Link: 2022 Important Policy Notices
For All Members:
- RealCare Privacy Policy
- General Guidelines Effective 11-1-21
- Qualifying Events
- C.A.R. Group Health Plan Administration and Fees
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.
2023 CAR Required Notices
- CAR Anthem Required Notices (Combined)
- CAR Kaiser Required Notices (Combined)
- CAR MetLife 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
- Covered CA Notice
- Patient Protections Notice
- No Surprises Act Notice
- Anthem Creditable Coverage Notice
- Anthem Non Creditable Coverage Notice
- Kaiser Creditable Coverage Notice
Medicare/CMS Creditable Coverage Notices
- 2023 Anthem Creditable Coverage Notice
- 2023 Anthem Non Creditable Coverage Notice
- 2023 Kaiser Creditable Coverage Notice
2023 Kaiser Evidence of Coverage Documents
HSA Plans
- Kaiser Bronze HDHP 7000-0 Evidence of Coverage Northern CA
- Kaiser Bronze HDHP 7000-0 Evidence of Coverage Southern CA
- Kaiser Silver HDHP 2700-25% Evidence of Coverage Northern CA
- Kaiser Silver HDHP 2700-25% Evidence of Coverage Southern CA
- Kaiser Gold HDHP 1600-15% Evidence of Coverage Northern CA
- Kaiser Gold HDHP Gold 1600-15% Evidence of Coverage Southern CA
HMO Plans
- Kaiser Bronze 5400-60 Evidence of Coverage Northern CA
- Kaiser Bronze 5400-60 Evidence of Coverage Southern CA
- Kaiser Bronze 6300-65 Evidence of Coverage Northern CA
- Kaiser Bronze 6300-65 Evidence of Coverage Southern CA
- Kaiser Silver 2800-65 Evidence of Coverage Northern CA
- Kaiser Silver 2800-65 Evidence of Coverage Southern CA
- Kaiser Silver 2300-65 Evidence of Coverage Northern CA
- Kaiser Silver 2300-65 Evidence of Coverage Southern CA
- Kaiser Silver 2500-55 Evidence of Coverage Northern CA
- Kaiser Silver 2500-55 Evidence of Coverage Southern CA
- Kaiser Silver 1900-65 Evidence of Coverage Northern CA
- Kaiser Silver 1900-65 Evidence of Coverage Southern CA
- Kaiser Gold HRA 2250-35 Evidence of Coverage Northern CA
- Kaiser Gold HRA 2250-35 Evidence of Coverage Southern CA
- Kaiser Gold 1000-40 Evidence of Coverage Northern CA
- Kaiser Gold 1000-40 Evidence of Coverage Southern CA
- Kaiser Gold 250-35 Evidence of Coverage Northern CA
- Kaiser Gold 250-35 Evidence of Coverage Southern CA
- Kaiser Gold 0-30 Evidence of Coverage Northern CA
- Kaiser Gold 0-30 Evidence of Coverage Southern CA
- Kaiser Platinum 0-20 Evidence of Coverage Northern CA
- Kaiser Platinum 0-20 Evidence of Coverage Southern CA
- Kaiser Platinum 0-10 Evidence of Coverage Northern CA
- Kaiser Platinum 0-10 Evidence of Coverage Southern CA
2023 Anthem Evidence of Coverage Documents
HSA Plans
- Anthem Bronze PPO 6700-0% 6RG7
- Anthem Bronze PPO 6000-45% 6RJK
- Anthem Silver PPO 2100-30% HSA 6RK0 Self Only
- Anthem Silver PPO 2100-30% HSA 6RJ5 Family
- Anthem Silver PPO 2600-35% HSA 6RG5 Self Only
- Anthem Silver PPO 2600-35% HSA 6RH6 Family
PPO Plans
- Anthem Bronze PPO 70-6600-35% 6RFV
- Anthem Bronze PPO 40-6200-40% 6RJN
- Anthem Silver PPO 55-2500-45% 6RFY
- Anthem Silver PPO 50-2200-40% 6RK6
- Anthem Silver PPO 55-1950-35% 6RJ0
- Anthem Silver PPO 45-1750-40% 6RGX
- Anthem Gold PPO 35-1000-20% 6RH1
- Anthem Gold PPO 30-750-20% 6RGS
- Anthem Gold PPO 30-500-20% 6RG9
- Anthem Gold PPO 25-30% 6RFN
- Anthem Platinum PPO 15-250-10% 6RG6
- Anthem Platinum PPO 15-40-10% 6RH4
HMO Plans
MetLife Dental and Vision Evidence of Coverage
- MetLife VALUE Dental Plan
- MetLife SELECT Dental Plan
- MetLife CHOICE Dental Plan
- MetLife Enhanced Vision Plan
- MetLife Basic Vision Plan
MetLife Life and AD&D Insurance Certificates
Summary of Benefits & Coverage (SBC)
2023 Anthem Blue Cross Plans
HSA Plans
- Anthem Bronze PPO 6700-0% HSA PrevRx CA PPO Small Group 6RG7
- Anthem Bronze PPO 6000-45% HSA PrevRx CA PPO Small Group 6RJK
- Anthem Silver PPO 2100_30% HSA PrevRx CA PPO Small Group 6RJ5
- Anthem Silver PPO 2100_30% HSA PrevRx CA PPO Small Group 6RK0
- Anthem Silver PPO 2600_35% HSA PrevRx CA PPO Small Group 6RG5
- Anthem Silver PPO 2600_35% HSA PrevRx CA PPO Small Group 6RH6
PPO Plans
- Anthem Bronze PPO 70-6600-35% CA PPO Small Group 6RFV
- Anthem Bronze PPO 40-6200-40% CA PPO Small Group 6RJN
- Anthem Silver PPO 55-2500-45% CA PPO Small Group 6RFY
- Anthem Silver PPO 55-1950-35% CA PPO Small Group 6RJ0
- Anthem Silver PPO 50-2200-40% CA PPO Small Group 6RK6
- Anthem Silver PPO 45-1750-40% CA PPO Small Group 6RGX
- Anthem Gold PPO 35-1000-20% CA PPO Small Group 6RH1
- Anthem Gold PPO 30-750-20% CA PPO Small Group 6RGS
- Anthem Gold PPO 30-500-20% CA PPO Small Group 6RG9
- Anthem Gold PPO 25-30% CA PPO Small Group 6RFN
- Anthem Platinum PPO 15-250-10% CA PPO Small Group 6RG6
- Anthem Platinum PPO 15-40-10% CA PPO Small Group 6RH4
HMO Plans
2023 Kaiser Permanente Plans
HSA Plans
HMO Plans
- Bronze 60 HMO 5400-60
- Bronze 60 HMO 6300-65
- Silver 70 HMO 2800-65
- Silver 70 HMO 2500-55
- Silver 70 HMO 2300-65
- Silver 70 HMO 1900-65
- Gold 80 HRA HMO 2250-35
- Gold 80 HMO 1000-40
- Gold 80 HMO 250-35
- Gold 80 HMO 0-30
- 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