Forms & Documents

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

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Brochures and Guides
ADMINISTRATIVE HANDBOOK
ADMINISTRATIVE HANDBOOK

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

BENEFIT SUMMARIES
BENEFIT SUMMARIES

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

BENEFIT SUMMARIES
BENEFIT SUMMARIES

Effective Date: 04/01/2021 - 06/01/2021

BENEFIT SUMMARIES
BENEFIT SUMMARIES

Effective Date: 07/01/2021 - 09/01/2021

BENEFIT SUMMARIES - BRONZE
BENEFIT SUMMARIES - BRONZE

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

BENEFIT SUMMARIES - BRONZE
BENEFIT SUMMARIES - BRONZE

Effective Date: 04/01/2021 - 06/01/2021

Forms
AGENT AGREEMENT
AGENT AGREEMENT

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

AGENT AGREEMENT AMENDMENT
AGENT AGREEMENT AMENDMENT

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

BROKER LICENSING
BROKER LICENSING

BROKER LICENSING
BROKER LICENSING

BROKER PRIVACY AGREEMENT
BROKER PRIVACY AGREEMENT

HIPAA compliant agent agreement required for all brokers

Alert: Mandatory: we cannot release any employee information to brokers without this completed form on file.

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

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

*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