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: 2-1-2012 to 3-31-2012

Applications & Forms..... Group Medical Dental Life Insurance Vision
Group Admin Manual:		Underwriting Guidelines:			Employer Handbook:
Aetna 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)
MC HSA HDHP $2000 80/50	10-2010	PPO	2000 indiv / 4000 family embedded aggregate	3500 indiv / 10000 family $5 million per member's lifetime. (In/Out combined)	20% co-insurance AD	$20 $40 Integrated with medical ded	20% AD 20% AD / $0 30% AD / $150 outpatient hospital department. 20% AD / $0 freestanding surgical facility
MC HSA HDHP $3,000 90/50 (TIF)	10-2010	PPO	3000 indiv / 6000 family	2500 indiv / 5000 family	10% co-insurance AD	$20 $40 Integrated with medical ded	-
MC HSA HDHP $3,500 80/50 (TIF)	10-2010	PPO	3500 indiv / 7000 family	2000 indiv / 4000 family	20% co-insurance AD	$20 $40 Integrated with medical ded	-
MC HSA HDHP $2500 80/50	01-2010	PPO	2500 indiv / 5000 family embedded aggregate	4200 indiv / 8400 family $5 million per member's lifetime. (In/Out combined)	20% co-insurance AD	$20 $40 Integrated with medical ded	20% AD 20% AD / $0 30% AD / $150 outpatient hospital department. 20% AD / $0 freestanding surgical facility
MC HSA HDHP $3000 100/50	4-09	PPO	3000 indiv / 6000 family embedded aggregate	4000 indiv / 8000 family $5 million per member's lifetime. (In/Out combined)	0% co-insurance AD	$20 $40 Integrated with medical ded	0% 0% / $0 0% / $0 AD
MC HSA HDHP $2500 80/50	01-2010	PPO	2500 indiv / 5000 family embedded aggregate	4200 indiv / 8400 family $5 million per member's lifetime. (In/Out combined)	20% co-insurance AD	$20 $40 Integrated with medical ded	20% AD 20% AD / $0 30% AD / $150 outpatient hospital department. 20% AD / $0 freestanding surgical facility
MC HSA HDHP $3000 100/50	4-09	PPO	3000 indiv / 6000 family embedded aggregate	4000 indiv / 8000 family $5 million per member's lifetime. (In/Out combined)	0% co-insurance AD	$20 $40 Integrated with medical ded	0% 0% / $0 0% / $0 AD
MC HSA HDHP $3300 80/50	1-2010	PPO	3300 indiv / 6600 family embedded aggregate	5000 indiv / 10000 family $5 million per member's lifetime. (In/Out combined)	20% co-insurance AD	$20 $40 Integrated with Medical Deductible	20% AD 20% AD / $0 30% AD / $150 outpatient hospital department. 20% AD / $0 freestanding surgical facility
Aetna HRA / PPO 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)
MC HRA HDHP $3000 80/50	10-2010	PPO	3000 indiv / 6000 fam	4500 indiv / 9000 family $5 million per member's lifetime. (In/Out combined)	$20 copay deductible waived	$20 $40 Integrated with Medical Deductible	20% 20% / $0 20% / $0 AD
MC HRA HDHP $5000 80/50	10-2010	PPO	3000 indiv / 6000 fam	4500 indiv / 9000 family $5 million per member's lifetime. (In/Out combined)	$20 copay deductible waived	$20 $40 Integrated with Medical Deductible	20% 20% / $0 20% / $0 AD
Aetna EPO / PPO 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)
EPO $500 80 (Open Access)	5-2010	PPO	500 / 1000	5500 indiv / 2 member max $5 millioin per member's lifetime	$25 copay AD	$15 $40 AD	20% AD 20% AD / $0 0% / $300 AD outpatient hospital department. 0% / $100 freestanding surgical facility
Aetna PPO 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)
MC 10000 100/50	10-2010	PPO	10000 indiv / 10000 family	10000 / 10000 $5 million per member's lifetime. (In/Out combined)	$15 copay deductible waived	$20 $40 AD	0% 0% / $0 0% / $0 AD
MC 3500 65/50	10-2010	PPO	3500 indiv / 2 mem max	8500 indiv / 2 member max $5 million per member's lifetime. (In/Out combined)	$35 copay deductible waived	$20 $40 $250 ded	35% AD 35% AD / $0 35% AD / $0 outpatient hospital department. 35% AD / $0 freestanding surgical facility
MC 2500 75/50	10-2010	PPO	2500 indiv / 2 mem max	7500 indiv / 2 mem max $5 million per member's lifetime. (In/Out combined)	$25 copay deductible waived	$20 $40 $250 ded	25% 25% / $0 25% / $0 AD
MC $2000 80/50/50	10-2010	PPO	2000 indiv / 2 mem max	7000 indiv / 2 member max $5 million per member's lifetime. (In/Out combined)	$25 copay deductible waived	$15 $40 AD	20% AD 20% Professional, 50% Facility AD / $0 30% Professional, 50% Facility AD / $0 outpatient hospital department. 20% Professional, 50% Facility AD / $0 freestanding surgical facility
MC $1000 70/50	10-2010	PPO	1000 indiv / 2 mem max	5000 indiv / 2 member max $5 million per member's lifetime. (In/Out combined)	$25 copay deductible waived	$15 / $40 / AD	30% AD 30% AD / $0 40% AD / $150 outpatient hospital department. 30% AD / $0 freestanding surgical facility
MC $1000 80/50/50	10-2010	PPO	1000 indiv / 2 mem max	6000 indiv / 2 member max $5 million per member's lifetime. (In/Out combined)	$25 copay deductible waived	$15 $40 AD	20% AD 20% Professional, 50% Facility AD / $0 30% Professional, 50% Facility AD / $0 outpatient hospital department. 20% Professional, 50% Facility AD / $0 freestanding surgical facility
Aetna PPO 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)
PPO $750 80/60	4-09	PPO	750 indiv / 2 mem max	5250 indiv / 2 member max $5 million per member's lifetime. (In/Out combined)	$25 copay deductible waived	$15 $40 AD	20% AD 20% AD / $0 30% AD / $150 outpatient hospital department. 20% AD / $0 freestanding surgical facility
MC $750 80/50/50	10-2010	PPO	750 indiv / 2 mem max	5750 indiv / 2 member max $5 million per member's lifetime. (In/Out combined)	$25 copay deductible waived	$15 $40 AD	20% AD 20% Professional, 50% Facility AD / $0 30% Professional, 50% Facility AD / $0 outpatient hospital department. 20% Professional, 50% Facility AD / $0 freestanding surgical facility
MC $500 80/60	4-09	PPO	500 indiv / 2 mem max	4500 indiv / 2 member max $5 million per member's lifetime. (In/Out combined)	$35 copay deductible waived	$15 $40 AD	20% AD 20% AD / $0 30% AD / $150 outpatient hospital department. 20% AD / $0 freestanding surgical facility
PPO $500 90/70	10-2010	PPO	500 indiv / 2 mem max	4500 indiv / 2 member max $5 million per member's lifetime. (In/Out combined)	$15 copay deductible waived	$15 $40 AD	10% AD 10% AD / $250 20% AD / $150 outpatient hospital department. 10% AD / $0 freestanding surgical facility
MC $250 80/60	10-2010	PPO	250 indiv / 2 mem max	3750 indiv / 2 member max $5 million per member's lifetime. (In/Out combined)	$20 copay deductible waived	$15 $40 AD	20% AD 20% AD / $0 30% AD / $0 outpatient hospital department. 20% AD / $0 freestanding surgical facility
MC $250 90/70	10-2010	PPO	250 indiv / 2 mem max	3250 indiv / 2 member max $5 million per member's lifetime. (In/Out combined)	$15 copay deductible waived	$10 $25 AD	10% AD 10% AD / $0 20% AD / $0 outpatient hospital department. 10% AD / $0 freestanding surgical facility
Indemnity	10-2010	PPO	500 indiv / 2 mem max	4000 indiv / 2 member max $5 million per member's lifetime. (In/Out combined)	20% co-insurance after deductible	$10 $25 150 $ded	20% AD 20% AD / $250 30% AD / $250 outpatient hospital department. 20% AD / $0 freestanding surgical facility
Aetna HMO 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)
HMO Coinsurance 70%	7-11	HMO	0 / 0	3500 indiv / 7000 family Unlimited Lifetime	$40 copay	$20 / $40 / $0 ded	30% 30% / $0 40% / $0 $0 ded
HMO Deductible	10-2010	HMO	1000 indiv / 2000 family	3500 indiv / 7000 family Unlimited Lifetime Max except where otherwise indicated.	$40 copay deductible waived	$20 $40 $0 ded	30% AD 30% AD / $0 30% AD / $0 outpatient hospital department. 30% AD / $0 freestanding surgical facility
HMO $50	10-2010	HMO	0 / 0	4000 indiv / 8000 family Unlimited Lifetime Max except where otherwise indicated	$50 copay	$15 / $35 / $0 ded	0% 0% / $1000 per day up to 3 days per admit 0% / $500 outpatient hospital facility. 0% / $250 performed other than a hospital outpatient facility
HMO $40	10-2010	HMO	0 / 0	3500 indiv / 7000 family Unlimited Lifetime Max except where otherwise indicated	$40 copay	$15 / $35 / $0 ded	0% 0% / $750 per day up to 3 days per admit 0% / $400 outpatient hospital facility. 0% / $200 performed other than a hospital outpatient facility
HMO $30	10-2010	HMO	0 / 0	3000 indiv / 6000 family Unlimited Lifetime Max except where otherwise indicated	$30 copay	$15 $35 $0 ded	0% 0% / $500 per day up to 3 days per admit 0% / $300 outpatient hospital facility. 0% / $150 performed other than a hospital outpatient facility
HMO $20	10-2010	HMO	0 / 0	2500 indiv / 5000 family Unlimited Lifetime Max except where otherwise indicated	$20 copay	$15 $35 $0 ded	0% 0% / $200 per day up to 3 days per admit 0% / $250 outpatient hospital facility. 0% / $100 performed other than a hospital outpatient facility
Aetna HMO 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)
HMO $10	10-2010	HMO	0 / 0	1500 indiv / 3000 family Unlimited Lifetime Max except where otherwise indicated	$10 copay	$15 $35 $0 ded	0% 0% / $0 per day up to 3 days per admit 0% / $100 outpatient hospital facility. 0% / $0 performed other than a hospital outpatient facility
Value Network* HMO $40/$50	10-2010	HMO	0 / 0	3500 indiv / 7000 family Unlimited Lifetime Max except where otherwise indicated	$40 copay	$20 $40 $0 ded	0% 0% / $800 per day up to 3 days per admit 0% / $400 outpatient hospital facility. 0% / $200 performed other than a hospital outpatient facility
Value Network* HMO $30/$40	10-2010	HMO	0 / 0	3000 indiv / 6000 family Unlimited Lifetime Max except where otherwise indicated	$30 copay	$20 $40 $0 ded	0% 0% / $600 per day up to 3 days per admit 0% / $300 outpatient hospital facility. 0% / $150 performed other than a hospital outpatient facility
Value Network* HMO $20/$30	10-2010	HMO	0 / 0	2500 indiv / 5000 family Unlimited Lifetime Max except where otherwise indicated	$20 copay	$20 $40 $0 ded	0% 0% / $400 per day up to 3 days per admit 0% / $200 outpatient hospital facility. 0% / $100 performed other than a hospital outpatient facility
Value Network* HMO $10/$20	10-2010	HMO	0 / 0	2000 indiv / 4000 family Unlimited Lifetime Max except where otherwise indicated	$10 copay	$20 $40 $0 ded	0% 0% / $100 per day up to 3 days per admit 0% / $100 outpatient hospital facility. 0% / $0 performed other than a hospital outpatient facility
Vitalidad HMO $5	4-08	HMO	0 / 0	1500 indiv / 3000 family Unlimited Lifetime Max	$5 copay	$5 $5 0 $ded	0% 0% / $0 0% / $0
Vitalidad HMO $10	10-2010	HMO	0 / 0	2000 indiv / 4000 family Unlimited Lifetime Max	$0	$10 $10 0 $ded	0% 0% / $100 per day up to $700 per admit 0% / $0
Vitalidad Plus California con Aetna HMO $40/$10	5-2010	HMO	0 / 0	3500 indiv / 7000 family Unlimited Lifetime Max	$40 copay	$15 $35 $0 ded	0% 0% / $800 per day up to 3 days per admit 0% / $400 outpatient hospital facility. 0% / $200 performed in a freestanding facility
Vitalidad Plus California con Aetna HMO $30/$10	10-2010	HMO	0 / 0	3000 indiv / 6000 family Unlimited Lifetime Max	$30 copay	$15 $35 $0 ded	0% 0% / $600 per day up to 3 days per admit 0% / $300 outpatient hospital facility. 0% / $150 performed in a freestanding facility
Vitalidad Plus California con Aetna HMO $20/$5	5-2010	HMO	0 / 0	2500 indiv / 5000 family Unlimited Lifetime Max	$20 copay	$15 $35 0 $ded	0% 0% / $400 per day up to 3 days per admit 0% / $200 outpatient hospital facility. 0% / $100 performed in a freestanding facility
Vitalidad Plus California con Aetna HMO $10/$5	10-2010	HMO	0 / 0	2000 indiv / 4000 family Unlimited Lifetime Max	$10 copay	$15 $35 $0 ded	0% 0% / $100 per day up to 3 days per admit 0% / $100 outpatient hospital facility. 0% / $50 performed in a freestanding facility
Aetna HMO 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)
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view / hide Anthem Blue Cross Details
		Rate Guides: EE 1-2012 EC 1-2012 Benefits 10-2011

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)	10-2011	PPO	3500 / 7000 aggregate	5000 / 10000 aggregate	20% co-ins AD	$10 $30 AD	20% 20% / $0 20% / $0 AD
Lumenos HSA 2500 (80/50)	10-2011	PPO	2500 / 5000 aggregate	5000 / 10000 aggregate	20% co-ins AD	$10 $30	20% 20% / $0 20% / $0 AD
Lumenos HSA 1500	10-2010	PPO	1500 / 3000 aggregate	3000 / 6000 aggregate	20% co-ins AD	$10 $30 AD	20% 20% / $0 20% / $0 AD
Lumenos HSA 1500 (80/50)	10-2011	PPO	1500 / 3000 aggregate	3000 / 6000 aggregate	20% co-ins AD	$10 $30	20% 20% / $0 20% / $0 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	10-2011	PPO	2000 / 4000 aggregate Health Incentive Plan Allocation 500 / 1000 aggregate	5000 / 10000 aggregate	40% co-ins AD	$10 $30 AD	40% 40% / $0 40% / $0 AD
Lumenos® HIA Plus 750	10-2011	PPO	1500 / 3000 aggregate Health Incentive Plan Allocation 750 / 1500 aggregate	5000 / 10000 aggregate	25% co-ins AD	$10 $30 AD	25% 25% / $0 25% / $0 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% 20% / $0 20% / $0 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 New Plan	10-2011	PPO	5000 / 10000	7000 / 14000	$30	$10 $30	20% 20% / $0 20% / $0
Lumenos HRA 5000D New Plan	10-2011	PPO	5000 / 10000	7000 / 14000	20%	$10 $30	20% 20% / $0 20% / $0
Lumenos HRA 3000C New Plan	10-2011	PPO	3000 / 6000	5000 / 10000	$20	$10 $30	20% 20% / $0 20% / $0
Lumenos HRA 3000D New Plan	10-2011	PPO	3000 / 6000	5000 / 10000	20%	$10 $30	20% 20% / $0 20% / $0
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	10-2011	PPO	2500 / 5000	5000 / 10000	$25 copay	$10 $30 250 $ded	25% 25% / $0 25% / $0 AD
Solution 3500 PPO	10-2011	PPO	3500 / 7000	5000 / 10000	$35 copay	$10 $35 250 $ded	35% 35% / $0 35% / $0 AD
Solution 5000 PPO	10-2011	PPO	5000 / 10000	7500 / 15000	$40 copay	$10 $35 250 $ded	40% 40% / $0 40% / $0 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	10-2011	PPO	750 / two-member max	5000 / 10000	40 copay	$10 $30 $150 ded	40% 40% / $0 40% / $0 AD
PPO $30 Copay	10-2011	PPO	500 / 1000	4500 / 9000	$30 copay	$10 $30 150 $ded	30% 30% / $0 30% / $0 AD
PPO $20 Copay	10-2011	PPO	250 / 500	4000 / 8000	$20 copay	$10 $30 150 $ded	20% 20% / $0 20% / $0 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	10-2011	PPO	1000 / 2000	5000 / 10000	$25 copay	$10 $30 $250 ded	30% 30% / $0 30% / $0 AD
PPO 2000/$45	10-2011	PPO	2000 / 4000	5000 / 10000	$45 copay	$10 $30 $250 ded	40% 40% / $0 40% / $0 AD
PPO 1500/$35	10-2011	PPO	1500 / 3000	5000 / 10000	$35 copay	$10 $30 $250 ded	40% 40% / $0 40% / $0 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*	10-2011	PPO	750 / 1500	5000 / 10000	$45 copay	$10 na $0 ded	45% 45% / $0 45% / $0 AD
PPO $35 Copay GenRx*	10-2011	PPO	500 / 1000	4500 / 9000	$35 copay	$10 na 0 $ded	35% 35% / $0 35% / $0 AD
PPO $25 Copay GenRx*	10-2011	PPO	250 / 500	4000 / 8000	$25 copay	$10 na 0 $ded	25% 25% / $0 25% / $0 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 $30 Copay	2-2011	PPO	500 / 1000	3500 per mem / two-mem max	$30 copay	$10 $25 $0 ded	30% 30% / $0 30% / $0 AD
Premier $20 Copay	10-2011	PPO	250 / 500	3500 / 7000	$20 copay	$10 $30 $0 ded	20% 20% / $0 20% / $0 AD
Premier $10 Copay	10-2011	PPO	250 / 500	3000 / 6000	$10 copay	$10 $30 0 $ded	10% 10% / $0 10% / $0 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% 30% / $0 30% / $0 AD
Elements Hospital Plus	10-2011	PPO	1500 / 3000	5000 / 10000	50% co-ins	$10 na AD	30% 30% / $0 30% / $0 AD
Elements Hospital Preferred	10-2011	PPO	1250 / 2500	5000 / 10000	50% co-ins	$10 $35 $250 ded	20% 20% / $0 20% / $0
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% 30% / $0 30% / $0 AD
Hospital Benefits Plus	10-2011	PPO	1500 / 3000	5000 / 10000	50% co-ins	$15 n/a	30% 30% / $0 30% / $0 AD
Hospital Benefits Preferred	10-2011	PPO	1250 / 2500	5000 / 10000	50% co-ins	$15 n/a	30% 30% / $0 30% / $0
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	10-2011	HMO	0 / 0	2500 / 5000 aggregate	$20 copay	$10 $30 $150 ded	0% 0% / $0 0% / $300
Saver 30 HMO	10-2011	HMO	0 / 0	3500 / 7000 aggregate	$30 copay	$10 $30 $150 ded	0% 0% / $0 0% / $500
Saver 40 HMO	10-2011	HMO	0 / 0	4000 / 8000 aggregate	$40 copay	$10 $30 250 $ded	0% 0% / $0 0% / $500
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)	10-2011	HMO	0 / 0	2500 / 5000 aggregate	$20 copay	$10 $30 $150 ded	0% 0% / $0 0% / $300
Saver 30 HMO (Select Network)	10-2011	HMO	0 / 0	3500 / 7000 aggregate	$30 copay	$10 $30 $150 ded	0% 0% / $0 0% / $500
Saver 40 HMO (Select Network)	10-2011	HMO	0 / 0	4000 / 8000 aggregate	$40 copay	$10 $30 250 $ded	0% 0% / $0 0% / $500
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	10-2011	HMO	0	2000 / 4000 aggregate	$20 copay	$10 $30 $150 ded	0% 0% / $0 20% / $0
Classic 30 HMO	10-2011	HMO	0	3000 / 6000 aggregate	$30 copay	$10 $30 $150 ded	0% 0% / $0 20% / $0
Classic 40 HMO	10-2011	HMO	0	3500 / 7000 aggregate	$40 copay	$10 $30 $250 ded	0% 0% / $0 30% / $0
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)	10-2011	HMO	0	2000 / 4000 aggregate	$20 copay	$10 $30 $150 ded	0% 0% / $0 20% / $0
Classic 30 HMO (Select Network)	10-2011	HMO	0	3000 / 6000 aggregate	$30 copay	$10 $30 $150 ded	0% 0% / $0 20% / $0
Classic 40 HMO (Select Network)	10-2011	HMO	0	3500 / 7000 aggregate	$40 copay	$10 $30 $250 ded	0% 0% / $0 30% / $0
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%	10-2011	HMO	0	2000 / 4000 aggregate	$25 copay	$10 $30 $150 ded	0% 0% / $0 0% / $0
HMO $10 100%	10-2011	HMO	0	1750 / 3500 aggregate	$10 copay	$10 $30 $150 ded	0% 0% / $0 0% / $0
HMO $25 100% (Select Network)	10-2011	HMO	0	1750 / 3500 aggregate	$25 copay	$10 $30 $150 ded	0% 0% / $0 0% / $0
HMO $10 100% (Select Network)	10-2011	HMO	0	1750 / 3500 aggregate	$10 copay	$10 $30 $150 ded	0% 0% / $0 0% / $0
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)
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				Rate Guide Eff: 1-2012

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	1-2012	PPO	3000 / 6000	5000 / 10000	$30 visit	$10 $30 $300 ded	30% 30% / $0 30% / $0 AD
Base PPO 40	1-2012	PPO	4000 / 8000	6000 / 12000	$40 visit	$10 $30 $300 ded	40% 40% / $0 40% / $0 AD
Base PPO 50	1-2012	PPO	5000 / 10000	7000 / 14000	$50 visit	$10 $30 $300 ded	50% 50% / $0 50% / $0 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	1-2012	PPO	2500 / 5000	5500 / 11000	$45 copay 3 visits only	$15 $30 $250 ded	35% 35% / $1000 35% / $500 surgery AD
Shield Spectrum PPO Plan 1500 Value	1-2012	PPO	1500 / 3000	4500 / 9000	$30 copay 3 visits only	$15 $30 or 30% $250 ded	30% 30% / $1000 30% / $500 surgery AD
Shield Spectrum PPO Plan 1000 Value	1-2012	PPO	1000 / 2000	4000 / 8000	$20 copay 3 visits only	$15 $30 or 30% $250 ded	30% 30% / $500 30% / $250 surgery AD
Shield Spectrum PPO Plan 750 Value	1-2012	PPO	750 / 1500	4000 / 8000	$15 copay 3 visits only	$15 $30 or 30% $250 ded	30% 30% / $500 30% / $250 surgery AD
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	1-2012	HMO	2500 / 5000	3500 / 7000	20% co-ins	$10 $30 AD	20% 20% / $0 20% / $0
Simple Savings 3400 / 6800	1-2012	HMO	3400 / 6800	4250 / 8500	20% co-ins	$10 $30 AD	20% 20% / $0 20% / $0
Simple Savings 3500 / 7000	1-2012	HMO	3500 / 7000	4500 / 9000	20% co-ins	$10 $30 AD	20% 20% / $0 20% / $0
Simple Savings 4500 / 9000	1-2012	HMO	4500 / 9000	5500 / 11000	20% co-ins	$10 $30 AD	20% 20% / $0 20% / $0
Simple Savings 5500 / 11000	1-2012	HMO	5500 / 11000	5950 / 11900	0% co-ins	$10 $30 AD	0% 0% / $0 0% / $0
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	1-2012	HMO	0 / 0	2000 / 4000	$15 copay	$10 $30 $300 ded	15% 15% / $0 15% / $0
Access+ HMO Enhanced Plan 25	1-2012	HMO	0 / 0	3000 / 6000	$25 copay	$10 $30 $300 ded	25% 25% / $0 25% / $0
Access+ HMO Enhanced Plan 35	1-2012	HMO	0 / 0	4000 / 8000	$35 copay	$10 $30 $300 ded	35% 35% / $0 35% / $0
Access+ HMO Enhanced Plan 40	1-2012	HMO	0 / 0	4500 / 9000	$40 copay	$10 $30 $300 ded	40% 40% / $0 40% / $0
Access+ HMO Enhanced Plan 45	1-2012	HMO	0 / 0	5000 / 10000	$45 copay	$10 $30 $300 ded	45% 45% / $0 45% / $0
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	1-2012	HMO	0 / 0	1500 / 3000	$15 copay	$10 $30 0 $ded	0% 0% / $150 0% / $150
Access+ HMO Premier Plan 25	1-2012	HMO	0 / 0	2500 / 5000	$25 copay	$10 $30 0 $ded	0% 0% / $250 0% / $300
Access+ HMO Premier Plan 35	1-2012	HMO	0 / 0	3500 / 7000	$35 copay	$10 $30 0 $ded	0% 0% / $350 0% / $750
Access+ HMO Premier Plan 45	1-2012	HMO	0 / 0	4500 / 9000	$45 copay	$10 $30 0 $ded	0% 0% / $450 0% / $1000
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	1-2012	HMO	0 / 0	2000 / 4000	$15 copay	$10 $30 $300 ded	15% 15% / $0 15% / $0
Local Access+ HMO Enhanced 25	1-2012	HMO	0 / 0	3000 / 6000	$25 copay	$10 $30 $300 ded	25% 25% / $0 25% / $0
Local Access+ HMO Enhanced 35	1-2012	HMO	0 / 0	4000 / 8000	$35 copay	$10 $30 $300 ded	35% 35% / $0 35% / $0
Local Access+ HMO Enhanced 45	1-2012	HMO	0 / 0	5000 / 10000	$45 copay	$10 $30 $300 ded	45% 45% / $0 45% / $0
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	1-2012	HMO	0 / 0	1500 / 3000	$15 copay	$10 $30 $0 ded	0% 0% / $150 up to 3 day max per admin 0% / $150 surgery
Local Access+ HMO Premier 25	1-2012	HMO	0 / 0	2500 / 5000	$25 copay	$10 $30 $0 ded	0% 0% / $250 up to 3 day max per admin 0% / $300 surgery
Local Access+ HMO Premier 35	1-2012	HMO	0 / 0	3500 / 7000	$35 copay	$10 $30 $0 ded	0% 0% / $350 up to 3 day max per admin 0% / $750 surgery
Local Access+ HMO Premier 45	1-2012	HMO	0 / 0	4500 / 9000	$45 copay	$10 $30 $150 ded	0% 0% / $450 up to 3 day max per admin 0% / $1000 surgery
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	1-2012	HMO	0 / 0	1000 / 2000	$10 copay	$10 $10 0 $ded	0% 0% / $100 0% / $50
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: 1-1-2012 to 6-1-2012

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 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)
CalChoice PPO 750		1-2010	PPO	750 / 2250 aggregate	3750 indiv / 7500 family 6 Million	$35 copay	$15 $30 150 $ded	20% 20% / $500 20% / $500
CalChoice PPO 1000		01-2011	PPO	1000 / 3000 aggregate	4000 indiv/ 8000 family 6 Million	$35 copay	$15 $30 200 $ded	30% 30% / $1000 30% / $500
CalChoice PPO 2400		01-2010	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 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)
Active Choice 500		1-2010	PPO	0 / 0	5000 / 10000 First Dollar Coverage $500 / $1000 6 Million	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 6 Million	20% AD	$15 $30 AD	20% 20% / $0 20% / $0 AD
CalChoice HSA 2400		1-2010	HSA	2400 / 4800 aggregate	3200 / 5800 6 Million	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 5 Million	$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 5 Million	$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 5 Million	$45 AD	$15 $30 AD	40% 40% / $0 40% / $0 AD
California Choice EOA 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)
Elect Open Access Participating Health Plans: Health Net		01-2011	HMO	0 / 0	2500 indiv / 6000 family	$25 copay HMO / $40 copay PPO	$15 $30 150 $ded	25% 25% / $0 25% / $0
EOA 25 (92H) Participating Health Plans: Health Net		7-09	HMO	0 / 0	2500 indiv / 6000 family	$25 copay HMO / $40 copay PPO	$15 $30 150 $ded	25% 25% / $0 25% / $0
California Choice HMO 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)
CalChoice HMO 15 Participating Health Plans: Blue Shield, Health Net, Kaiser Permanente, Sharp, Western Health Advantage		01-2011	HMO	0 / 0	2000 indiv / 4000 family	$15 copay	$10 $20 0 $ded	0% 0% / $400 0% / $200
CalChoice HMO 25 Participating Health Plans: Blue Shield, Sharp, Western Health Advantage		1-2011	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 Participating Health Plans: Health Net		1-2011	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		01-2011	HMO	0 / 0	2500 indiv / 5000 family	$25 copay	$10 $25 0 $ded	0% 0% / $400 0% / $300
CalChoice HMO 25 Value Participating Health Plans: Health Net		01-2011	HMO	0 / 0	3000 indiv / 6000 family	$25 copay	$15 $30 100 $ded	25% 25% / $0 25% / $0
CalChoice HMO 25 Value Participating Health Plans: Blue Shield		01-2011	HMO	1000 / 2000	3000 indiv / 6000 family	$25 copay	$15 $30 200 $ded	0% AD 0% / $400 per day AD, max $1600 0% / $400 AD
Salud HMO y mas Participating Health Plans: Health Net		1-2010	HMO	0 / 0	2500 indiv / 5000 family	$25 copay	$15 $25 0 $ded	0% 0% / $500 per day, max $1000 0% / $300
California Choice HMO 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)
CalChoice HMO 30 Participating Health Plans: Blue Shield, Health Net, Sharp, Western Health Advantage		01-2011	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		01-2011	HMO	0 / 0	3000 indiv / 6000 family	$30 copay	$15 $30 0 $ded	0% 0% / $450 0% / $400
CalChoice HMO 30 Value Participating Health Plans: Health Net		01-2011	HMO	0 / 0	3500 indiv / 7000 family	$30 copay	$20 $30 200 $ded	30% 30% / $0 30% / $0
CalChoice HMO 40 Participating Health Plans: Blue Shield, Health Net, Sharp, Western Health Advantage		01-2011	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		01-2011	HMO	0 / 0	3500 indiv / 7000 family	$40 copay	$15 $30 0 $ded	0% 0% / $500 per day 0% / $500
CalChoice HMO 40 Value Participating Health Plans: Health Net		01-2011	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: Blue Shield		01-2011	HMO	1500 / 3000	4000 indiv / 8000 family	$40 copay	$15 $30 250 $ded	0% 0% / $750 per day AD 0% / $750 AD
CalChoice HMO 40 Value Participating Health Plans: Western Health Advantage		01-2011	HMO	2500 / 5000	5000 indiv / 10000 family	$40 copay	$20 $30 250 $ded	0% 0% / $500 per day AD 0% / $250
California Choice HMO 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)
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		Rate Guide Effective: 8-2011 through 1-31-2012

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

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	10-2010	PPO	4500 / 9000	6000 / 12000 5 million combined with PPO and OON	$40 copay AD	$15 $30 AD	50% 50% / $500 per calendar year 50% / $250 per calendar year
Value HSA 3500	10-2010	PPO	3500 / 7000	5000 / 10000 5 million combined with PPO and OON	$30 copay AD	$15 $30 AD	30% AD 30% / $250 per calendar year 30% / $250 per calendar year
Value HSA 2500	10-2010	PPO	2500 / 5000	4000 / 8000 5 million combined with PPO and OON	$20 copay AD	$15 $30 AD	20% AD 20% / $250 per calendar year 20% / $250 per calendar year
Value HSA 1500	10-2010	PPO	1500 / 3000	3000 / 6000 5 million combined with PPO and OON	$10 copay AD	$10 $25 AD	20% 20% / $0 20% / $0 AD
Standard HSA 2000 - Plan 9G2	5-2010	PPO	2000 / 4000	4000 / 8000 5 million combined with PPO and OON	0% co-ins AD	$10 $25 AD	0% 0% / $0 0% / $0 AD
Standard HSA 3000 - Plan 9G3	5-2010	PPO	3000 / 6000	5000 / 10000 5 million combined with PPO and OON	0% co-ins AD	$10 $25 AD	0% 0% / $0 0% / $0 AD
Standard HSA 4000	10-2010	PPO	4000 / 8000	5950 / 11900 5 million combined with PPO and OON	0% co-ins AD	$10 $25 AD	0% 0% / $0 0% / $0 AD
Hn Options PPO HSA 4000	10-2010	PPO	4000 / 8000	5000 / 10000 5 million combined with PPO and OON	$35 copay AD	$15 $30 AD	40% AD 40% / $250 per calendar year 40% / $250 per calendar year
Hn Options PPO HSA 3000	10-2010	PPO	3000 / 6000	4000 / 8000 5 million combined with PPO and OON	$25 copay AD	$15 $30 AD	30% AD 30% / $250 per calendar year 30% / $250 per calendar year
Health Net 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 3000	11-2010	PPO	3000 / 6000	4000 / 8000 5 million combined with PPO and OON	not covered	$10 $25 AD	20% 20% / $0 20% / $0 AD
HRA 5000	11-2010	PPO	5000 / 10000	6000 / 12000 5 million combined with PPO and OON	not covered	$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 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)
PPO-40 Standard	10-2010	PPO	500 / 1000	5500 / 11000 5 million combined with PPO and OON	$40 copay AD	$15 $30 $0 ded	40% AD 40% / $500 ded per calendar year 40% / $250 ded per calendar year
PPO - 40 Value	10-2010	PPO	1500 / 3000	6500 / 13000 5 million combined with PPO and OON	$40 copay AD	$15 $30 $250 ded	50% AD 50% / $500 ded per calendar year 50% / $250 ded per calendar year
PPO - 30 Standard	10-2010	PPO	500 / 1000	4000 / 8000 5 million combined with PPO and OON	$30 copay AD	$15 $30 $0 ded	20% AD 20% / $250 ded per calendar year 20% / $250 ded per calendar year
PPO - 30 Value	10-2010	PPO	1500 / 3000	6000 / 12000 5 million combined with PPO and OON	$30 copay AD	$15 $30 $200 ded	30% AD 30% / $250 ded per calendar year 30% / $250 ded per calendar year
PPO-20 Standard	10-2010	PPO	250 / 500	3250 / 6500 5 million combined with PPO and OON	$20 copay AD	$15 $30 0 $ded	10% AD 10% / $250 ded per calendar year 10% / $250 ded per calendar year
PPO - 20 Value	10-2010	PPO	1250 / 2500	4750 / 9500 5 million combined with PPO and OON	$20 copay AD	$15 $30 $150 ded	20% AD 20% / $250 ded per calendar year 20% / $250 ded per calendar year
PPO-10 Standard	10-2010	PPO	0 / 0	2500 / 5000 5 million combined with PPO and OON	$10 copay	$10 $25 0 $ded	10% 10% / $0 10% / $0
PPO - 10 Value	10-2010	PPO	1000 / 2000	3500 / 7000 5 million combined with PPO and OON	$10 copay AD	$10 $25 $100 ded	20% 20% / $0 20% / $0 AD
Health Net PPO Plans (EOA = Elect Open Access plan) (SN = Silver Network plan)	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)
Hn Options PPO 1750	10-2010	PPO	1750 / 3500	6750 / 13500 5 million combined with PPO and OON	$35 copay AD	$15 $30 $200 ded	40% 40% / $250 ded per calendar year 40% / $250 ded per calendar year
Hn Options PPO 1500	10-2010	PPO	1500 / 3000	5500 / 11000 5 million combined with PPO and OON	$25 copay AD	$15 $30 $200 ded	30% 30% / $250 ded per calendar year 30% / $250 ded per calendar year
Hn Options PPO 500 - Plan 9R4	10-2010	PPO	500 / 1000	4500 / 9000 5 million combined with PPO and OON	$35 copay AD	$15 $30 200 $ded	30% 30% / $250 ded per calendar year 30% / $250 ded per calendar year
Hn Options PPO 250	10-2010	PPO	250 / 500	3750 / 7500 5 million combined with PPO and OON	$25 copay AD	$15 $30 150 $ded	20% AD 20% / $250 ded per calendar year 20% / $250 ded per calendar year
Hn OPTIONS EOA 35 SN Hn OPTIONS EOA 35 - Plan 9T6	05-2010	PPO	0 / 0	4000 / 8000 No Lifetime Max	$50 copay	$15 $30 $200 ded	30% 30% / $0 30% / $0
Hn OPTIONS EOA 25 SN Hn OPTIONS EOA 25	10-2010	PPO	0 / 0	3000 / 6000 No Lifetime Max	$40 copay	$15 $30 $150 ded	20% 20% / $0 20% / $0
Flex Net Indemnity	11-2010	PPO	300 / 900	1500 / 4500 1 million	20% co-ins	20% 20% $75 ded	20% 20% / $0 20% / $0
Health Net PPO, HMO, EPO 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)
POS 10 - Plan 87C	5-2010	PPO	250 / 500	3000 single / 2 per family 5 million combined with PPO and OON	$20 copay AD	$10 $25 0 $ded	10% 10% / $250 per calendar year 10% / $250 per calendar year
POS 10 - Plan 87C	5-2010	HMO	0 / 0	1500 / 3000 None	$10 copay	$10 $25 0 $ded	0% 0% / $0 0% / $0
POS 20 - Plan 87D	5-2010	PPO	500 / 1000	3500 single / 2 per family 5 million combined with PPO and OON	$30 copay AD	$15 $30 0 $ded	20% AD 20% / $250 per calendar year 20% / $250 per calendar year
POS 20 - Plan 87D	5-2010	HMO	0 / 0	2000 / 4000 None	$20 copay	$15 $30 0 $ded	0% 0% / $250 per calendar year 0% / $250 per calendar year
Salud con Health Net PPO - Plan 9S2	5-2010	PPO	100 / max 2 per family	2000 / 4000 5 million combined with PPO and OON	$15 copay	$10 $35 0 $ded	20% AD 20% / $250 per admission ded 20% / $250
Salud EPO Primero - Plan 9U2	5-2010	EPO HMO	0 / 0	1500 / 4500 5 million	$15 copay	$10 $35 0 $ded	20% 0% / $250 per admit 20% / $0
Salud Mexico HMO - Plan 35W	5-2010	EPO HMO	0 / 0	1500 / 4500 No Maximum	$5 copay	$5 $5 0 $ded	0% 0% / $0 0% / $0
Salud HMO y Mas 35	10-2010	HMO	0 / 0	4000 / 8000 Unlimited Lifetime Max	$35 copay	$10 $35 $250 ded	20% 0% / $500 per day (4 day copay max) 20% / $0
Salud HMO y Mas 25	10-2010	HMO	0 / 0	3500 / 7000 Unlimited Lifetime Max	$25 copay	$10 $35 $250 ded	20% 0% / $250 per day (4 day copay max) 20% / $0
Salud HMO y Mas 15	10-2010	HMO	0 / 0	1500 single / 3000 two-party / 4500 family Unlimited Lifetime Max	$15 copay	$5 $15 $0 ded	20% 0% / $250 per day (4 day copay max) 20% / $0
Salud con Health Net EPO	10-2010	EPO HMO	0 / 0	1500 / 4500 5 million combined with PPO and OON	$15 copay	$10 $35 0 $ded	20% 0% / $250 per admission ded 20% / $0
Health Net HMO Plans (EOA = Elect Open Access plan) (SN = Silver Network plan)	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)
EOA Standard 40 - Plan 873 SN EOA Standard 40 - Plan 7K1	5-2010	HMO	0 / 0	4000 / 8000 None	$40 copay	$15 $30 $0 ded	0% 0% / $1000 per day for max of 3 days per admit 0% / $1000
EOA Value 40 - Plan 877 SN EOA Value 40 - Plan 7K5	5-2010	HMO	0 / 0	4500 / 9000 None	$40 copay	$15 $30 250 $ded	40% 40% / $0 40% / $0
EOA Standard 30 - Plan 872 SN EOA Standard 30 - Plan 7J9	5-2010	HMO	0 / 0	3000 / 6000 None	$30 copay	$15 $30 $0 ded	0% 0% / $500 per day for a max of 3 days per admit 0% / $500
EOA Value 30 - Plan 876 SN EOA Value 30 - Plan 7K4	5-2010	HMO	0 / 0	3500 / 7000 None	$30 copay	$15 $30 200 $ded	30% 30% / $0 30% / $0
EOA Standard 20 - Plan 871 SN EOA Standard 20 - Plan 7J8	5-2010	HMO	0 / 0	2000 / 4000 None	$20 copay	$15 $30 $0 ded	0% 0% / $250 per day for a max of 3 days per admit 0% / $250
EOA Value 20 - Plan 875 SN EOA Value 20 - Plan 7K3	5-2010	HMO	0 / 0	2500 / 5000 None	$20 copay	$15 $30 150 $ded	20% 20% / $0 20% / $0
EOA Standard 10 - Plan 86Z SN EOA Standard 10 - Plan 7J7	5-2010	HMO	0 / 0	1500 / 3000 None	$10 copay	$10 $25 $ded	0% 0% / $0 0% / $0
EOA Value 10 - Plan 874 SN EOA Value 10 - Plan 7k2	5-2010	HMO	0 / 0	2000 / 4000 None	$10 copay	$10 $25 100 $ded	10% 10% / $0 10% / $0
Health Net HMO Plans (SN = Silver Network plan)	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)
40 Standard HMO - Plan 885 and SN 40 Standard HMO - Plan S44	5-2010	HMO	0 / 0	4000 / 8000 None	$40 copay	$15 $30 0 $ded	0% 0% / $1000 per day 3 day max 0% / $1000
40 Value HMO - Plan 88E and SN 40 Value HMO - Plan S48	5-2010	HMO	0 / 0	4500 / 9000 None	$40 copay	$15 $30 $250 ded	40% 40% / $0 40% / $0
30 Standard HMO - Plan 884 and SN 30 Standard HMO - Plan S42	5-2010	HMO	0 / 0	3000 / 6000 None	$30 copay	$15 $30 0 $ded	0% 0% / $500 per day, 3 day max 0% / $500
30 Value HMO - Plan 88D and SN 30 Value HMO - Plan S45	5-2010	HMO	0 / 0	3500 / 7000 None	$30 copay	$15 $30 200 $ded	30% 30% / $0 30% / $0
20 Standard HMO - Plan 883 and SN 20 Standard HMO - Plan S41	5-2010	HMO	0 / 0	2000 / 4000 None	$20 copay	$15 $30 0 $ded	0% 0% / $250 per day, max 3 days 0% / $250
20 Value HMO - Plan 88C and SN 20 Value HMO - Plan S47	5-2010	HMO	0 / 0	2500 / 5000 None	$20 copay	$15 $30 150 $ded	20% 20% / $0 20% / $0
10 Standard HMO - Plan 888 and SN 10 Standard HMO - Plan S43	5-2010	HMO	0 / 0	1500 / 3000 None	$10 copay	$10 $25 0 $ded	0% 0% / $0 0% / $0
10 Value HMO - Plan 88H and SN 10 Value HMO - Plan S46	5-2010	HMO	0 / 0	2000 / 4000 None	$10 copay	$10 $25 100 $ded	10% 10% / $0 10% / $0
Health Net HMO Plans (SN = Silver Network plan)	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)
Hn Options HMO 35 - Plan 87H SN Hn Options HMO 35 - Plan S5Z	5-2010	HMO	0 / 0	4000 / 8000 No Lifetime Max	$35 copay	$15 $30 $200 ded	30% 30% / $0 30% / $0
Hn Options HMO 25 - Plan 87G SN Hn Options HMO 25 - Plan S5Y	5-2010	HMO	0 / 0	3000 / 6000 No Lifetime Max	$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 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)
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HSA California 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)