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.
2022 CAR Required Notices
- Anthem CAR Required Notices (Combined)
- Kaiser CAR Required Notices (Combined)
- MetLife Required Documents (Combined)
Required Notices Include:
-
- HIPAA Notice of Special Enrollment Rights
- Newborns’ and Mothers’ Health Protection Act
- Women’s Health & Cancer Rights Act
- Covered CA Notice
- Patient Protections Notice
- Anthem Creditable Coverage Notice
- Anthem Non Creditable Coverage Notice
- Kaiser Creditable Coverage Notice
Medicare/CMS Creditable Coverage Notices
- 2022 Anthem Creditable Coverage Notice
- 2022 Anthem Non Creditable Coverage Notice
- 2022 Kaiser Creditable Coverage Notice
- 2021 Creditable Coverage Notice Kaiser
- 2021 Creditable Coverage Notice Anthem
- 2021 Non-Creditable Coverage Notice Anthem
2022 Kaiser Evidence of Coverage Documents
Kaiser North
- 652363 Kaiser Bronze 60 HDHP HMO 7000-0
- 652363 Kaiser Silver 70 HDHP HMO 2500-20%
- 652363 Kaiser Gold 80 HDHP HMO 1600-15%
- 652363 Kaiser Bronze 60 HMO 5400-60
- 652363 Kaiser Bronze 60 HMO 6300-65
- 652363 Kaiser Silver 70 HMO 1650-55
- 652363 Kaiser Silver 70 HMO 2100-55
- 652363 Kaiser Silver 70 HMO 2250-55
- 652363 Kaiser Silver 70 HMO 2600-55
- 652363 Kaiser Gold 80 HMO 0-30
- 652363 Kaiser Gold 80 HMO 250-35
- 652363 Kaiser Gold 80 HMO 1000-40
- 652363 Kaiser Gold 80 HRA HMO 2250-35
- 652363 Kaiser Platinum 90 HMO 0-10
- 652363 Kaiser Platinum 90 HMO 0-20
Kaiser South
- 291764 Kaiser Bronze 60 HDHP HMO 7000-0
- 291764 Kaiser Silver 70 HDHP HMO 2500-20%
- 291764 Kaiser Gold 80 HDHP HMO 1600-15%
- 291764 Kaiser Bronze 60 HMO 5400-60
- 291764 Kaiser Bronze 60 HMO 6300-65
- 291764 Kaiser Silver 70 HMO 1650-55
- 291764 Kaiser Silver 70 HMO 2100-55
- 291764 Kaiser Silver 70 HMO 2250-55
- 291764 Kaiser Silver 70 HMO 2600-55
- 291764 Kaiser Gold 80 HMO 0-30
- 291764 Kaiser Gold 80 HMO 250-35
- 291764 Kaiser Gold 80 HMO 1000-40
- 291764 Kaiser Gold 80 HRA HMO 2250-35
- 291764 Kaiser Platinum 90 HMO 0-10
- 291764 Kaiser Platinum 90 HMO 0-20
2022 Anthem Evidence of Coverage Documents
HSA Plans
- Anthem Bronze PPO 6700-0% w HSA 6BSK
- Anthem Bronze PPO 6000-45% w HSA 6BS7
- Anthem Silver PPO 2100-30% w HSA 6BNP
- Anthem Silver PPO 2100-30% w HSA 6BU0
- Anthem Silver PPO 2600-35% w HSA 6BJE
- Anthem Silver PPO 2600-35% w HSA 6BJN
PPO Plans
- Anthem Bronze PPO 70-6600-35% 6BUR
- Anthem Bronze PPO 40-6200-40% 6BU4
- Anthem Bronze PPO 4600-50% 6BKW
- Anthem Bronze PPO 60-6850-40% 6BME
- Anthem Bronze PPO 75-7300-40% 6BJW
- Anthem Silver PPO 55-2500-45% 6BKJ
- Anthem Silver PPO 50-2200-40% 6BPK
- Anthem Silver PPO 55-1950-35% 6BQV
- Anthem Silver PPO 45-1750-40% 6BQD
- Anthem Gold PPO 35-1000-20% 6BQ1
- Anthem Gold PPO 30-750-20% 6BPT
- Anthem Gold PPO 30-500-20% 6BP1
- Anthem Gold PPO 25-30% 6BNT
- Anthem Platinum PPO 15-250-10% 6BPB
- Anthem Platinum PPO 15-40-10% 6BNC
HMO Plans
- Anthem Silver HMO 60-2500-45% 6BRT
- Anthem Silver HMO 55 6BQZ
- Anthem Gold HMO 35 6BUH
- Anthem Gold HMO 30 6BN0
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)
2022 Anthem Blue Cross Plans
- Anthem Bronze PPO 6700_0% w_HSA PrevRx_CA_PPO_Small Group_6BSK
- Anthem Bronze PPO 6000_45% w_HSA PrevRx_CA_PPO_Small Group_6BS7
- Anthem Bronze PPO 4600_50%_CA_PPO_Small Group_6BKW
- Anthem Bronze PPO 75_7300_40%_CA_PPO_Small Group_6BJW
- Anthem Bronze PPO 70_6600_35%_CA_PPO_Small Group_6BUR
- Anthem Bronze PPO 60_6850_40%_CA_PPO_Small Group_6BME
- Anthem Bronze PPO 40_6200_40%_CA_PPO_Small Group_6BU4
- Anthem Silver PPO 2600_35% w_HSA PrevRx_CA_PPO_Small Group_6BJN
- Anthem Silver PPO 2600_35% w_HSA PrevRx_CA_PPO_Small Group_6BJE
- Anthem Silver PPO 2100_30% w_HSA PrevRx_CA_PPO_Small Group_6BU0
- Anthem Silver PPO 2100_30% w_HSA PrevRx_CA_PPO_Small Group_6BNP
- Anthem Silver PPO 55_2500_45%_CA_PPO_Small Group_6BKJ
- Anthem Silver PPO 55_1950_35%_CA_PPO_Small Group_6BQV
- Anthem Silver PPO 50_2200_40%_CA_PPO_Small Group_6BPK
- Anthem Silver PPO 45_1750_40%_CA_PPO_Small Group_6BQD
- Anthem Silver HMO 60_2500_45%_CA_HMO_Small Group_6BRT
- Anthem Silver HMO 55_CA_HMO_Small Group_6BQZ
- Anthem Gold PPO 35_1000_20%_CA_PPO_Small Group_6BQ1
- Anthem Gold PPO 30_750_20%_CA_PPO_Small Group_6BPT
- Anthem Gold PPO 30_500_20%_CA_PPO_Small Group_6BP1
- Anthem Gold PPO 25_30%_CA_PPO_Small Group_6BNT
- Anthem Gold HMO 35_CA_HMO_Small Group_6BUH
- Anthem Gold HMO 30_CA_HMO_Small Group_6BN0
- Anthem Platinum PPO 15_250_10%_CA_PPO_Small Group_6BPB
- Anthem Platinum PPO 15_40_10%_CA_PPO_Small Group_6BNC
2022 Kaiser Permanente Plans
- Bronze 60 HMO 6300-65 (Pending Regulatory Approval)
- Bronze 60 HMO 5400-60
- Bronze 60 HDHP HMO 7000-0%
- Silver 70 HMO 2600-55
- Silver 70 HMO 2250-55
- Silver 70 HMO 2100-55
- Silver 70 HMO 1650-55
- Silver 70 HDHP HMO 2500-20%
- Gold 80 HMO 250-35
- Gold 80 HMO 0-30
- Gold 80 HDHP HMO 1600-15%
- Gold 80 HRA HMO 2250-35
- Gold 80 HMO 1000-40
- Platinum 90 HMO 0-10 SBC
- Platinum 90 HMO 0-20 SBC
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