional Plans Uses separate rx pdf	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Choice Plus Traditional with Deductible 20/250/90% (J3A)	2-2011	PPO	250 / 750 embedded	3000 / 6000	$20 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	10% coIns 10% / $0 InP 10% / $0 OutP AD
Choice Plus Traditional with Deductible 30/250/80% Plan (J3D)	2-2011	PPO	250 / 750 embedded	4000 / 8000	$30 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	20% coIns 20% / $0 InP 20% / $0 OutP AD
Choice Plus Traditional with Deductible 30/500/80% (J3F)	2-2011	PPO	500 / 1500 embedded	4000 / 8000	$30 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	20% coIns 20% / $0 InP 20% / $0 OutP AD
Choice Plus Traditional with Deductible 40/500/70% Plan 5E-K (J3K)	2-2011	PPO	500 / 1500 embedded	4000 / 8000	$40 copay	OUC Rx Plan $15 / $35 OUD Rx Plan $20 / $40 Sgl / Fam Ded $300 / $900	30% coIns 30% / $0 InP 30% / $0 OutP AD
PacifiCare SignatureValue Alliance HMO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
SV Alliance 15-30 / 300a (CH-2) New	5-2012	HMO	0 / 0	1500 / 3000	$15 copay	$15 $35 $150 ded	0% coIns 0% / $300 per admit InP 0% / $250 per admit OutP
SV Alliance 20-40 / 300d (CH-3) New	5-2012	HMO	0 / 0	2000 / 4000	$20 copay	$15 $35 $150 ded	0% coIns 0% / $300 per day, two day max per stay InP 0% / $300 per admit OutP
SV Alliance 20-40 / 70% 1500ded (CH-7)New	5-2012	HMO	1500 / 3000	5000 / 10000	$20 copay	$20 $35 $150 ded	30% coIns 30% / $0 InP 30% / $0 OutP AD
SV Alliance 30-40 / 500d (CH-4) New	5-2012	HMO	0 / 0	2000 / 4000	$20 copay	$15 $35 $150 ded	0% coIns 0% / $300 per day, two day max per stay InP 0% / $300 per admit OutP
SV Alliance 40-60 / 60% (CH-6) New	5-2012	HMO	0 / 0	5000 / 10000	$40 copay	$20 $35 $150 ded	40% coIns 40% / $0 InP 40% / $0 OutP
SV Alliance 40-60 / 70% 2000ded (CH-8)New	5-2012	HMO	2000 / 4000	5000 / 10000	$40 copay	$20 $35 $150 ded	30% coIns 30% / $0 InP 30% / $0 OutP AD
SV Alliance 40-60 / 800d (CH-5) New	5-2012	HMO	0 / 0	3000 / 6000	$30 copay	$20 $35 $150 ded	0% coIns 0% / $500 per day, four day max per stay InP 0% / $400 per admit OutP
PacifiCare SignatureValue and SignatureValue Advantage HMO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
SV & SV Advantage 10-30/100% SV Plan PC-F SV Advantage Plan PC-L	10-2010	HMO	0 / 0	1500 / 4500	$10 copay	$10 $25 $0 ded	0% coIns 0% / $0 InP 0% / $0 OutP
SV & SV Advantage 15-30/300a SV Plan PC-G SV Advantage Plan PC-M	10-2010	HMO	0 / 0	1500 / 4500	$15 copay	$15 $35 150 $ded	0% coIns 0% / $300 per admit InP 0% / $250 per admit OutP
SV & SV Advantage 20-40/1500ded SV Plan PD-M SV Advantage Plan PD-R	10-2010	HMO	1500 / 3000 Embedded	4000 / 8000	$20 copay	$20 $35 $150 ded	0% coIns 0% / $500 per day InP 0% / $300 per admit OutP AD
SV & SV Advantage 20-40/300d SV Plan PD-I SV Advantage Plan PD-N	10-2010	HMO	0 / 0	2000 / 6000	$20 copay	$15 $35 $150 ded	0% coIns 0% / $300 per day, 2 days per admit InP 0% / $300 per admit OutP
SV & SV Advantage 20-40/1500ded SV Plan PC-K SV Advantage Plan PC-Q	10-2010	HMO	1500 / 3000 Embedded	4000 / 8000	$20 copay	$20 $35 150 $ded	0% coIns 0% / $500 per day InP 0% / $300 per admit OutP AD
SV & SV Advantage 30-40/500d SV Plan PD-J SV Advantage Plan PD-O	10-2010	HMO	0 / 0	3000 / 9000	$30 copay	$20 $35 $150 ded	0% coIns 0% / $500 per day, 4 days per admit InP 0% / $400 per admit OutP
SV & SV Advantage 40-60/60% SV Plan PD-L SV Advantage Plan PD-Q	3-2010	HMO	0 / 0	5000 / 15000	$40 copay	$20 $35 $150 ded	40% coIns 40% / $0 InP 40% / $0 OutP
SV & SV Advantage 40-60/70%/2000ded SV Plan PD-N SV Advantage Plan PD-S	10-2010	HMO	2000 / 4000 Embedded	5000 / 10000	$40 copay	$20 $35 $150 ded	30% coIns 30% / $0 InP 30% / $0 OutP AD
SV & SV Advantage 40-60/800d SV Plan PD-K SV Advantage Plan PD-P	10-2010	HMO	0 / 0	4000 / 12000	$40 copay	$20 $35 $150 ded	0% coIns 0% / $800 per day, 4 days per admit InP 0% / $500 per admit OutP
SV Advantage 40-60/2000ded SV Advantage ONLY - Plan PD-P	10-2010	HMO	2000 / 6000 Embedded	5000 / 15000	$40 copay	$20 $35 $150 ded	0% coIns 0% / $0 AD InP 0% / $1000 per admit OutP
PacifiCare SignatureValue Flex Network HMO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
SV Flex 15-30/300a Package A - Network 1 (CB3) New	3-2012	HMO	0 / 0	1500 / 3000	$15 copay	$15 $35 $150 ded	0% coIns 0% / $300 per admit InP 0% / $250 per admit OutP
SV Flex 20-40/300d Package A - Network 2 (CB4) New	3-2012	HMO	0 / 0	2000 / 4000	$20 copay	$20 $35 $150 ded	0% coIns 0% / $300 two day max per stay InP 0% / $300 per admit OutP
SV Flex 20-40/300d Package B - Network 1 (CBT) New	3-2012	HMO	0 / 0	2000 / 4000	$20 copay	$15 $35 $150 ded	0% coIns 0% / $300 two day max per stay InP 0% / $300 per admit OutP
SV Flex 20-40/70% 1500ded Package D - Network 3 (CB2) New	3-2012	HMO	1500 / 3000	5000 / 10000	$20 copay	$20 $35 $150 ded	30% coIns 30% / $0 InP 30% / $0 OutP AD
SV Flex 30-40/500d Package A - Network 3 (CB5) New	3-2012	HMO	0 / 0	3000 / 6000	$30 copay	$20 $35 $150 ded	0% coIns 0% / $500 four day max per stay InP 0% / $400 per admit OutP
SV Flex 30-40/500d Package B - Network 2 (CBU) New	3-2012	HMO	0 / 0	3000 / 6000	$30 copay	$20 $35 $150 ded	0% coIns 0% / $500 four day max per stay InP 0% / $400 per admit OutP
SV Flex 30-40/500d Package C - Network 1 (CBW) New	3-2012	HMO	0 / 0	3000 / 6000	$30 copay	$15 $35 $150 ded	0% coIns 0% / $500 four day max per stay InP 0% / $400 per admit OutP
SV Flex 40-60/60% Package C - Network 3 (CBY) New	3-2012	HMO	0 / 0	5000 / 10000	$40 copay	$20 $35 $150 ded	40% coIns 40% / $0 InP 40% / $0 OutP
SV Flex 40-60/60% Package D - Network 2 (CB1) New	3-2012	HMO	0 / 0	5000 / 10000	$40 copay	$20 $35 $150 ded	40% coIns 40% / $0 InP 40% / $0 OutP
SV Flex 40-60/800d Package B - Network 3 (CBV) New	3-2012	HMO	0 / 0	4000 / 8000	$40 copay	$20 $35 $150 ded	0% coIns 0% / $800 four day max per stay InP 0% / $500 per admit OutP
SV Flex 40-60/800d Package C - Network 2 (CBX) New	3-2012	HMO	0 / 0	4000 / 8000	$40 copay	$20 $35 $150 ded	0% coIns 0% / $800 four day max per stay InP 0% / $500 per admit OutP
SV Flex 40-60/800d Package D - Network 1 (CBZ) New	3-2012	HMO	0 / 0	4000 / 8000	$40 copay	$15 $35 $150 ded	0% coIns 0% / $800 four day max per stay InP 0% / $500 per admit OutP
PacifiCare SignatureValue HCP Network HMO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
SV HCP Network 25-50/500ded Plan PD-G	3-2010	HMO	500 / 1000 Embedded	4000 / 8000	$25 copay AD	$15 $35 $150 ded	20% coIns 20% / $0 InP 20% / $0 OutP AD
SV HCP Network 25-75/500ded Plan PD-F	3-2010	HMO	500 / 1000 Embedded	1500 / 3000	$25 copay AD	$15 $35 $150 ded	20% coIns 20% / $0 InP 20% / $0 OutP AD
SV HCP Network 25-75/1500ded Plan PD-H	3-2010	HMO	1500 / 3000 Embedded	4000 / 8000	$25 copay AD	$15 $35 $150 ded	40% coIns 40% / $0 InP 40% / $0 OutP AD
PacifiCare SignatureValue HCP Network HMO Plans	Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
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	Rate Guide Effective: 1-1-2010 to 12-31-2010

Applications & Forms..... Group Medical						Provider Networks

Western Health Advantage Plans		Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
		Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)
Western 1800 HSA Compatible		1-2011	HSA	1800 / 3600	1800 / 3600	$0 AD	$0 $0 AD	0% coIns 0% / $0 InP 0% / $0 OutP AD
Western 2800B HSA Compatible		1-2011	HSA	2800 / 5600	4000 / 8000	$40 AD	$10 $30 AD	0% coIns 0% / $500 per day InP 0% / $250 per visit OutP AD
Western 2800 HSA Compatible		1-2011	HSA	2800 / 5600	4000 / 8000	$40 AD	$10 $30 AD	0% coIns 0% / $500 per day InP 0% / $250 per visit OutP AD
Western Health Advantage HMO Plans		Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
Premier 10		1-2011	HMO	0 / 0	1000 / 2500	$10 copay	excluded unless employer selects option Rx rider plan	0% coIns 0% / $0 InP 0% / $100 per visit OutP
Premier 15		1-2011	HMO	0 / 0	1500 / 2500	$15 copay	excluded unless employer selects option Rx rider plan	0% coIns 0% / $0 InP 0% / $100 per visit OutP
Premier 20		1-2011	HMO	0 / 0	1500 / 2500	$20 copay	excluded unless employer selects option Rx rider plan	0% coIns 0% / $0 InP 0% / $100 per visit OutP
Premier 40		1-2011	HMO	0 / 0	1500 / 2500	$40 copay	excluded unless employer selects option Rx rider plan	0% coIns 0% / $0 InP 0% / $100 per visit OutP
Premier Medicare Supplement 10		1-2011	HMO	0 / 0	1000 indiv / 2500 family	$10 copay	excluded unless employer selects option Rx rider plan	0% coIns 0% / $0 InP 0% / $100 OutP
Advantage 15-30		1-2011	HMO	0 / 0	1500 / 2500	$15 copay	excluded unless employer selects option Rx rider plan	0% coIns 0% / $250 per day, up to 3 days InP 0% / $100 per visit OutP
Advantage 420		1-2011	HMO	0 / 0	2500 / 4500	$20 copay	excluded unless employer selects option Rx rider plan	0% coIns 0% / $500 per day, up to 5 days InP 0% / $100 per visit OutP
Advantage 70		1-2011	HMO	0 / 0	3000 / 5000	$20 copay	excluded unless employer selects option Rx rider plan	30% coIns 30% / $0 InP 30% / $0 OutP
Advantage 40		1-2011	HMO	0 / 0	3000 / 5000	$40 copay	excluded unless employer selects option Rx rider plan	30% coIns 30% / $0 InP 30% / $0 OutP
Western 4010 (Rx included)		1-2011	HMO	1000 / 2000	4000 / 8000	$40 copay	$10 $30 $150 ded	0% coIns 0% / $500 per day InP 0% / $250 per visit OutP AD
Western 2025 (Rx included)		1-2011	HMO	2500 / 5000	5000 / 10000	$20 copay	$10 $30 $150 ded	0% coIns 0% / $500 per day InP 0% / $250 per visit OutP AD
Western 4025 (Rx included)		1-2011	HMO	2500 / 5000	5000 / 10000	$40 copay	$10 $30 $150 ded	0% coIns 0% / $500 per day InP 0% / $250 per visit OutP AD
Rx H		1-2011	HMO	n/a	n/a	n/a	$10 $30 $0 ded	n/a
Rx J		1-2011	HMO	n/a	n/a	n/a	$10 $40 $0 ded	n/a
Rx W		1-2011	HMO	n/a	n/a	n/a	$10 $30 $150 ded	n/a
Western Health Advantage HMO Plans		Effective	Network	In-Network Ded Sgl/Fam	In-Network Out/pocket max	In-Network Office visits (AD = after deductible)	Rx Drugs... Generic Brand Name Deductible (AD = after deductible)	Professional Services... CoInsurance InP CoIns/Copay OutP CoIns/Copay (AD = after deductible)
VIEW DISCONTINUED WESTERN HEALTH ADVANTAGE PLANS - CLICK HERE view / hide Western Health Advantage Details

Group Medical Carriers (CA):	Aetna \| Anthem Blue Cross \| Blue Shield \| California Choice \| Health Net \| Independence American \| HSA California \| Kaiser \| Kaiser Choice Solution \| SeeChange \| Sharp \| UHC / PacifiCare \| Western Health Advantage
Dental Carriers (CA):	Aetna \| Anthem Blue Cross \| Blue Shield \| New Dental Choice \| PacifiCare \| Premier Access \| UHC
Disability Carriers (CA):	American Fidelity \| The Hartford \| The Standard \| Unum
HSA Administration (CA):	First Horizon \| Health Equity \| HSA Bank \| Sterling HSA
Life Carriers (CA):	Aetna \| American Fidelity \| Anthem Blue Cross \| Blue Shield \| The Hartford \| The Standard \| UHC \| Unum
Specialty Products (CA):	Ceridian \| coPower \| Satori
Supplemental & Voluntary (CA):	Aflac \| American Fidelity \| Colonial
Vision Carriers (CA):	Aetna \| Anthem Blue Cross \| Blue Shield \| UHC \| VSP
Wellness At Work (CA):	My Wellchoice+