Forms & Documents

View and download frequently used forms, brochures, guides, and other information related to products and eligibility.

Enter your search criteria in the fields below.

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Member Flyers
CAL PERKS FLYER
CAL PERKS FLYER

CALIFORNIA RX CARD FLYER
CALIFORNIA RX CARD FLYER

CHIROPRACTIC BENEFITS FLYER
CHIROPRACTIC BENEFITS FLYER

Effective Date: 01/01/2024 - 12/01/2024

CHOOSEHEALTHY FLYER
CHOOSEHEALTHY FLYER

DENTAL BENEFITS FLYER
DENTAL BENEFITS FLYER

Effective Date: 01/01/2024 - 12/01/2024

DENTEGRA FLYER
DENTEGRA FLYER

Brochures and Guides
ADMINISTRATIVE HANDBOOK
ADMINISTRATIVE HANDBOOK

Effective Date: 07/01/2024 - 12/01/2024

To assist Employers with the healthcare administration of new hires, terminations, benefit and policy changes, etc

BENEFIT SUMMARIES - BRONZE - REVISED 8/16/23
BENEFIT SUMMARIES - BRONZE - REVISED 8/16/23

Effective Date: 01/01/2024 - 03/01/2024

BENEFIT SUMMARIES - BRONZE - REVISED 8/16/23
BENEFIT SUMMARIES - BRONZE - REVISED 8/16/23

Effective Date: 04/01/2024 - 08/01/2024

BENEFIT SUMMARIES - BRONZE - REVISED 8/16/23
BENEFIT SUMMARIES - BRONZE - REVISED 8/16/23

Effective Date: 09/01/2024 - 12/01/2024

BENEFIT SUMMARIES - GOLD - REVISED 8/16/23
BENEFIT SUMMARIES - GOLD - REVISED 8/16/23

Effective Date: 01/01/2024 - 03/01/2024

BENEFIT SUMMARIES - GOLD - REVISED 8/16/23
BENEFIT SUMMARIES - GOLD - REVISED 8/16/23

Effective Date: 04/01/2024 - 08/01/2024

Forms
AGENT AGREEMENT
AGENT AGREEMENT

Effective Date: 07/01/2021 - 03/01/2025

*FILLABLE* Must be completed by broker to sell CaliforniaChoice program. Commissions will not be paid until received.

AGENT AGREEMENT AMENDMENT
AGENT AGREEMENT AMENDMENT

Effective Date: 07/01/2021 - 03/01/2025

*FILLABLE* Must be completed by broker to sell CaliforniaChoice program. Commissions will not be paid until received.

ANNUAL COBRA / CAL-COBRA STATUS NOTIFICATION
ANNUAL COBRA / CAL-COBRA STATUS NOTIFICATION

Effective Date: 01/01/2024 - 12/01/2024

ANNUAL COBRA / CAL-COBRA STATUS NOTIFICATION
ANNUAL COBRA / CAL-COBRA STATUS NOTIFICATION

Effective Date: 01/01/2025 - 03/01/2025

*Fillable*

BROKER LICENSING
BROKER LICENSING

CHANGE REQUEST - EMPLOYEE (ENGLISH)
CHANGE REQUEST - EMPLOYEE (ENGLISH)

Effective Date: 01/01/2024 - 03/01/2024

*Fillable*

Existing members should log in to view their coverage specific Summary of Benefits and Coverages (SBC) and Evidence of Coverage (EOC). Existing groups must log in to view their Group Service Agreement (GSA).

Search Result

SUPPORT
Address

721 South Parker, Suite 200
Orange, CA 92868

Office Hours

Monday - Friday 8:00 am to 5:00 pm PT

Customer Service

Phone: (800) 558-8003
Fax: (714) 558-8000
Email: CustomerService@CalChoice.com

Sales

Phone: (800) 542-4218
Fax: (800) 500-9088
Email: Sales@CalChoice.com

Department of Insurance License

#0B42994

SUPPORT
Address

721 South Parker, Suite 200
Orange, CA 92868

Office Hours

Monday - Friday 8:00 am to 5:00 pm PT

Customer Service

Phone: (800) 558-8003
Fax: (714) 558-8000
Email: CustomerService@CalChoice.com

Sales

Phone: (800) 542-4218
Fax: (800) 500-9088
Email: Sales@CalChoice.com

Department of Insurance License

#0B42994