2022 Import Policy Notices

• 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

• MetLife Voluntary AD&D
• MetLife Term Life and AD&D

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