Covered California (CA)

Covered California for Small Business offers four levels of coverage — Bronze, Silver, Gold and Platinum — each with multiple plan options. We make it easy for you to choose not one level, but two adjoining levels of coverage.

 

Form Name Effective Date Download Form
Employee Roster
Download
Employer Change Form
01/01/2017 Download
Employer Application
03/01/2017 Download
Employer Guide
Download
Enrollment Checklist
Download
Navigating Your bill
Download
Form Name Effective Date Download Form
Employee Application
03/01/2017 Download
Employee Application
01/01/2017 Download
Employee Change Form
01/01/2017 Download
Form Name Effective Date Download Form
Medical HMO
Blue Shield Platinum 90 HMO 0/15 Child Dental INF
01/01/2017 SBC
CCHP Platinum 90 HMO 0/15 Child Dental INF
01/01/2017 SBC
CCHP Platinum 90 HMO 0/15 Child Dental
01/01/2017 SBC
Kaiser Platinum 90 HMO 0/10 Alt INF
01/01/2017 SBC
Kaiser Platinum 90 HMO 0/10 Alt
01/01/2017 SBC
Kaiser Platinum 90 HMO 0/15 Alt INF
01/01/2017 SBC
Kaiser Platinum 90 HMO 0/15 Alt
01/01/2017 SBC
Sharp Platinum 90 HMO 0/15 Child Dental Network 1 INF
01/01/2017 SBC
Sharp Platinum 90 HMO 0/15 Child Dental Network 1
01/01/2017 SBC
Sharp Platinum 90 HMO 0/15 Child Dental Network 2 INF
01/01/2017 SBC
Sharp Platinum 90 HMO 0/15 Child Dental Network 2
01/01/2017 SBC
Western Health Advantage Platinum 90 HMO 0/15 Child Dental
01/01/2017 SBC
Blue Shield Gold 80 HMO 0/30 Child Dental INF
01/01/2017 SBC
CCHP Gold 80 HMO 0/30 Child Dental INF
01/01/2017 SBC
CCHP Gold 80 HMO 0/30 Child Dental
01/01/2017 SBC
Kaiser Gold 80 HMO 0/30 INF
01/01/2017 SBC
Kaiser Gold 80 HMO 0/30
01/01/2017 SBC
Kaiser Gold 80 HMO 500/35 Alt INF
01/01/2017 SBC
Kaiser Gold 80 HMO 500/35 Alt
01/01/2017 SBC
Sharp Gold 80 HMO 0/30 Child Dental Network 1 INF
01/01/2017 SBC
Sharp Gold 80 HMO 0/30 Child Dental Network 1
01/01/2017 SBC
Sharp Gold 80 HMO 0/30 Child Dental Network 2 INF
01/01/2017 SBC
Sharp Gold 80 HMO 0/30 Child Dental Network 2
01/01/2017 SBC
Western Health Advantage Gold 80 HMO 0/30 Child Dental
01/01/2017 SBC
Blue Shield Silver 70 HMO 2000/45 INF
01/01/2017 SBC
CCHP Silver 70 HMO 2000/45 Child Dental INF
01/01/2017 SBC
CCHP Silver 70 HMO 2000/45 Child Dental
01/01/2017 SBC
Kaiser Silver 70 HDHP HMO 2000/20 INF
01/01/2017 SBC
Kaiser Silver 70 HDHP HMO 2000/20
01/01/2017 SBC
Kaiser Silver 70 HMO 1000/50 Alt INF
01/01/2017 SBC
Kaiser Silver 70 HMO 1000/50 Alt
01/01/2017 SBC
Kaiser Silver 70 HMO 2000/45 INF
01/01/2017 SBC
Kaiser Silver 70 HMO 2000/45
01/01/2017 SBC
Sharp Silver 70 HDHP HMO 2000/20 Child Dental Network 1 INF
01/01/2017 SBC
Sharp Silver 70 HDHP HMO 2000/20 Child Dental Network 1
01/01/2017 SBC
Sharp Silver 70 HMO 2000/45 Child Dental Network 1 INF
01/01/2017 SBC
Sharp Silver 70 HMO 2000/45 Child Dental Network 1
01/01/2017 SBC
Sharp Silver 70 HMO 2000/45 Child Dental Network 2 INF
01/01/2017 SBC
Sharp Silver 70 HMO 2000/45 Child Dental Network 2
01/01/2017 SBC
Western Health Advantage Silver 70 HDHP HMO 2000/20 Child Dental
01/01/2017 SBC
Western Health Advantage Silver 70 HMO 2000/45 Child Dental
01/01/2017 SBC
CCHP Bronze 60 HMO 6300/75 Child Dental INF
01/01/2017 SBC
CCHP Bronze 60 HMO 6300/75 Child Dental
01/01/2017 SBC
Kaiser Bronze 60 HDHP HMO 4800/40 INF
01/01/2017 SBC
Kaiser Bronze 60 HDHP HMO 4800/40
01/01/2017 SBC
Kaiser Bronze 60 HMO 6300/75 INF
01/01/2017 SBC
Kaiser Bronze 60 HMO 6300/75
01/01/2017 SBC
Sharp Bronze 60 HDHP HMO 4800/40 Child Dental Network 1 INF
01/01/2017 SBC
Sharp Bronze 60 HDHP HMO 4800/40 Child Dental Network 1
01/01/2017 SBC
Sharp Bronze 60 HMO 6300/75 Child Dental Network 2 INF
01/01/2017 SBC
Sharp Bronze 60 HMO 6300/75 Child Dental Network 2
01/01/2017 SBC
Western Health Advantage Bronze 60 HDHP HMO 4800/40 Child Dental
01/01/2017 SBC
Western Health Advantage Bronze 60 HDHP HMO 6500/0 Child Dental
01/01/2017 SBC
Western Health Advantage Bronze 60 HMO 6300/75 Child Dental
01/01/2017 SBC
Medical PPO
Blue Shield Platinum 90 PPO 0/15 Child Dental INF
01/01/2017 SBC
Blue Shield Platinum 90 PPO 0/15 Child Dental
01/01/2017 SBC
Health Net Platinum 90 PPO 0/15 Child Dental INF
01/01/2017 SBC
Health Net Platinum 90 PPO 0/15 Child Dental
01/01/2017 SBC
Blue Shield Gold 80 PPO 0/30 Child Dental INF
01/01/2017 SBC
Blue Shield Gold 80 PPO 0/30 Child Dental
01/01/2017 SBC
Health Net Gold Value PPO
10/01/2017 SBC
Health Net Gold 80 EPO 1300/20 Child Dental Alt INF
01/01/2017 SBC
Health Net Gold 80 EPO 1300/20 Child Dental Alt
01/01/2017 SBC
Health Net Gold 80 PPO 0/30 Child Dental INF
01/01/2017 SBC
Health Net Gold 80 PPO 0/30 Child Dental
01/01/2017 SBC
Blue Shield Silver 70 PPO 2000/45 Child Dental INF
01/01/2017 SBC
Blue Shield Silver 70 PPO 2000/45 Child Dental
01/01/2017 SBC
Health Net Siver Value PPO
10/01/2017 SBC
Health Net Silver Value PPO INF
10/01/2017 SBC
Health Net Silver 70 EPO 2000/20 Child Dental Alt INF
01/01/2017 SBC
Health Net Silver 70 EPO 2000/20 Child Dental Alt
01/01/2017 SBC
Health Net Silver 70 PPO 2000/45 Child Dental INF
01/01/2017 SBC
Health Net Silver 70 PPO 2000/45 Child Dental
01/01/2017 SBC
Blue Shield Bronze 60 PPO 6300/75 Child Dental INF
01/01/2017 SBC
Blue Shield Bronze 60 PPO 6300/75 Child Dental
01/01/2017 SBC
Health Net Bronze PPO HSA
10/01/2017 SBC
Health Net Bronze PPO HSA INF
10/01/2017 SBC
Health Net Bronze 60 PPO 6300/75 Child Dental INF
01/01/2017 SBC
Health Net Bronze 60 PPO 6300/75 Child Dental
01/01/2017 SBC

SBC

SBC
Form Name Effective Date Download Form
Schedule Of Commissions
01/01/2018 Download
Eligibility and Enrollment Agent Guide
Download
Nonpayment of Premiums Policy Change Effective January 1, 2017
01/01/2017 Download
Small Business Trifold
Download
Tax Credits Make Providing Employee Insurance More Affordable
01/01/2017 Download
Form Name Effective Date Download Form
Contact Sheet
Download