California Choice

At┬áCalifornia Choice, we understand the unique needs of small businesses. As the only Small Group Private Exchange in California, our goal is to provide great benefits, simple administration, and the best customer service, year-round, to all our customers. We’ve worked with brokers, small business owners, and employees for more than 17 years and we love what we do.

Provider Finder

Form Name Effective Date Download Form
Changes to Group Policy
Download
Common Ownership Statement
01/01/2017 Download
Employee Termination Notification form
Download
Employer Application
04/01/2017 Download
Employer Application
01/01/2017 Download
Employer Dental Application
07/01/2017 Download
Employer Administrative Guide
07/01/2017 Download
Employer Program Guide
04/01/2017 Download
Employer Voluntary Vision App
Download
Employer Voluntary Dental 3000
Download
Employer Recertification Form
Download
Exception Request Form
Download
Group Size Attestation
01/01/2017 Download
Employer Group Contact Change
Download
Employer Change Request Form
04/01/2017 Download
Employer Change Request Form
01/01/2017 Download
Employer Buy-Up Dental Application
Download
Employer Buy-Up Dental Checklist
Download
Group COBRA Billing Contact
Download
Initial Payment Form
01/01/2017 Download
Owner Partner Statement Form
01/01/2017 Download
Termination Notification
Download
Prior Carrier Cancel Template
01/01/2017 Download
Self Funding Declaration
01/01/2017 Download
Small Group Case Submission Checklist
04/01/2017 Download
Form Name Effective Date Download Form
Employee Application
04/01/2017 Download
Employee Application
01/01/2017 Download
Employee Change Request Form
04/01/2017 Download
Employee Change Request Form
01/01/2017 Download
RX Claim Form - Aetna
Download
RX Claim Form - Anthem Express Scripts
Download
RX Claim Form - Health Net
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RX Claim Form - Sharp
Download
RX Claim Form - UHC
Download
RX by Mail Claim Form - Aetna
Download
RX by Mail Claim Form - Anthem
Download
RX by Mail Claim Form - Health Net
Download
RX by Mail Claim Form - Kaiser
Download
RX by Mail Claim Form - Sharp
Download
RX by Mail Claim Form - UHC
Download
Form Name Effective Date Download Form
Medical Summaries
Benefit Summaries All Tiers
04/01/2017 Summary
Benefit Summaries All Tiers
01/01/2017 Summary
Benefit Summaries Platinum
04/01/2017 Summary
Benefit Summaries Platinum
01/01/2017 Summary
Benefit Summaries Platinum/Gold
04/01/2017 Summary
Benefit Summaries Platinum/Gold
01/01/2017 Summary
Benefit Summaries Gold
04/01/2017 Summary
Benefit Summaries Gold
01/01/2017 Summary
Benefit Summaries Gold/Silver
04/01/2017 Summary
Benefit Summaries Gold/Silver
01/01/2017 Summary
Benefit Summaries Silver
04/01/2017 Summary
Benefit Summaries Silver
01/01/2017 Summary
Benefit Summaries Silver/Bronze
04/01/2017 Summary
Benefit Summaries Silver/Bronze
01/01/2017 Summary
Benefit Summaries Bronze
04/01/2017 Summary
Benefit Summaries Bronze
01/01/2017 Summary
Medical HMO SBCs
Health Net Platinum HMO A
01/01/2017 SBC
Kaiser Permanente Platinum HMO A
01/01/2017 SBC
Sharp Platinum HMO A
01/01/2017 SBC
Sharp Platinum HMO B
01/01/2017 SBC
Sharp Platinum HMO C SBC
01/01/2017 SBC
Sutter Health Plus Platinum HMO A
01/01/2017 SBC
Sutter Health Plus Platinum HMO B
01/01/2017 SBC
UnitedHealthCare Platinum HMO A
01/01/2017 SBC
UnitedHealthCare Platinum HMO B
01/01/2017 SBC
UnitedHealthCare Platinum HMO C
01/01/2017 SBC
Western Health Advantage Platinum HMO A
01/01/2017 SBC
Western Health Advantage Platinum HMO B
01/01/2017 SBC
Health Net Gold HMO A
01/01/2017 SBC
Health Net Gold HMO B
01/01/2017 SBC
Health Net Gold HSP A
01/01/2017 SBC
Kaiser Permanente Gold HMO A
01/01/2017 SBC
Kaiser Permanente Gold HMO B
01/01/2017 SBC
Sharp Gold HMO A
01/01/2017 SBC
Sharp Gold HMO B
01/01/2017 SBC
Sharp Gold HMO C SBC
01/01/2017 SBC
Sutter Health Plus Gold HMO A
01/01/2017 SBC
Sutter Health Plus Gold HMO B
01/01/2017 SBC
UnitedHealthCare Gold HMO A
01/01/2017 SBC
UnitedHealthCare Gold HMO B
01/01/2017 SBC
UnitedHealthCare Gold HMO C
01/01/2017 SBC
Western Health Advantage Gold HMO A
01/01/2017 SBC
Western Health Advantage Gold HMO B
01/01/2017 SBC
Western Health Advantage Gold HMO C
01/01/2017 SBC
Western Health Advantage Gold HMO D
01/01/2017 SBC
Aetna Silver HMO A
01/01/2017 SBC
Health Net Silver HSP A
01/01/2017 SBC
Kaiser Permanente Silver HMO B
01/01/2017 SBC
Kaiser Permanente Silver HMO C
01/01/2017 SBC
Kaiser Permanente Silver HMO D
01/01/2017 SBC
Sharp Silver HMO A
01/01/2017 SBC
Sharp Silver HMO B
01/01/2017 SBC
Sharp Silver HMO C
01/01/2017 SBC
Sutter Health Plus Silver HMO B
01/01/2017 SBC
Sutter Health Plus Silver HMO C
01/01/2017 SBC
UnitedHealthCare Silver HMO A
01/01/2017 SBC
UnitedHealthCare Silver HMO B
01/01/2017 SBC
UnitedHealthCare Silver HMO C
01/01/2017 SBC
UnitedHealthCare Silver HMO D
01/01/2017 SBC
Western Health Advantage Silver HMO A
01/01/2017 SBC
Western Health Advantage Silver HMO B
01/01/2017 SBC
Western Health Advantage Silver HMO C
01/01/2017 SBC
Health Net Bronze HSP A
01/01/2017 SBC
Kaiser Permanente Bronze HMO B
01/01/2017 SBC
Kaiser Permanente Bronze HMO C
01/01/2017 SBC
Sharp Bronze HMO A
01/01/2017 SBC
Sharp Bronze HMO B
01/01/2017 SBC
Sharp Bronze HMO D
01/01/2017 SBC
Sutter Health Plus Bronze HMO A
01/01/2017 SBC
Sutter Health Plus Bronze HMO B
01/01/2017 SBC
UnitedHealthCare Bronze HMO B
01/01/2017 SBC
UnitedHealthCare Bronze HMO C
01/01/2017 SBC
Western Health Advantage Bronze HMO B
01/01/2017 SBC
Western Health Advantage Bronze HMO C
01/01/2017 SBC
Western Health Advantage Bronze HMO D
01/01/2017 SBC
Medical PPO SBCs
Anthem Blue Cross Bronze EPO B
01/01/2017 SBC
Anthem Blue Cross Silver EPO B
01/01/2017 SBC
Dental
Vision
Other
Chiropractic ACU Benefits
Summary
Hearing Benefits
Summary
Form Name Effective Date Download Form
Anthem Adv PPO Tier Hospital Network Advantage PPO
Download
Anthem Advantage PPO Three-Tier Hospital Network
Download
Cal Perks S. CA
Download
Changes to Group Policy - When and How
Download
Dentegra Smile Club for April 2016 Renewal Groups
Download
DocFind 5 Steps Provider Search
Download
Employer Program Guide
Download
Employer Optional Benefits Guide
Download
Infertility Services
Download
Medicare Part D
Download
Mobile App Flyer
Download
Online Enrollment Flyer
Download
Private Exchange Brochure Dec 2016
Download
Producer Guidelines
Download
Program Highlights
Download
Provider Network Definitions January-September 2016
Download
Provider Search
Download
Summary of Changes 3rd Quarter
07/01/2017 Download
Underwriting Guidelines
Download
Form Name Effective Date Download Form
Carrier Contacts
Download
Contact Sheet
Download