Important Policy Notices

For All Members:

• RealCare Privacy Notice
• General Plan 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.

Required Notices – Anthem (PDF)

Required Notices – Kaiser (PDF)

Required Notices – MetLife (PDF)

• 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 Notices

Important Kaiser Permanente Documents and Links

• Member Rights & Responsibilities

• Northern California
• Southern California

• Member Guidebooks (including grievance procedures)

Medicare/CMS Creditable Coverage Notices

• 2018 Creditable Coverage Notice Kaiser
• 2018 Creditable Coverage Notice Anthem
• 2018 Non-Creditable Coverage Notice Anthem
• 2018 Non-Creditable Coverage Notice Kaiser

Evidence of Coverage Booklets (EOC) – 2018 Plans

2018 Kaiser and Anthem EOC documents

• 2018 Kaiser Permanente Plans
  • Bronze 60 HMO 6300/75 North
  • Bronze 60 HDHP HMO 4800/40% (HSA) North
  • Silver 70 HMO 1000/50 North
  • Silver 70 HMO 2000/45 North
  • Silver 70 HDHP HMO 2000/20% (HSA) North
  • Gold 80 HMO 0/25 North
  • Gold 80 HMO 500/30 North
  • Gold 80 HRA HMO 2250/35 North
  • Platinum 90 HMO 0/10 North
  • Platinum 90 HMO 0/15 North
  • Bronze 60 HMO 6300/75 South
  • Bronze 60 HDHP HMO 4800/40% (HSA) South
  • Silver 70 HMO 1000/50 South
  • Silver 70 HMO 2000/45 South
  • Silver 70 HDHP HMO 2000/20% (HSA) South
  • Gold 80 HMO 0/25 South
  • Gold 80 HMO 500/30 South
  • Gold 80 HRA HMO 2250/35 South
  • Platinum 90 HMO 0/10 South
  • Platinum 90 HMO 0/15 South
  • KP CA DME Benefits Flyer
  • Chrioproactic and Acupuncture Info Sheet 2018
  • Child Dental Plan HMO 2018

• 2018 Anthem Blue Cross Plans 
  • Anthem Bronze PPO 6500/0%/6500 HSA (2ZZW)
  • Anthem Bronze PPO 5000/35%/6550 HSA (2ZZN)
  • Anthem Bronze PPO 6000/35%/7350 (3028)
  • Anthem Bronze PPO 5000/30%/7350 (301D)
  • Silver PPO 2000/20%/6000 HSA (99A2 – Families)
  • Silver PPO 2000/20%/6000 HSA (99AF – Singles)
  • Silver PPO 1750/35%/7350 (304H)
  • Silver PPO 2000/40%/7350 (303F)
  • Gold PPO 2000/20%/4000 (3024)
  • Gold PPO 1000/20%/6000 (303X)
  • Gold PPO 500/20%/6500 (302Q)
  • Gold PPO 20/30%/6500 (302G)
  • Platinum PPO 200/10%/3000 (3037)
  • Platinum PPO 20/10%/3000 (3057)
  • Silver HMO 2000/40%/7350 (2ZZ2)
  • Gold HMO 40/20%/4500 (301V)
  • Gold HMO 500/20%/5000 (2ZYU)

2018 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)

2018 Anthem Blue Cross Plans

• Anthem Bronze PPO 6500/0%/6500 HSA (2ZZW)
• Anthem Bronze PPO 5000/35%/6550 HSA (2ZZN)
• Anthem Bronze PPO 6000/35%/7350 (3028)
• Anthem Bronze PPO 5000/30%/7350 (301D)
• Silver PPO 2000/20%/6000 HSA (99A2 – Families)
• Silver PPO 2000/20%/6000 HSA (99AF – Singles)
• Silver PPO 1750/35%/7350 (304H)
• Silver PPO 2000/40%/7350 (303F)
• Gold PPO 2000/20%/4000 (3024)
• Gold PPO 1000/20%/6000 (303X)
• Gold PPO 500/20%/6500 (302Q)
• Gold PPO 20/30%/6500 (302G)
• Platinum PPO 200/10%/3000 (3037)
• Platinum PPO 20/10%/3000 (3057)
• Silver HMO 2000/40%/7350 (2ZZ2)
• Gold HMO 40/20%/4500 (301V)
• Gold HMO 500/20%/5000 (2ZYU)

2018 Kaiser Permanente Plans

• Bronze 60 HMO 6300/75
• Bronze 60 HDHP HMO 4800/40% (HSA)
• Silver 70 HMO 1000/50
• Silver 70 HMO 2000/45
• Silver 70 HDHP HMO 2000/20% (HSA)
• Gold 80 HMO 0/25
• Gold 80 HMO 500/30
• Gold 80 HRA HMO 2250/35
• Platinum 90 HMO 0/10
• Platinum 90 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