Ruby 20 HMO Platinum
CCHP Ruby 20 HMO Platinum Plan Benefit Highlights
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2018 Benefit Highlights
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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 5/2018)
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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
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)
CCHP Pharmaceutical Management Procedures (English) (PDF)
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ASH Chiropractic Provider Search
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