Aetna Rev. 031618 HMO 1-100 HMO plans; network pairings include HMO, HMO Deductible, Aetna Value Network HMO, HMO Basic, WholeHealth ACO OA Managed Choice POS 1-100 PPO plans utilizing the Managed Choice POS; network pairings include MC, WholeHealth ACO OA Managed Choice POS HDHP 1-100 Managed Choice HSA compatible plans Open Choice PPO 1-100 PPO plans utilizing the Open Choice PPO Network Aetna Whole Health EPO 1-100 In-network only plan paired with Aetna's WholeHealth ACO network; no PCP or referral required Pick-A-Plan 1-100 Full Aetna portfolio; Limited to 5 plan selection HMO 1-100 Full HMO network (74,602 docs / 330 hospitals) HMO Basic 1-100 Subset of HMO network; HMO and HMO Deductible plans may be paired with this network (17,616 docs / 197 hospitals) HMO Deductible 1-100 Subset of HMO network specific to the HMO Deductible plans (66,335 docs / 441 hospitals) Aetna Value Network HMO 1-100 Aetna Whole Health 1-100 Subset of HMO network; may be paired with HMO plans for premium savings (42,704 docs / 307 hospitals) Network including PrimeCare, Providence, MemorialCare ; may be paired with specific MC and EPO plans OA Managed Choice POS 1-100 Manage Choice POS network specific to the MC plans (80,519 docs / 337 hospitals) Savings Plus OA Managed Choice POS 1-100 Subset of MC network; may be paired with MC plans for premium savings (189 hospitals) Open Choice PPO 1-100 Open Choice PPO network specific to PPO plans (66,858 docs / 327 hospitals) Value Formulary 1-100 Four-tier formulary for all plans Rx Mail Order 1-100 Aetna Rx Mail Order Behavioral Health 1-100 Aetna Mental Health network Pediatric Dental 1-100 Dental network (National PPO) for embedded pediatric Dental benefits within Medical plans Pediatric Vision 1-100 Vision network (EyeMed) for embedded pediatric Vision benefits within Medical plans Anthem Blue Cross Rev. 110416 HMO 1-100 HMO plans; available in Platinum, Gold and Silver metallic tiers PPO 1-100 PPO plans; available for all metallic tiers HSA 1-100 HSA-compatible PPO plans; Silver and Bronze metallic tiers only EPO 1-100 In-network only plan paired with Anthem's Prudent Buyer PPO network; no PCP or referral required EmployeeElect 1-100 Full Anthem portfolio CaliforniaCare HMO 1-100 Full traditional HMO network; only available with certain HMO plan offerings (42,000 docs / 330 hospitals) Select HMO 1-100 Subset of HMO network; high performance narrow network available for HMO plan offerings (26,000 docs / 250 hospitals) Prudent Buyer PPO 1-100 Full statewide PPO network; only available with certain PPO plan offerings (60,000 docs / 330 hospitals) Select PPO 1-100 Subset of PPO network; available for PPO plan offerings, including OOS employees (40,000 docs / 300 hospitals) Select Formulary 1-100 Formulary available with all plans; 100% of the top 25 drugs are covered Rx Mail Order 1-100 Express Scripts Behavioral Health 1-100 Behavioral Health network Pediatric Dental 1-100 Dental network (Prime Dental) for bundled pediatric Dental benefits with Medical plans Pediatric Vision 1-100 Vision network (Blue View/EyeMed) for embedded pediatric Vision benefits within Medical plans
CaliforniaChoice Rev. 110117 Anthem Select HMO 1-100 HMO plans available to be paired with the Select HMO network (23,000+ docs / 250 hospitals) Anthem EPO 1-100 In-network only HSA compatible plan paired with Anthem's Prudent Buyer PPO network (60,000+ docs / 330 hospitals) Anthem Select PPO 1-100 PPO plans; available options include Advantage PPO and Select PPO (40,000+ docs / 300 hospitals) Health Net HMO 1-100 HMO plans paired with Health Net's WholeCare network Health Net Salud y Mas HMO 1-100 designs with cross-border coverage utilizing the Salud network Health Net HSP (Health Service Plan) 1-100 EPO that requires members to select a PCP though they may self-refer to in-network providers from PureCare HSP network Kaiser HMO 1-100 HMO plans paired with Kaiser's Full HMO network Kaiser HMO HSA 1-100 HSA compatible HMOs paired with Kaiser's Full HMO network Sharp HMO 1-100 HMO plans paired with Sharp's Premier or Performance HMO networks Sharp HMO HSA 1-100 HSA compatible HMOs paired with Sharp's Full HMO network Sutter HMO 1-100 HMO plans available through Sutter Health in 14 Northern California counties Sutter HMO HSA 1-100 HSA compatible HMOs paired with Sutter's Full HMO network UHC SignatureValue HMO 1-100 HMO plans with full HMO network UHC Alliance HMO 1-100 Same benefit level as SignatureValue plans paired with Alliance network UHC Alliance HMO HSA 1-100 HSA compatible HMOs paired with UHC's Full HMO network UHC Focus HMO 1-100 Same benefit level as SignatureValue plans but paired with Focus network WHA HMO 1-100 HMO plans paired with WHA's Full HMO network in limited Northern California counties WHA HMO HSA 1-100 HSA compatible HMOs paired with WHA's Full HMO network All 1-100 Two adjacent metallic tiers may be purchased Anthem Select HMO 1-100 Subset of HMO network; available with Anthem HMO plan offerings (26,000 docs / 250 hospitals) Anthem Prudent Buyer PPO 1-100 Full statewide PPO network; only available with certain PPO plan offerings (60,000 docs / 330 hospitals) Anthem Select PPO 1-100 Subset of PPO network; available with certain PPO plan offerings; Blue Card available to OOS (40,000 docs / 300 hospitals) Anthem Advantage PPO 1-100 Subset of PPO network; available with certain Anthem PPO plan offerings; Blue Card available to OOS Health Net WholeCare 1-100 Health Net Salud y Mas HMO 1-100 Expanded HMO network available in 30 counties; only available with Health Net HMO plan offerings (27,097 docs / 182 hospitals) Tailored HMO network in Southern California; available only with Salud y Mas plans (6,498 docs / 30 hospitals) Health Net PureCare HSP 1-100 Very narrow network; paired with PureCare HSP plans (34,284 docs / 217 hospitals) Kaiser HMO Network 1-100 Full HMO network; available with all Kaiser HMO and HMO HSA plan offerings Sharp Performance 1-100 Sharp Premier 1-100 Full HMO network in San Diego county; only available with certain Sharp HMO and HMO HSA plan offerings Subset of Performance network in San Diego county; only available with certain Sharp HMO plan offerings Sutter Health Plus 1-100 HMO network through Sutter Health in 14 Northern California counties UHC SignatureValue 1-100 Full HMO network; available with SignatureValue plans (48,000 docs / 210 hospitals) UHC Alliance 1-100 Subset of HMO network; only available with Alliance plans (23,000 docs / 127 hospitals) UHC Focus 1-100 Subset of HMO network; only available with Focus plans (14,000 docs / 110 hospitals) WHA HMO (includes Canopy Health) 1-100 Anthem - Select Formulary 1-100 Anthem's National Formulary Full HMO network in limited Northern California counties; available with all WHA HMO and HMO HSA plan offerings Anthem Pediatric Dental 1-100 Dental network (Prime Dental) for bundled pediatric Dental benefits with Medical plans Anthem Pediatric Vision 1-100 Vision network (Blue View/EyeMed) for embedded pediatric Vision benefits within Medical plans Health Net Pediatric Dental HMO 1-100 Dental network (Dental Benefits Provider) for embedded pediatric Dental benefits within Medical plans Health Net Pediatric Dental PPO 1-100 Dental network for embedded pediatric Dental benefits within Medical plans Health Net Pediatric Vision 1-100 Vision network (EyeMed) for embedded pediatric Vision benefits within Medical plans
CaliforniaChoice Rev. 110117 Kaiser Pediatric Dental 1-100 Dental network (Delta Dental) for embedded pediatric Dental benefits within Medical plans Kaiser Pediatric Vision 1-100 Vision network for embedded pediatric Vision benefits within Medical plans Sharp Pediatric Dental 1-100 Dental network for embedded pediatric Dental benefits within Medical plans Sharp Pediatric Vision 1-100 Vision network for embedded pediatric Vision benefits within Medical plans UHC Pediatric Dental 1-100 Dental network (CA Select Managed Care DHMO) for pediatric Dental benefits within Medical plans UHC Pediatric Vision 1-100 Vision network (Spectera) for embedded pediatric Vision benefits within Medical plans WHA Pediatric Dental 1-100 Dental network (Delta Dental) for embedded pediatric Dental benefits within Medical plans WHA Pediatric Vision 1-100 Vision network (MES Vision) for embedded pediatric Vision benefits within Medical plans Delta Dental Rev. 031717 PPO Value & Enhanced 2-49 50-99 PPO plan; balance billing when utilizing Premier dentists PPO Plus Premier Enhanced 2-49 50-99 PPO plans with access to Premier network; no balance billing with Premier dentists PPO Plus Premier Value 2-49 50-99 PPO plans with access to Premier network for groups of 5-99; no balance billing with Premier dentists DeltaCare 2-49 50-99 HMO plans Options PPO 1-3 50-99 PPO plans with 2-3 deductible options, CYM, Ortho coverage and max, Endodontics, and Periodontics coverage DeltaCare 2-49 50-99 HMO network PPO 2-49 50-99 PPO network; roughly 46% of dentists nationwide Premier 2-49 50-99 Larger PPO network ; roughly 80% of dentists nationwide Vision 2-49 50-99 EyeMed Vision network Guardian Rev. 082217 Value 2-99 Dental PPO plan; fee schedule Network Access Plan (NAP) 2-99 Dental PPO Network Access Plan; UCR out of network Choice 2-99 Dental PPO plan that gives choice between Value Plan and Network Access Plan; may switch annually Vision Access Plan 2-99 Discounted vision services available with all Guardian Dental plans; VSP network Vision 2-99 VSP Vision plans DHMO 2-99 HMO network PPO 2-99 PPO network - Dental Guard Preferred Vision 2-99 VSP network Health Net Rev. 092917 HMO 1-100 HMO plans to be paired with the Full HMO network WholeCare 1-100 HMO plans; only available in Platinum and Gold metallic tiers SmartCare HMO 1-100 Available in regions 7, 9, 15-19; tailored network with expanded benefits CommunityCare HMO 1-100 Available in Los Angeles & Orange Counties; tailored network with expanded benefits Salud y Mas HMO 1-100 designs with cross-border coverage utilizing the Salud network PPO 1-100 PPO plans available in all metallic tiers PPO Value 1-100 PPO plans with integrated deductible for medical and pharmacy, where deductible applies to all benefits EnhancedCare PPO 1-100 PPO plans available in Gold, Silver, and Bronze metallic tiers
Health Net Rev. 092917 HSA 1-100 Available only with PPO Network PureCare HSP (Health Service Plan) 1-100 PureCare One EPO 1-100 EPO plan using the PureCare One EPO network Enhanced Choice Package 1-100 EnhancedCare PPO Choice Package 1-100 EPO that requires members to select a PCP though they may self-refer to in-network providers from PureCare HSP network Full HMOs, WholeCare, HMOs, SmartCare HMOs, Salud y Mas HMOs, CommunityCare HMOs, HSPs, EPOs, and Full PPOs Full HMOs, WholeCare, HMOs, SmartCare HMOs, Salud y Mas HMOs, CommunityCare HMOs, HSPs, EPOs, EnhancedCare PPOs, Full PPO Bronze HSA and Full Bronze 60 PPO HMO 1-100 Full HMO network (37,489 docs / 230 hospitals) WholeCare 1-100 Subset of HMO network (27,097 docs / 182 hospitals) SmartCare HMO 1-100 Subset of HMO network (11,108 docs / 89 hospitals) CommunityCare 1-100 Subset of HMO network Salud y Mas 1-100 PPO 1-100 PPO network (57,276 docs / 323 hospitals) EnhancedCare PPO 1-100 Tailored PPO network in Los Angeles Salud networks limited to specific service areas with cross border access to the SIMNSA network (6,498 docs / 30 hospitals) PureCare HSP 1-100 Very narrow network; paired with PureCare HSP plans (34,284 docs / 217 hospitals) PureCare One 1-100 Very narrow EPO network; paired with PureCare One plan (34,109 docs / 217 hospitals) Rx Mail Order 1-100 CVS Caremark Behavioral Health 1-100 Mental Health Network (HMO); PPO network (PPO) Pediatric Dental HMO/HSP 1-100 Dental network (Dental Benefits Provider) for embedded pediatric Dental benefits within Medical plans Pediatric Dental PPO/EPO 1-100 Dental network for embedded pediatric Dental benefits within Medical plans Pediatric Vision 1-100 Vision network (EyeMed) for embedded pediatric Vision benefits within Medical plans MetLife Rev. 120106 DHMO 2-99 HMO plans PPO 2-99 PPO plans utilizing the Preferred Dentist Program Plus network Vision 2-99 PPO vision plans DHMO 2-99 HMO network Preferred Dentist Program Plus 2-99 PPO network Vision 2-99 VSP network and MetLife direct retail network UnitedHealthcare Rev. 110117 Choice HMO 1-100 State HMO 1-100 HMO plans unique to the Choice portfolio that may be paired with SignatureValue, Advantage, Alliance and Focus networks HMO plans unique to the State portfolio that may be paired with SignatureValue, Alliance and Focus networks HMO HSA 1-100 HMO HSA plans within the Choice and State portfolio that may only be paired with the Alliance network Choice PPO 1-100 PPO plans unique to the Choice portfolio that may be paired with the Select Plus, Core and Navigate networks State PPO 1-100 PPO plans unique to the State portfolio that may be paired with the Core and Navigate networks Choice PPO HSA 1-100 HSA-compatible plans unique to the Choice portfolio that may be paired with the Select Plus, Core and Navigate networks
UnitedHealthcare Rev. 110117 State PPO HSA 1-100 Navigate PPO 1-100 HSA-compatible plans unique to the State portfolio that may be paired with the Core and Navigate networks PPO plans similar to EPOs consisting of in-network benefits only; PCP selection and electronic referrals are required. Choice Simplified 1-100 1-100 Medical plans consisting of all metallic levels associated with all networks Multi-Choice State 1-100 1-100 Medical plans consisting of all metallic levels that may be paired with all networks except Select Plus and Advantage network SignatureValue 1-100 Full HMO network (48,000 docs / 210 hospitals) Advantage (includes Canopy Health) 1-100 Subset of full HMO network (28,000 docs / 153 hospitals) Alliance 1-100 Narrow HMO network comprised of specific medical groups (23,000 docs / 127 hospitals) Focus 1-100 Narrow HMO network comprised of specific medical groups (14,000 docs / 110 hospitals) Select Plus 1-100 Full PPO network (100,000 docs / 303 hospitals) Core 1-100 Narrow PPO network comprised of distinct providers (75,000 docs / 295 hospitals) Navigate 1-100 Select EPO 1-100 Full PPO network for non-differential PPO only Narrow PPO network that pairs only with Navigate PPO plans ; network consist of approximate 72,000 docs / 285 hospitals. California Custom PDL 1-100 4-Tier Prescription Drug List for 1-100 PPO and EPO plans SignatureValue Formulary 1-100 4-Tier Formulary for 1-100 HMO Rx Mail Order 1-100 OptumRx Behavioral Health 1-100 United Behavioral Health network CA Select Managed Care DHMO 1-100 HMO Dental network for DHMO National Options 30 1-100 PPO Dental network for MAA PPO Dental plans National Options 20 1-100 PPO Dental network for MAC/INO Pediatric Dental HMO 1-100 Dental network (CA Select Managed Care DHMO) for embedded pediatric Dental benefits within Medical plans Pediatric Dental PPO 1-100 Dental network (National Options 20) for embedded pediatric Dental benefits within Medical plans Pediatric Vision 1-100 Vision network (Spectera) for embedded pediatric Vision benefits within Medical plans VSP Rev. 032217 Signature 5-99 Higher premiums, richer benefits Choice 5-99 Lower premiums VSP 5-99 Full VSP network; 30,000 preferred providers and 50,000 access points nationwide