HMO Plans

HMO Plans

Prescription drug options

Access+ HMO Plans Summary of Benefits Optional Benefits Disclosures
Access+ HMO® Zero Admit 10 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
 
Access+ HMO® Zero Admit 15 English (PDF, 952KB)
Spanish (PDF, 139KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® Zero Admit 20 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® Zero Admit 30 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® Per Admit 10-250 English (PDF, 1MB)
Spanish (PDF, 162KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® Per Admit 20-250 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)  
Access+ HMO® Per Admit 20-500 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Access+ HMO® Per Admit 25-750 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® Per Admit 40-1000 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)  
Access+ HMO® Per Day 15-500 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® Per Day 25-750  English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)  
Access+ HMO® Facility Coinsurance
15-20%		 English (PDF, 1MB)
Spanish (PDF, 162KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Access+ HMO® Facility Coinsurance
20-20%		 English (PDF, 1MB)
Spanish (PDF, 162KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® Facility Coinsurance
25-25%		 English (PDF, 1MB)
Spanish (PDF, 1MB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)

Access+ HMO® Facility Coinsurance 30-30%

 English (PDF, 1MB)
Spanish (PDF, 162KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Access+ HMO® Facility Coinsurance
40-40%		 English (PDF, 1MB)
Spanish (PDF, 162KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)  
Access+ HMO® Zero Facility Deductible
30-20%		 English  (PDF, 1MB)
Spanish (PDF, 162KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)  
Access+ HMO® Facility Deductible 15-10%/250 English (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® Facility Deductible 15-10%/500 English  (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Access+ HMO® Facility Deductible 15-10%/750 English (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® Facility Deductible
15-10%/1500		 English (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)
Additional infertility 95% (PDF, 110KB)

English (1.1MB)  
Access+ HMO® Facility Deductible
20-25%/1500		 English (PDF, 1MB)
Spanish (PDF, 162KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® Facility Deductible
30-10%/1500		 English (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Access+ HMO® Facility Deductible 30-30%/2000 English (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® Facility Deductible 40-40%/2000 English (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)  
Access+ HMO® Facility Deductible 40-40%/5800 English (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)

 

Access+ HMO SaveNet Plans Summary of Benefits Optional Benefits Disclosures
Access+ HMO® SaveNet
Zero Admit 10		 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® SaveNet
Zero Admit 20		 English (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)  
Access+ HMO® SaveNet
Zero Admit 30		 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® SaveNet
Per Admit 10-250		 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® SaveNet
Per Admit 20-500		 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® SaveNet
Per Admit 25-750		 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® SaveNet
Per Admit 40-1000		 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® SaveNet
Facility Coinsurance 15-20%		 English (PDF, 1MB)
Spanish (PDF, 162KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® SaveNet
Facility Coinsurance 20-20%		 English (PDF, 1MB)
Spanish (PDF, 162KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Access+ HMO® SaveNet
Facility Coinsurance 25-25%		 English (PDF, 1MB)
Spanish (PDF, 162KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® SaveNet
Facility Coinsurance 40-40%		 English (PDF, 1MB)
Spanish (PDF, 162KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Access+ HMO® SaveNet 
Facility Deductible
15-10%/1500		 English (PDF, 1MB)
Spanish (PDF, 162KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Access+ HMO® SaveNet
Facility Deductible
20-25%/1500		 English (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Access+ HMO® SaveNet
Facility Deductible
30-30%/2000		 English (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Access+ HMO® SaveNet
Facility Deductible
40-40%/2000		 English (PDF, 1MB)
Spanish (PDF, 166KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)
Additional infertility 95% (PDF, 110KB)

English (1.1MB)
Access+ HMO® SaveNet
Facility Deductible
40-40%/5800		 English (PDF, 1MB)
Spanish (PDF, 152KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)

 

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

English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Local Access+ HMO® Zero Admit 20 English  (PDF, 1MB)
Spanish  (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Local Access+ HMO® Zero Admit 30 English  (PDF, 1MB)
Spanish  (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Local Access+ HMO® Per Admit 10-250 English  (PDF, 1MB)
Spanish  (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Local Access+ HMO® Per Admit 20-500 English  (PDF, 1MB)
Spanish  (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Local Access+ HMO® Per Admit 25-750 English  (PDF, 1MB)
Spanish  (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Local Access+ HMO® Per Admit 40-1000 English  (PDF, 1MB)
Spanish  (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Local Access+ HMO® Facility Coinsurance 15-20% English  (PDF, 1MB)
Spanish  (PDF, 162KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Local Access+ HMO® Facility Coinsurance 20-20% English  (PDF, 1MB)
Spanish  (PDF, 162KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)  
Local Access+ HMO® Facility Coinsurance 25-25%

English (PDF, 1MB)
Spanish (PDF, 162KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Local Access+ HMO® Facility Coinsurance 40-40% English  (PDF, 1MB)
Spanish  (PDF, 162KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)  
Local Access+ HMO® Facility Deductible 15-10%/1500 English  (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Local Access+ HMO® Facility Deductible 20-25%/1500 English  (PDF, 1MB)
Spanish  (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Local Access+ HMO® Facility Deductible 30-30%/2000 English  (PDF, 1MB)
Spanish  (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Local Access+ HMO® Facility Deductible 40-40%/2000 English  (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Local Access+ HMO® Facility Deductible 40-40%/5800 English  (PDF, 1MB)
Spanish  (PDF,166KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 

 

Trio HMO Plans Summary of Benefits Optional Benefits Disclosures
Trio HMO Zero Admit 10 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
 
Trio HMO Zero Admit 15 English  (PDF, 1MB)
Spanish  (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Trio HMO Zero Admit 20 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Trio HMO Zero Admit 30 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Trio HMO Per Admit 10-250 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Trio HMO Per Admit 20-250 English (PDF, 1MB)
Spanish (PDF, 161KB)


Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Trio HMO Per Admit 20-500 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)  
Trio HMO Per Admit 25-750 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Trio HMO Per Admit 40-1000 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Trio HMO Per Day 15-500 English (PDF, 1MB)
Spanish (PDF, 160KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Trio HMO Per Day 25-750 English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Trio HMO Facility Coinsurance 15-20% English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Trio HMO Facility Coinsurance 20-20% English  (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Trio HMO Facility Coinsurance 25-25% English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Trio HMO Facility Coinsurance 30-30% English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Trio HMO Facility Coinsurance 40-40% English (PDF, 1MB)
Spanish (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Trio HMO Facility Deductible 15-10%/250 English (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Trio HMO Facility Deductible 15-10%/500

 

English (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Trio HMO Facility Deductible 15-10%/750 English (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Trio HMO Facility Deductible 15-10%/1500 English (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Trio HMO Facility Deductible 20-25%/1500 English  (PDF, 1MB)
Spanish  (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Trio HMO Facility Deductible 30-10%/1500 English (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Trio HMO Facility Deductible 30-30%/2000 English  (PDF, 1MB)
Spanish  (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB) 
Trio HMO Facility Deductible 40-40%/2000 English (PDF, 1MB)
Spanish (PDF, 165KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Trio HMO Facility Deductible 40-40%/5800 English  (PDF, 1MB)
Spanish (PDF, 166KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)
Trio HMO Zero Facility Deductible 30-20% English  (PDF, 1MB)
Spanish  (PDF, 161KB)

Chiropractic (PDF, 992KB)
Chiropractic and acupuncture (PDF, 994KB)
Hearing aid (PDF, 987KB)
Base infertility 50% (PDF, 991KB)
Additional infertility 50% (PDF, 991KB)
Additional infertility 80% (PDF, 991KB)
Additional infertility 95% (PDF, 991KB)

Spanish
Chiropractic (PDF, 1.7MB)
Chiropractic and acupuncture (PDF, 1.7MB)
Hearing aid (PDF, 1.7MB)
Base infertility 50% (PDF, 1.7MB)
Additional infertility 50% (PDF, 1.7MB)
Additional infertility 80% (PDF, 1.7MB)
Additional infertility 95% (PDF, 1.7MB)

English (1.1MB)  

 

Contact Us

  • Producer Services (800) 559-5905

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  • Blue Shield of California

    PO Box 272540

    Chico, CA 95927-2540

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