Important Policy Notices

For All Members:

• RealCare Privacy Policy
• General Guidelines
• Qualifying Events

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.

2020 CAR Required Notices

• Anthem Required Notices
• Kaiser Required Notices
• MetLife Required Notices

Required Notices Include:

• • HIPAA Notice of Special Enrollment Rights
  • Newborns’ and Mothers’ Health Protection Act
  • Women’s Health & Cancer Rights Act
  • Patient Protections Notice
  • CMS Creditable Coverage Notice Anthem
  • CMS Creditable Coverage Notice Kaiser

Medicare/CMS Creditable Coverage Notices

• 2020 Creditable Coverage Notice Kaiser
• 2020 Creditable Coverage Notice Anthem
• 2020 Non-Creditable Coverage Notice Anthem

Evidence of Coverage Booklets (EOC)

2020 Kaiser EOC Documents 

Kaiser North

• KP Bronze HMO 6300/65
• KP Bronze HDHP HMO 6900/0
• KP Silver HMO 1650/55
• KP Silver HMO 1800/55
• KP Silver HMO 2250-50
• KP Silver HDHP HMO 2500/20
• KP Gold HMO 250/25
• KP Gold HMO 500/30
• KP Gold HRA HMO 2250/35
• KP Platinum HMO 0/10
• KP Platinum HMO 0/15

Kaiser South

• KP Bronze HMO 6300/65
• KP Bronze HDHP HMO 6900/0
• KP Silver HMO 1650/55
• KP Silver HMO 1800/55
• KP Silver HMO 2250/50
• KP Silver HDHP HMO 2500/20
• KP Gold HMO 250/25
• KP Gold HMO 500/30
• KP Gold HRA HMO 2250/35
• KP Platinum HMO 0/10
• KP Platinum HMO 0/15

2020 Anthem EOC Documents

• Anthem Bronze PPO 6600/0% w/HSA (52SM)
• Anthem Bronze PPO 5000/45% w/HSA (52SH)
• Anthem Bronze PPO 3950/50% (4J09)
• Anthem Bronze PPO 70-6300-35 (4HY6)
• Anthem Bronze PPO 60-350-40 (4HU5)
• Anthem Bronze PPO 40-5600-40 (4HUE)
• Anthem Silver HMO 55/2250/45% (4HYF)
• Anthem Silver HMO 55 (4HTA)
• Anthem Silver PPO 2000/30% w/HSA – RxC (4HVU)
• Anthem Silver PPO 2000/30% w/HSA – RxC (4HW2)
• Anthem Silver PPO 55/2500/45% (4J00)
• Anthem Silver PPO 55/1850/35% (4HY0)
• Anthem Silver PPO 50/2000/40% (4HWY)
• Anthem Silver PPO 45/1750/40% (4HXN)
• Anthem Gold HMO 35 (4HUV)
• Anthem Gold HMO 30 (4HV5)
• Anthem Gold PPO 35/1000/20% (4HXE)
• Anthem Gold PPO 30/750/20% (4HX6)
• Anthem Gold PPO 30/500/20% (4HWE)
• Anthem Gold PPO 20/30% (4HW6)
• Anthem Platinum PPO 20/10% (4HVH)
• Anthem Platinum PPO 15/250/10% (4HWQ)

2020 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)

• 2020 Anthem Blue Cross Plans
  • Anthem Bronze PPO 6600/0% w/HSA (52SM)
  • Anthem Bronze PPO 5000/45% w/HSA (52SH)
  • Anthem Bronze PPO 70/6300/35% (4HY6)
  • Anthem Bronze PPO 3950/50% (NEW) (4JO8)
  • Anthem Bronze PPO 40/5600/40% (4HUE)
  • Anthem Bronze PPO 60/6350/40% (NEW) (4HU5)
  • Anthem Silver PPO 2000/30% w/HSA – RxC (4HVU)
  • Anthem Silver PPO 2000/30% w/HSA – RxC (4HW2)
  • Anthem Silver PPO 55/2500/45% (4J00)
  • Anthem Silver PPO 50/2000/40% (4HWY)
  • Anthem Silver PPO 55/1850/35% (4HY0)
  • Anthem Silver PPO 45/1750/40% (4HXN)
  • Anthem Gold PPO 35/1000/20% (4HXE)
  • Anthem Gold PPO 30/750/20% (4HX6)
  • Anthem Gold PPO 30/500/20%  (4HWE)
  • Anthem Gold PPO 20/30% (4HW6)
  • Anthem Platinum PPO 15/250/10% (4HWQ)
  • Anthem Platinum PPO 20/10% (4HVH)
  • Anthem Silver HMO 55/2250/45% (4HYF)
  • Anthem Silver HMO 55 (4HTA)
  • Anthem Gold HMO 35 (4HUV)
  • Anthem Gold HMO 30 (4HV5)
• 2020 Kaiser Permanente Plans 
  • KP Bronze HMO 6300/65
  • KP Bronze HDHP HMO 6900/0
  • KP Silver HMO 1650/55
  • KP Silver HMO 1800/55
  • KP Silver HMO 2250/50
  • KP Silver HDHP HMO 2500/20
  • KP Gold HMO 250/25
  • KP Gold HMO 500/30
  • KP Gold HRA HMO 2250/35
  • KP Platinum HMO 0/10
  • KP Platinum HMO 0/15

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