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:
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- 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
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)
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