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PPO Plan Forms: UC Care, Health Savings Plan, CORE
PPO Plans: UC Care, Health Savings Plan, CORE
UC Blue & Gold HMO
UC High Option Supplement to Medicare
2023
High Option Supplement to Medicare—Navitus 2023 Vaccine Coverage [PDF]
High Option Supplement to Medicare 2023 Benefit Booklet [PDF]
High Option Supplement to Medicare 2023 Medical Plan Benefits Summary [PDF]
High Option Supplement to Medicare—Navitus 2023 Annual Notice of Changes [PDF]
High Option Supplement to Medicare—Navitus 2023 Evidence of Coverage [PDF]
High Option Supplement to Medicare—Navitus 2023 Medicare Part D Formulary [PDF]
High Option Supplement to Medicare—Navitus MedicareRx 2023 Summary of Benefits [PDF]
2022
High Option Supplement to Medicare 2022 Benefit Booklet [PDF]
High Option Supplement to Medicare 2022 Medical Plan Benefits Summary [PDF]
High Option Supplement to Medicare 2022 Summary of Benefits & Coverage—Spanish [PDF]
UC Blue & Gold HMO
2023
Comprehensive and easy-to-use benefits available to University of California Health Net members
UC Blue and Gold 2023 Evidence of Coverage [PDF]
UC Blue and Gold 2023 Summary of Benefits & Coverage [PDF]
Forms
Health Net forms
PPO Plans: UC Care, Health Savings Plan, CORE
2023
Core 2023 Benefits Booklet [PDF]
CORE 2023 Medical Plan Benefits Summary [PDF]
Core 2023 Prescription Drug Plan Benefits Booklet [PDF]
CORE 2023 Summary of Benefits & Coverage [PDF]
CORE 2023 Summary of Benefits & Coverage—Spanish [PDF]
Health Savings Plan 2023 Benefits Booklet [PDF]
Health Savings Plan 2023 Medical Plan Benefits Summary [PDF]
Health Savings Plan 2023 Prescription Drug Plan Benefits Booklet [PDF]
Health Savings Plan 2023 Summary of Benefits & Coverage [PDF]
Health Savings Plan 2023 Summary of Benefits & Coverage—Spanish [PDF]
Navitus 2023 Formulary [PDF]
Navitus Maintenance Drug Program and UC Medical Center Pharmacies [PDF]
UC Care 2023 Benefits Booklet [PDF]
UC Care 2023 Medical Plan Benefits Summary [PDF]
UC Care 2023 Prescription Drug Plan Benefits Booklet [PDF]
UC Care 2023 Summary of Benefits & Coverage [PDF]
UC Care 2023 Summary of Benefits & Coverage—Spanish [PDF]
2022
2022 PPO Open Enrollment Guide [PDF]
CORE 2022 Benefits Booklet [PDF]
CORE 2022 Medical Benefits Summary—Spanish [PDF]
CORE 2022 Medical Plan Benefits Summary [PDF]
CORE 2022 Navitus Pharmacy Member Brochure [PDF]
CORE 2022 Prescription Drug Summary Plan Description [PDF]
CORE 2022 Summary of Benefits & Coverage—English [PDF]
CORE 2022 Summary of Benefits & Coverage—Spanish [PDF]
Health Savings Plan 2022 Benefits Booklet [PDF]
Health Savings Plan 2022 Medical Benefits Summary—Spanish [PDF]
Health Savings Plan 2022 Medical Plan Benefits Summary [PDF]
Health Savings Plan 2022 Navitus Pharmacy Member Brochure [PDF]
Health Savings Plan 2022 Prescription Drug Summary Plan Description [PDF]
Health Savings Plan 2022 Summary of Benefits & Coverage—English [PDF]
Health Savings Plan 2022 Summary of Benefits & Coverage—Spanish [PDF]
UC Care 2022 Benefits Booklet [PDF]
UC Care 2022 Medical Plan Benefits Summary [PDF]
UC Care 2022 Navitus Pharmacy Member Brochure [PDF]
UC Care 2022 Prescription Drug Summary Plan Description [PDF]
UC Care 2022 Summary of Benefits & Coverage—English [PDF]
UC Care 2022 Summary of Benefits & Coverage—Spanish [PDF]
UC Medicare PPO
2023
Medicare PPO 2023 Benefit Booklet [PDF]
Medicare PPO 2023 Medical Plan Benefits Summary [PDF]
Medicare PPO—Navitus 2023 Annual Notice of Changes [PDF]
Medicare PPO—Navitus 2023 Evidence of Coverage [PDF]
Medicare PPO—Navitus 2023 Medicare Part D Formulary [PDF]
Medicare PPO—Navitus 2023 Vaccine Coverage [PDF]
Medicare PPO—Navitus MedicareRx 2023 Summary of Benefits [PDF]
2022
2022 PPO Open Enrollment Guide [PDF]
Medicare PPO 2022 Benefit Booklet [PDF]
Medicare PPO 2022 Medical Plan Benefits Summary [PDF]
Medicare PPO 2022 Summary of Benefits & Coverage—Spanish [PDF]
UC Medicare PPO Without Prescription Drugs
2023
Medicare PPO w/o Prescription Drugs 2023 Benefit Booklet [PDF]
Medicare PPO w/o Prescription Drugs 2023 Medical Plan Benefits Summary [PDF]
2022
Medicare PPO w/o Prescription Drugs 2022 Benefit Booklet [PDF]
Medicare PPO w/o Prescription Drugs 2022 Medical Plan Benefits Summary [PDF]
Medicare PPO w/o Prescription Drugs 2022 Summary of Benefits & Coverage—Spanish [PDF]
PPO Plan Forms: UC Care, Health Savings Plan, CORE
Forms
Authorization of Release of Personal and Health Information [PDF]
International Medical Claim Form [PDF]
Medical Claim Form [PDF]
Prescription Drug Claim Form [PDF]
UC Medicare PPO Health Plans
Forms
Authorization of Release of Personal and Health Information [PDF]
International Medical Claim Form [PDF]
Medical Claim Form [PDF]
Prescription Drug Claim Form [PDF]
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