For All Members:
For C.A.R. Group Insurance Program Members:
Thank you for your participation in the C.A.R. Insurance Plan. Below are important policy notices that you should read, print and retain for safekeeping.
2021 CAR Required Notices
- Anthem CAR Required Notices (Combined)
- Kaiser CAR Required Notices (Combined)
- MetLife CAR Required Notices (Combined)
Required Notices Include:
-
- HIPAA Notice of Special Enrollment Rights
- Newborns’ and Mothers’ Health Protection Act
- Women’s Health & Cancer Rights Act
- 2021 Medicare Part D Creditable Coverage Notice Kaiser
- 2021 Medicare Part D Creditable Coverage Notice Anthem
- 2021 Medicare Part D Non-Creditable Coverage Notice Anthem
- Patient Protections Notice
Medicare/CMS Creditable Coverage Notices
- 2021 Medicare Part D Creditable Coverage Notice Kaiser
- 2021 Medicare Part D Creditable Coverage Notice Anthem
- 2021 Medicare Part D Non-Creditable Coverage Notice Anthem
- 2020 Creditable Coverage Notice Kaiser
- 2020 Creditable Coverage Notice Anthem
- 2020 Non-Creditable Coverage Notice Anthem
Evidence of Coverage Booklets (EOC)
2021 EOC Documents will be added soon. Please check back periodically or call RealCare at (800) 939-8088, Option 2
2021 Kaiser EOC Documents
Kaiser North
- 652363 Bronze 60 HMO 5400-60 EOC
- 652363 Bronze 60 HMO 6300-65 EOC
- 652363 Bronze 60 HDHP HMO 7000-0 EOC
- 652363 Silver 70 HMO 1650-55 EOC
- 652363 Silver 70 HMO 2100-55 EOC
- 652363 Silver 70 HMO 2250-55 EOC
- 652363 Silver 70 HMO 2600-55 EOC
- 652363 Silver 70 HDHP HMO 2500-20% EOC
- 652363 Gold 80 HMO 0-30 EOC
- 652363 Gold 80 HMO 250-35 EOC
- 652363 Gold 80 HMO 1000-40 EOC
- 652363 Gold 80 HRA HMO 2250-35 EOC
- 652363 Platinum 90 HMO 0-10 EOC
- 652363 Platinum 90 HMO 0-20 EOC
Kaiser South
- 291764 Bronze 60 5400-60 EOC
- 291764 Bronze 60 6300-65 EOC
- 291764 Bronze 60 7000-0 EOC
- 291764 Silver 70 1650-55 EOC
- 291764 Silver 70 2100-55 EOC
- 291764 Silver 70 2250-55 EOC
- 291764 Sliver70 2600-55 EOC
- 291764 Silver 70 2500-20% EOC
- 291764 Gold 80 0-30 EOC
- 291764 Gold 80 250-35 EOC
- 291764 Gold 80 1000-40 EOC
- 291764 Gold 80 HRA 2250-35 EOC
- 291764 Platinum 90 0-10 EOC
- 291764 Platinum 90 0-20 EOC
2021 Anthem EOC Documents
- HSA Plans
- Anthem Bronze PPO 6950-0 W HSA 5SU5 5SU5CY-01012021-EOC
- Anthem Bronze PPO 5600-45 W HSA 5STX 5STXCY-01012021-EOC
- Anthem Silver PPO 2000-30 w HSA 5SWD-5SW5 5SWDCY-01012021-EOC
- Anthem Silver 2500-35 w HSA 5T0Z 5T0ZCY-01012021-EOC
- PPO Plans
- Anthem Bronze PPO 70-6600 5SXL 5SXLCY-01012021-EOC
- Anthem Bronze PPO 40-5600 5SWH 5SWHCY-01012021-EOC
- Anthem Bronze 4600-50 5SR9 5SR9CY-01012021-EOC
- Anthem Bronze 60-6350 5SSR 01012021-EOC
- Anthem Bronze 75-7300 5T09 5T09CY-01012021-EOC
- Anthem Silver 55-2500 5SR1 5SR1CY-01012021-EOC
- Anthem Silver 60-2200 5SYL 5SYLCY-01012021-EOC
- Anthem Silver PPO 55-1850 2LHZ 2LHZCY-01012021-EOC
- Anthem Silver 45-1750 5SZA 5SZACY-01012021-EOC
- Anthem Gold 35-1000 5SZ2 5SZ2CY-01012021-EOC
- Anthem Gold 30-750 5SYU 5SYUCY-01012021-EOC
- Anthem Gold 30-500 5SY2 5SY2CY-01012021-EOC
- Anthem Gold 20-30 5SXU 5SXUCY-01012021-EOC
- Anthem Platinum 15-250 5SYC 5SYCCY-01012021-EOC
- Anthem Platinum PPO 20-10 5SVU 5SVUCY-01012021-EOC
- HMO Plans
- Anthem Silver HMO 55-2250 5SX8 5SX8CY-01012021-EOC
- Anthem Silver HMO 55 5ST7 5ST7CY-01012021-EOC
- Anthem Gold HMO 5SWWW 5SWWCY-01012021-EOC
- Anthem Gold HMO 30 5SVG 5SVGCY-01012021-EOC
MetLife Group Dental, Vision and Life Evidence of Coverage Documents
- MetLife Evidence of Coverage – VALUE Plan
- MetLife Evidence of Coverage – SELECT Plan
- MetLife Evidence of Coverage – CHOICE Plan
- MetLife Voluntary AD&D
- MetLife Term Life and AD&D
Summary of Benefits & Coverage (SBC)
2021 Anthem Blue Cross Plans
- Anthem Platinum PPO 20 10% CA PPO Small Group 5SVU SBC
- Anthem Platinum PPO 15 250 10% CA PPO Small Group 5SYC SBC
- Anthem Gold PPO 20 30% CA PPO Small Group 5SXU SBC
- Anthem Gold HMO 35 CA HMO Small Group 5SWW SBC
- Anthem Gold HMO 30 CA HMO Small Group 5SVG SBC
- Anthem Gold PPO 35 1000 20% CA PPO Small Group 5SZ2 SBC
- Anthem Gold PPO 30 750 20% CA PPO Small Group 5SYU SBC
- Anthem Gold PPO 30 500 20% CA PPO Small Group 5SY2 SBC
- Anthem Silver PPO 50 2200 40% CA PPO Small Group 5SYL SBC
- Anthem Silver PPO 55 1850 35% CA PPO Small Group 2LHZ SBC
- Anthem Silver PPO 55 2500 45% CA PPO Small Group 5SR1 SBC
- Anthem Silver PPO 2000 30% w HSA – RxC CA PPO Small Group 5SW5
- Anthem Silver PPO 2000 30% w HSA – RxC CA PPO Small Group 5SWD
- Anthem Silver PPO 2500 35% w HSA PrevRx CA PPO Small Group 5T0V
- Anthem Silver PPO 2500 35% w HSA PrevRx CA PPO Small Group 5T0Z
- Anthem Silver HMO 55 2250 45% CA HMO Small Group 5SX8 SBC
- Anthem Silver HMO 55 CA HMO Small Group 5ST7 SBC
- Anthem Silver PPO 45 1750 40% CA PPO Small Group 5SZA SBC
- Anthem Bronze PPO 60 6350 40% CA PPO Small Group 5SSR SBC
- Anthem Bronze PPO 40 5600 40% CA PPO Small Group 5SWH SBC
- Anthem Bronze PPO 6950 0% w HSA CA PPO Small Group 5SU5 SBC
- Anthem Bronze PPO 5600 45% w HSA CA PPO Small Group 5STX SBC
- Anthem Bronze PPO 4600 50% CA PPO Small Group 5SR9 SBC
- Anthem Bronze PPO 75 7300 40% CA PPO Small Group 5T09 SBC
- Anthem Bronze PPO 70 6600 35% CA PPO Small Group 5SXL SBC
- 2021 Kaiser Permanente Plans
- Bronze_60_HMO_5400_60
- Bronze_HDHP_HMO_7000_0
- Bronze_HMO_6300_65
- Silver_70_HDHP_HMO_2500_20
- Silver_70_HMO_1650_55
- Silver_70_HMO_2100_55
- Silver_70_HMO_2250_55
- Silver_70_HMO_2600_55
- Gold_80_HMO_0_30
- Gold_80_HMO_250_35
- Gold_80_HMO_1000_40
- Gold_80_HRA_HMO_2250_35
- Platinum_90_HMO_0_20
- Platinum_90_HMO_0_10
If you have any questions about your health plan or would like a copy of these documents mailed to you, please call RealCare at (800) 939-8088, Option 2