HMO Plans

HMO Plans

Prescription drug options

Access+ HMO Plans Summary of Benefits Optional Benefits Disclosures
Access+ HMO® Zero Admit 10 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 


Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 
Access+ HMO Zero Admit 15 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 


Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage
Access+ HMO® Zero Admit 20 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® Zero Admit 30 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® Per Admit 10-250 English(PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 


 


Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 


 
Access+ HMO® Per Admit 20-250 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® Per Admit 20-500 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® Per Admit 25-750 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 



Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 


 
Access+ HMO® Per Admit 40-1000 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® Per Day 15-500 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® Per Day 25-750  English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® Facility Coinsurance
15-20%		 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® Facility Coinsurance
20-20%		 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® Facility Coinsurance
25-25%		 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Access+ HMO Facility Coinsurance                30-30%

 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage
Access+ HMO® Facility Coinsurance
40-40%		 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)


With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® Zero Facility Deductible
30-20%		 English  (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage

 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO Facility Deductible 15-10%/250 English (PDF, 47KB)
Spanish (PDF, 47KB))

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage

 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage
Access+ HMO Facility Deductible 15-10%/500 English  (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage

 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage
Access+ HMO Facility Deductible 15-10%/750 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage
Access+ HMO® Facility Deductible
15-10%/1500		 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage   

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® Facility Deductible
20-25%/1500		 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)
 

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® Facility Deductible
30-10%/1500		 English(PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® Facility Deductible 30-30%/2000 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage


Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® Facility Deductible 40-40%/2000 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® Facility Deductible 40-40%/5800 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 

Access+ HMO SaveNet Plans Summary of Benefits Optional Benefits Disclosures
Access+ HMO® SaveNet
Zero Admit 10		 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® SaveNet
Zero Admit 20		 English (PDF, 47KB)
Spanish(PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 


Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® SaveNet
Zero Admit 30		 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® SaveNet
Per Admit 10-250		 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® SaveNet
Per Admit 20-500		 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® SaveNet
Per Admit 25-750		 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® SaveNet
Per Admit 40-1000		 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® SaveNet
Facility Coinsurance 15-20%		 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® SaveNet
Facility Coinsurance 20-20%		 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® SaveNet
Facility Coinsurance 25-25%		 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 


Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® SaveNet
Facility Coinsurance 40-40%		 English (PDF, 47KB)
Spanish (PDF,47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® SaveNet 
Facility Deductible 15-10%/1500		 English (PDF, 47KB)
Spanish (PDF,47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® SaveNet
Facility Deductible 20-25%/1500		 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® SaveNet
Facility Deductible 30-30%/2000		 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® SaveNet
Facility Deductible 40-40%/2000		 English (PDF, 47KB)
Spanish (PDF,47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Access+ HMO® SaveNet
Facility Deductible 40-40%/5800		 English (PDF, 47KB)
Spanish (PDF,47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 

Local Access+ HMO Plans Summary of Benefits Optional Benefits Disclosures
Local Access+ HMO® Zero Admit 10

English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage

 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 
Local Access+ HMO® Zero Admit 20 English  (PDF, 47KB)
Spanish  (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 
Local Access+ HMO® Zero Admit 30 English  (PDF, 47KB))
Spanish  (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 


Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 
Local Access+ HMO® Per Admit 10-250 English  (PDF, 47KB)
Spanish  (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Local Access+ HMO® Per Admit 20-500 English  (PDF, 47KB)
Spanish  (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Local Access+ HMO® Per Admit 25-750 English  (PDF, 47KB)
Spanish  (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 


Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 
Local Access+ HMO® Per Admit 40-1000 English  (PDF, 47KB)
Spanish  (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx PrescriptionDrug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Local Access+ HMO® Facility Coinsurance 15-20% English  (PDF, 47KB)
Spanish  (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 


Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 
Local Access+ HMO® Facility Coinsurance
20-20%		 English  (PDF, 47KB)
Spanish  (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 




Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 


 
Local Access+ HMO® Facility Coinsurance |25-25%

English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Local Access+ HMO® Facility Coinsurance
40-40%		 English  (PDF, 47KB)
Spanish  (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 
Local Access+ HMO® Facility Deductible
15-10%/1500		 English  (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 
Local Access+ HMO® Facility Deductible
20-25%/1500		 English  (PDF, 47KB)
Spanish  (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 
Local Access+ HMO® Facility Deductible
30-30%/2000		 English  (PDF, 47KB)
Spanish  (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 
Local Access+ HMO® Facility Deductible
40-40%/2000		 English  (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 
Local Access+ HMO® Facility Deductible
40-40%/5800		 English  (PDF, 47KB)
Spanish  (PDF,47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 


Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

 

 

Trio HMO Plans Summary of Benefits Optional Benefits Disclosures
Trio HMO Zero Admit 10 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Zero Admit 15 English  (PDF, 47KB)
Spanish  (PDF,47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Zero Admit 20 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Zero Admit 30 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Per Admit 10-250 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 
 

Spanish
With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Per Admit 20-250 English (PDF, 47KB)
Spanish (PDF, 47KB)


Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)
 

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Per Admit 20-500 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Per Admit 25-750 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Per Admit 40-1000 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 

Spanish
With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Per Day 15-500 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Per Day 25-750 English (PDF, 47KB)
Spanish (PDF, 47KB)


Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Facility Coinsurance 15-20% English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 

Spanish
With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Facility Coinsurance 20-20% English  (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

 

Spanish
With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Facility Coinsurance 25-25% English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 

Spanish
With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Facility Coinsurance 30-30% English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 

Spanish
With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage
Trio HMO Facility Coinsurance 40-40% English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 

Spanish
With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage
Trio HMO Facility Deductible 15-10%/250 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 


Spanish
With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Facility Deductible 15-10%/500

 

English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 


Spanish
With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Facility Deductible 15-10%/750 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 


Spanish 
With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Facility Deductible 15-10%/1500 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 

Spanish
With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Facility Deductible 20-25%/1500 English  (PDF, 47KB)
Spanish  (PDF,47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 



Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 


 
Trio HMO Facility Deductible 30-10%/1500 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB) 

With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx Prescription
Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Facility Deductible 30-30%/2000 English  (PDF, 47KB)
Spanish  (PDF,47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Facility Deductible 40-40%/2000 English (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

Spanish
With Basic Rx PrescriptionDrug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Facility Deductible 40-40%/5800 English  (PDF, 47KB)
Spanish (PDF, 47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)
 

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
Trio HMO Zero Facility Deductible 30-20% English  (PDF, 47KB)
Spanish  (PDF,47KB)

Chiropractic (PDF, 104KB)
Chiropractic and acupuncture (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

Spanish
Chiropractic (PDF, 104KB)
Chiropractic and acupuncture  (PDF, 104KB)
Hearing aid (PDF, 104KB)
Infertility 50% (PDF, 104KB)
Infertility 80% (PDF, 104KB)
Infertility 95% (PDF, 104KB)

With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 
 

Spanish
With Basic Rx Prescription Drug Coverage
With Enhanced or Premier Rx Prescription Drug Coverage 

 

 

Contact Us

  • Producer Services (800) 559-5905

    Employer Services (800) 325-5166

  • Blue Shield of California

    PO Box 272540

    Chico, CA 95927-2540

© California Physicians’ Service DBA Blue Shield of California 1999-2022. All rights reserved. California Physicians’ Service DBA Blue Shield of California is an independent member of the Blue Shield Association.

Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.