Skip to main content
MENU
Medicare
Documents & Forms
Contacts & Mobile Apps
Close
Main navigation
UC Medicare Supplement Plans
Compare the Plans
UC Medicare PPO Plan
UC Medicare PPO Plan Without Prescription Drugs
UC High Option Supplement to Medicare Plan
Filing Claims
Prescription Drugs
Find Care
Wellness Resources
Behavioral Health
Physical Health
Discounts
Transitioning to Medicare
Documents & Forms
Contacts & Mobile Apps
Search
Search
Documents & Forms
Breadcrumb
Home
Documents & Forms
Filter by health plan
Filter by health plan
All health plans
UC High Option Supplement to Medicare
UC Medicare PPO
UC Medicare PPO Health Plans
UC Medicare PPO Without Prescription Drugs
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]
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]
Navitus 2023 Formulary [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]
2022
2022 Navitus Maintenance Drug Program and UC Medical Center Pharmacies [PDF]
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]
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]
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]