Ruby 20 HMO Platinum

2019 Benefit Highlights

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Plan Benefit Highlights (PDF) (Coming Soon)

Pediatric Dental Summary (PDF) (Coming Soon)
Pediatric Vision Summary (PDF) (Coming Soon)

Optional Riders:
Adult Vision Summary (B) (PDF) (Coming Soon)
Adult Vision Summary (C) (PDF) (Coming Soon)

Rates
Employer Group Plans Rate - San Francisco County (PDF)
Employer Group Plans Rate - Northern San Mateo County (PDF)

Summary of Benefits (SBC) (Coming Soon)      Chinese       Spanish

Health Plan Benefits and Coverage Matrix (PDF) (Coming Soon)

Evidence of Coverage (EOC) (PDF) (Coming Soon)

CCHP Provider Directory - HMO (English and Chinese) (PDF) (Coming Soon)

Start an online Provider Search

CCHP Pharmacy Directory (English) (PDF) (Coming Soon)

List of Covered Drugs (Formulary) (English) (No changes made since X/201X) (Coming Soon)

2018 Benefit Highlights

The following PDF links open in a new window.
Download Adobe PDF reader

Plan Benefit Highlights (PDF)

Pediatric Dental Summary (PDF)
Pediatric Vision Summary (PDF)

Optional Riders:
Adult Vision Summary (B) (PDF)
Adult Vision Summary (C) (PDF)

Rates
Employer Group Plans Rate - San Francisco County (PDF)
Employer Group Plans Rate - Northern San Mateo County (PDF)
California Plain-Language Filing Description (PDF)

Summary of Benefits (SBC)      Chinese       Spanish

Health Plan Benefits and Coverage Matrix (PDF)

Evidence of Coverage (EOC) (PDF)

CCHP Provider Directory - HMO (English and Chinese) (PDF)

Start an online Provider Search

CCHP Pharmacy Directory (English) (PDF)

List of Covered Drugs (Formulary) (English) (No changes made since 8/2018)

2017 Benefit Highlights

• $0 Annual Deductible
• $0 Copay for Preventive Services
• $10 Copay for Lab Tests & X-Rays
• $0 Copay for Maternity Care (Preconception/Prenatal/Postnatal Care)
• $20 Office Visit Copay
• Maximum out-of-pocket: Individual $4,000/ Family $8,000

The following PDF links open in a new window.
Download Adobe PDF reader

Plan Benefit Highlights (PDF)

Pediatric Dental Summary (PDF)

Pediatric Vision Summary (PDF)

Optional Riders:
Adult Vision Summary (B) (PDF)
Adult Vision Summary (C) (PDF)
Chiropractic Summary (PDF)

Employer Group Plans Rate - San Francisco County (PDF)

Employer Group Plans Rate - Northern San Mateo County (PDF)

Summary of Benefits (SBC) (PDF)

Health Plan Benefits and Coverage Matrix (PDF)

Evidence of Coverage (EOC) (PDF)

CCHP Provider Directory - HMO (English and Chinese) (PDF)

Start an online Provider Search

CCHP Pharmacy Directory (English) (PDF)

List of Covered Drugs (Formulary) (English) (PDF) (No changes made since 11/2017)

Formulary Changes for 2017 (English) (PDF)