"BUSINESS YEAR","STATE CODE","ISSUER NAME","ISSUER ID","SOURCE NAME","VERSION NUMBER","IMPORT DATE","BENEFIT PACKAGE ID","MARKET COVERAGE","DENTAL ONLY PLAN","TIN","STANDARD COMPONENT ID","PLAN MARKETING NAME","HIOS PRODUCT ID","HPID","NETWORK ID","SERVICE AREA ID","FORMULARY ID","IS IT A NEW PLAN","PLAN TYPE","METAL LEVEL","UNIQUE PLAN DESIGN","QHP NONQHP TYPE ID","IS NOTICE REQUIRED FOR PREGNACY","IS REFERRAL REQUIRED FOR SPECIALIST","SPECIALIST REQUIRING REFERRAL","PLAN LEVEL EXCLUSIONS","IS HSA ELIGIBLE","HSA OR HRA EMPLOYER CONTRIBUTION","HSA OR HRA EMPLOYER CONTRIBUTION AMOUNT","CHILD ONLY OFFERING","CHILD ONLY PLAN ID","WELLNESS PROGRAM OFFERED","DISEASE MANAGEMENT PROGRAMS OFFERED","EHB PEDIATRIC DENTAL APPORTIONMENT QUANTITY","IS GUARANTEED RATE?","SPECIALITY DRUG MAXIMUM COINSURANCE","INPATIENT COPAYMENT MAXIMUM DAYS","BEGIN PRIMARY CARE COST SHARING AFTER NUMBER OF VISITS","BEGIN PRIMARY CARE DEDUCTIBLE COINSURANCE AFTER NUMBER OF COPAYS","PLAN EFFECTIVE DATE","PLAN EXPIRATION DATE","OUT OF COUNTRY COVERAGE","OUT OF COUNTRY COVERAGE DESCRIPTION","OUT OF SERVICE AREA COVERAGE","OUT OF SERVICE AREA COVERAGE DESCRIPTION","NATIONAL NETWORK","URL FOR SUMMARY OF BENEFITS COVERAGE","URL FOR ENROLLMENT PAYMENT","PLAN BROCHURE","FORMULARY URL","PLAN ID","CSR VARIATION TYPE","ISSUER ACTUARIAL VALUE","AV CALCULATOR OUTPUT NUMBER","MEDICAL DRUG DEDUCTIBLES INTEGRATED","MEDICAL DRUG MAXIMUM OUT OF POCKET INTEGRATED","MULTIPLE NETWORK TIERS","FIRST TIER UTILIZATION","SECOND TIER UTILIZATION","MEHB INN TIER 1 INDIVIDUAL MOOP","MEHB INN TIER 1 FAMILY MOOP","MEHB INN TIER 2 INDIVIDUAL MOOP","MEHB INN TIER 2 FAMILY MOOP","MEHB OUT OF NET INDIVIDUAL MOOP","MEHB OUT OF NET FAMILY MOOP","MEHB COMB INN OON INDIVIDUAL MOOP","MEHB COMB INN OON FAMILY MOOP","DEHB INN TIER 1 INDIVIDUAL MOOP","DEHB INN TIER 2 INDIVIDUAL MOOP","DEHB INN TIER 1 FAMILY MOOP","DEHB INN TIER 2 FAMILY MOOP","DEHB OUT OF NET INDIVIDUAL MOOP","DEHB OUT OF NET FAMILY MOOP","DEHB COMB INN OON INDIVIDUAL MOOP","DEHB COMB INN OON FAMILY MOOP","TEHB INN TIER 1 INDIVIDUAL MOOP","TEHB INN TIER 1 FAMILY MOOP","TEHB INN TIER 2 INDIVIDUAL MOOP","TEHB INN TIER 2 FAMILY MOOP","TEHB OUT OF NET INDIVIDUAL MOOP","TEHB OUT OF NET FAMILY MOOP","TEHB COMB INN OON INDIVIDUAL MOOP","TEHB COMB INN OON FAMILY MOOP","MEHB DED INN TIER1 INDIVIDUAL","MEHB DED INN TIER1 FAMILY","MEHB DED INN TIER1 COINSURNACE","MEHB DED INN TIER2 INDIVIDUAL","MEHB DED INN TIER2 FAMILY","MEHB DED INN TIER2 COINSURANCE","MEHB DED OUT OF NET INDIVIDUAL","MEHB DED OUT OF NET FAMILY","MEHB DED COMB INN OON INDIVIDUAL","MEHB DED COMB INN OON FAMILY","DEHB DED INN TIER1 INDIVIDUAL","DEHB DED INN TIER1 FAMILY","DEHB DED INN TIER1 COINSURNACE","DEHB DED INN TIER2 INDIVIDUAL","DEHB DED INN TIER2 FAMILY","DEHB DED INN TIER2 COINSURANCE","DEHB DED OUT OF NET INDIVIDUAL","DEHB DED OUT OF NET FAMILY","DEHB DED COMB INN OON INDIVIDUAL","DEHB DED COMB INN OON FAMILY","TEHB DED INN TIER 1 INDIVIDUAL","TEHB DED INN TIER 1 FAMILY","TEHB DED INN TIER 1 COINSURANCE","TEHB DED INN TIER 2 INDIVIDUAL","TEHB DED INN TIER 2 FAMILY","TEHB DED INN TIER 2 COINSURANCE","TEHB DED OUT OF NET INDIVIDUAL","TEHB DED OUT OF NET FAMILY","TEHB DED OUT COMB INN OON INDIVIDUAL","TEHB DED OUT COMB INN OON FAMILY","SBC HAVING A BABY DEDUCTIBLE","SBC HAVING A BABY COPAYMENT","SBC HAVING A BABY COINSURANCE","SBC HAVING A BABY LIMIT","SBC HAVING DIABETES DEDUCTIBLE","SBC HAVING  DIABETES COPAYMENT","SBC HAVING DIABETES COINSURANCE","SBC HAVING DIABETES LIMIT"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","1","Individual","No",,"27603CA1150038","Platinum 90 HMO","27603CA115",,"CAN003","CAS054","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No",,,,,"27603CA1150038-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","1","Individual","No",,"27603CA1150038","Platinum 90 HMO","27603CA115",,"CAN003","CAS054","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No",,,,,"27603CA1150038-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$200","$60","$0","$1,300","$0","$60"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","1","Individual","No",,"10544CA0090001","Platinum 90 Select EPO","10544CA009",,"CAN001","CAS001","CAF001","Existing","EPO","Platinum","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0090001-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$400","$0","$50","$0","$400","$100","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","1","Individual","No",,"10544CA0090001","Platinum 90 Select EPO","10544CA009",,"CAN001","CAS001","CAF001","Existing","EPO","Platinum","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0090001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$50","$0","$0","$0","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","1","Individual","No",,"10544CA0090001","Platinum 90 Select EPO","10544CA009",,"CAN001","CAS001","CAF001","Existing","EPO","Platinum","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0090001-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$400","$0","$50","$0","$400","$100","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","No",,"10544CA0840001","Oscar Circle Platinum 90 EPO 0/20 + Child Dental","10544CA084",,"CAN002","CAS001","CAF001","Existing","EPO","Platinum","No","On the Exchange","No","No",,,,,,"Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"10544CA0840001-01","Standard Platinum On Exchange Plan",,"0.882935144","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$400","$0","$50","$0","$400","$100","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","2","Individual","No",,"10544CA0100001","Gold 80 Select EPO","10544CA010",,"CAN001","CAS001","CAF001","Existing","EPO","Gold","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0100001-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$50","$0","$1,200","$200","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","2","Individual","No",,"10544CA0100001","Gold 80 Select EPO","10544CA010",,"CAN001","CAS001","CAF001","Existing","EPO","Gold","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0100001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$50","$0","$0","$0","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","2","Individual","No",,"10544CA0100001","Gold 80 Select EPO","10544CA010",,"CAN001","CAS001","CAF001","Existing","EPO","Gold","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0100001-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$50","$0","$1,200","$200","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"10544CA0830001","Oscar Circle Platinum 90 EPO 0/20 + Child Dental INF","10544CA083",,"CAN002","CAS001","CAF002","Existing","EPO","Platinum","No","On the Exchange","No","No",,,,,,"Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"10544CA0830001-01","Standard Platinum On Exchange Plan",,"0.882935144","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$400","$0","$50","$0","$400","$100","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","3","Individual","No",,"10544CA0120001","Silver 70 Select EPO","10544CA012",,"CAN001","CAS001","CAF001","Existing","EPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0120001-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,030","$300","$1,200","$50","$300","$1,200","$200","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","3","Individual","No",,"10544CA0120001","Silver 70 Select EPO","10544CA012",,"CAN001","CAS001","CAF001","Existing","EPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0120001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$50","$0","$0","$0","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","3","Individual","No",,"10544CA0120001","Silver 70 Select EPO","10544CA012",,"CAN001","CAS001","CAF001","Existing","EPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0120001-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,030","$300","$1,200","$50","$300","$1,200","$200","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","3","Individual","No",,"10544CA0120001","Silver 70 Select EPO","10544CA012",,"CAN001","CAS001","CAF001","Existing","EPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0120001-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,730","$300","$1,200","$50","$275","$1,100","$200","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","3","Individual","No",,"10544CA0120001","Silver 70 Select EPO","10544CA012",,"CAN001","CAS001","CAF001","Existing","EPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0120001-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$200","$1,300","$50","$100","$500","$200","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","3","Individual","No",,"10544CA0120001","Silver 70 Select EPO","10544CA012",,"CAN001","CAS001","CAF001","Existing","EPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0120001-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$50","$900","$50","$0","$200","$100","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","3","SHOP (Small Group)","No",,"10544CA0860001","Oscar Circle Gold 80 EPO 250/35 + Child Dental","10544CA086",,"CAN002","CAS001","CAF001","Existing","EPO","Gold","No","On the Exchange","No","No",,,,,,"Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"10544CA0860001-01","Standard Gold On Exchange Plan",,"0.794329718","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,800","$15600 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$50","$0","$1,200","$200","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","4","Individual","No",,"10544CA0110001","Bronze 60 Select EPO","10544CA011",,"CAN001","CAS001","CAF001","Existing","EPO","Expanded Bronze","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0110001-01","Standard Bronze On Exchange Plan","64.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,330","$100","$1,600","$50","$1,900","$400","$1,100","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","4","Individual","No",,"10544CA0110001","Bronze 60 Select EPO","10544CA011",,"CAN001","CAS001","CAF001","Existing","EPO","Expanded Bronze","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0110001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$50","$0","$0","$0","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","4","Individual","No",,"10544CA0110001","Bronze 60 Select EPO","10544CA011",,"CAN001","CAS001","CAF001","Existing","EPO","Expanded Bronze","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0110001-03","Limited Cost Sharing Plan Variation","64.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,330","$100","$1,600","$50","$1,900","$400","$1,100","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"10544CA0850001","Oscar Circle Gold 80 EPO 250/35 + Child Dental INF","10544CA085",,"CAN002","CAS001","CAF002","Existing","EPO","Gold","No","On the Exchange","No","No",,,,,,"Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"10544CA0850001-01","Standard Gold On Exchange Plan",,"0.794329718","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,800","$15600 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$50","$0","$1,200","$200","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","5","Individual","No",,"10544CA0320004","Bronze 60 HDHP Select EPO","10544CA032",,"CAN001","CAS001","CAF001","New","EPO","Expanded Bronze","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0320004-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$50","$5,200","$0","$0","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","5","Individual","No",,"10544CA0320004","Bronze 60 HDHP Select EPO","10544CA032",,"CAN001","CAS001","CAF001","New","EPO","Expanded Bronze","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0320004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0","$0","$50","$0","$0","$0","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","5","Individual","No",,"10544CA0320004","Bronze 60 HDHP Select EPO","10544CA032",,"CAN001","CAS001","CAF001","New","EPO","Expanded Bronze","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0320004-03","Limited Cost Sharing Plan Variation",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$50","$5,200","$0","$0","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","5","SHOP (Small Group)","No",,"10544CA0900001","Oscar Circle Silver 70 EPO 2250/55 + Child Dental","10544CA090",,"CAN002","CAS001","CAF001","Existing","EPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"10544CA0900001-01","Standard Silver On Exchange Plan","70.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,250","$400","$2,300","$50","$300","$1,600","$300","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","6","Individual","No",,"10544CA0080001","Minimum Coverage Select EPO","10544CA008",,"CAN001","CAS001","CAF001","Existing","EPO","Catastrophic","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"10544CA0080001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,550","$0","$0","$50","$4,800","$0","$0","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"10544CA0890001","Oscar Circle Silver 70 EPO 2250/55 + Child Dental INF","10544CA089",,"CAN002","CAS001","CAF002","Existing","EPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"10544CA0890001-01","Standard Silver On Exchange Plan","70.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,250","$400","$2,300","$50","$300","$1,600","$300","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","7","SHOP (Small Group)","No",,"10544CA0920001","Oscar Circle Bronze 60 HDHP EPO 7000/0% + Child Dental","10544CA092",,"CAN002","CAS001","CAF001","Existing","EPO","Expanded Bronze","No","On the Exchange","No","No",,,,,,"Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"10544CA0920001-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$50","$5,200","$0","$0","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","8","SHOP (Small Group)","No",,"10544CA0910001","Oscar Circle Bronze 60 HDHP EPO 7000/0% + Child Dental INF","10544CA091",,"CAN002","CAS001","CAF002","Existing","EPO","Expanded Bronze","No","On the Exchange","No","No",,,,,,"Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"10544CA0910001-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$50","$5,200","$0","$0","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"10544CA0220001","Oscar Circle Gold 80 EPO 0/30 + Child Dental Alt","10544CA022",,"CAN002","CAS001","CAF001","Existing","EPO","Gold","No","On the Exchange","No","No",,,,,,"Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"10544CA0220001-01","Standard Gold On Exchange Plan",,"0.818811998","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$3,000","$50","$0","$1,100","$300","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","10","SHOP (Small Group)","No",,"10544CA0210001","Oscar Circle Gold 80 EPO 0/30 + Child Dental Alt INF","10544CA021",,"CAN002","CAS001","CAF002","Existing","EPO","Gold","No","On the Exchange","No","No",,,,,,"Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"10544CA0210001-01","Standard Gold On Exchange Plan",,"0.818811998","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$3,000","$50","$0","$1,100","$300","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"10544CA0540001","Oscar Circle Silver 70 EPO 1500/50 + Child Dental Alt","10544CA054",,"CAN002","CAS001","CAF001","Existing","EPO","Silver","No","On the Exchange","No","No",,,,,,"Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"10544CA0540001-01","Standard Silver On Exchange Plan",,"0.714193967","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,300","$16600 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per group","50.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,500","$400","$4,200","$50","$1,000","$1,300","$0","$20"
"2021","CA","Oscar Health Plan of California","10544","SERFF","1","3/8/2021 8:38","12","SHOP (Small Group)","No",,"10544CA0530001","Oscar Circle Silver 70 EPO 1500/50 + Child Dental Alt INF","10544CA053",,"CAN002","CAS001","CAF002","Existing","EPO","Silver","No","On the Exchange","No","No",,,,,,"Allows Adult-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"10544CA0530001-01","Standard Silver On Exchange Plan",,"0.714193967","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,300","$16600 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3000 per group","50.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,500","$400","$4,200","$50","$1,000","$1,300","$0","$20"
"2021","CA","MOLINA HEALTHCARE OF CALIFORNIA","18126","SERFF","1","3/8/2021 8:38","1","Individual","No",,"18126CA0010001","Platinum 90 HMO","18126CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"18126CA0010001-01","Standard Platinum On Exchange Plan",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","MOLINA HEALTHCARE OF CALIFORNIA","18126","SERFF","1","3/8/2021 8:38","1","Individual","No",,"18126CA0010001","Platinum 90 HMO","18126CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"18126CA0010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$60"
"2021","CA","MOLINA HEALTHCARE OF CALIFORNIA","18126","SERFF","1","3/8/2021 8:38","1","Individual","No",,"18126CA0010001","Platinum 90 HMO","18126CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"18126CA0010001-03","Limited Cost Sharing Plan Variation",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","MOLINA HEALTHCARE OF CALIFORNIA","18126","SERFF","1","3/8/2021 8:38","2","Individual","No",,"18126CA0010002","Gold 80 HMO","18126CA001",,"CAN001","CAS001","CAF002","Existing","HMO","Gold","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"18126CA0010002-01","Standard Gold On Exchange Plan",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","MOLINA HEALTHCARE OF CALIFORNIA","18126","SERFF","1","3/8/2021 8:38","2","Individual","No",,"18126CA0010002","Gold 80 HMO","18126CA001",,"CAN001","CAS001","CAF002","Existing","HMO","Gold","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"18126CA0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$60"
"2021","CA","MOLINA HEALTHCARE OF CALIFORNIA","18126","SERFF","1","3/8/2021 8:38","2","Individual","No",,"18126CA0010002","Gold 80 HMO","18126CA001",,"CAN001","CAS001","CAF002","Existing","HMO","Gold","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"18126CA0010002-03","Limited Cost Sharing Plan Variation",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","MOLINA HEALTHCARE OF CALIFORNIA","18126","SERFF","1","3/8/2021 8:38","3","Individual","No",,"18126CA0010003","Silver 70 HMO","18126CA001",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"18126CA0010003-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","MOLINA HEALTHCARE OF CALIFORNIA","18126","SERFF","1","3/8/2021 8:38","3","Individual","No",,"18126CA0010003","Silver 70 HMO","18126CA001",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"18126CA0010003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$60"
"2021","CA","MOLINA HEALTHCARE OF CALIFORNIA","18126","SERFF","1","3/8/2021 8:38","3","Individual","No",,"18126CA0010003","Silver 70 HMO","18126CA001",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"18126CA0010003-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","MOLINA HEALTHCARE OF CALIFORNIA","18126","SERFF","1","3/8/2021 8:38","3","Individual","No",,"18126CA0010003","Silver 70 HMO","18126CA001",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"18126CA0010003-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","MOLINA HEALTHCARE OF CALIFORNIA","18126","SERFF","1","3/8/2021 8:38","3","Individual","No",,"18126CA0010003","Silver 70 HMO","18126CA001",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"18126CA0010003-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","MOLINA HEALTHCARE OF CALIFORNIA","18126","SERFF","1","3/8/2021 8:38","3","Individual","No",,"18126CA0010003","Silver 70 HMO","18126CA001",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"18126CA0010003-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","MOLINA HEALTHCARE OF CALIFORNIA","18126","SERFF","1","3/8/2021 8:38","4","Individual","No",,"18126CA0010004","Bronze 60 HMO","18126CA001",,"CAN001","CAS001","CAF004","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"18126CA0010004-01","Standard Bronze On Exchange Plan","64.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$2,100","$200","$1,200","$20"
"2021","CA","MOLINA HEALTHCARE OF CALIFORNIA","18126","SERFF","1","3/8/2021 8:38","4","Individual","No",,"18126CA0010004","Bronze 60 HMO","18126CA001",,"CAN001","CAS001","CAF004","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"18126CA0010004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$60"
"2021","CA","MOLINA HEALTHCARE OF CALIFORNIA","18126","SERFF","1","3/8/2021 8:38","4","Individual","No",,"18126CA0010004","Bronze 60 HMO","18126CA001",,"CAN001","CAS001","CAF004","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"18126CA0010004-03","Limited Cost Sharing Plan Variation","64.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$2,100","$200","$1,200","$20"
"2021","CA","MOLINA HEALTHCARE OF CALIFORNIA","18126","SERFF","1","3/8/2021 8:38","5","Individual","No",,"18126CA0010005","Minimum Coverage HMO","18126CA001",,"CAN001","CAS001","CAF005","Existing","HMO","Catastrophic","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"18126CA0010005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$5,300","$0","$0","$20"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","1","Individual","No",,"27603CA1150038","Platinum 90 HMO","27603CA115",,"CAN003","CAS054","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No",,,,,"27603CA1150038-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$200","$60","$0","$1,300","$0","$60"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","2","Individual","No",,"40513CA0380002","Gold 80 HMO","40513CA038",,"CAN001","CAS002","CAF002","Existing","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380002-01","Standard Gold On Exchange Plan",,"0.780701991","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,100","$0","$50","$0","$1,400","$100","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","2","Individual","No",,"40513CA0380002","Gold 80 HMO","40513CA038",,"CAN001","CAS002","CAF002","Existing","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$50","$0","$0","$0","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","2","Individual","No",,"40513CA0380002","Gold 80 HMO","40513CA038",,"CAN001","CAS002","CAF002","Existing","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380002-03","Limited Cost Sharing Plan Variation",,"0.780701991","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,100","$0","$50","$0","$1,400","$100","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","2","Individual","No",,"40513CA0380013","Gold 80 HMO Coinsurance","40513CA038",,"CAN001","CAS002","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380013-01","Standard Gold On Exchange Plan",,"0.819672186","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$500","$1,700","$50","$0","$1,400","$100","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","2","Individual","No",,"40513CA0380013","Gold 80 HMO Coinsurance","40513CA038",,"CAN001","CAS002","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380013-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$50","$0","$0","$0","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","2","Individual","No",,"40513CA0380013","Gold 80 HMO Coinsurance","40513CA038",,"CAN001","CAS002","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380013-03","Limited Cost Sharing Plan Variation",,"0.819672186","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$500","$1,700","$50","$0","$1,400","$100","$0"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"27603CA1330004","Family Dental PPO","27603CA133",,"CAN004","CAS022",,"Existing","PPO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes",,,,,"27603CA1330004-01","Standard High On Exchange Plan","86.20%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"$75","$150 per group",,,,,"$75","$150 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","1","Individual","No",,"27603CA1500008","Platinum 90 EPO","27603CA150",,"CAN001","CAS053","CAF011","Existing","EPO","Platinum","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500008-01","Standard Platinum On Exchange Plan",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$1,300","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","1","Individual","No",,"27603CA1500008","Platinum 90 EPO","27603CA150",,"CAN001","CAS053","CAF011","Existing","EPO","Platinum","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","1","Individual","No",,"27603CA1500008","Platinum 90 EPO","27603CA150",,"CAN001","CAS053","CAF011","Existing","EPO","Platinum","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500008-03","Limited Cost Sharing Plan Variation",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$1,300","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","2","Individual","No",,"27603CA1150037","Gold 80 HMO","27603CA115",,"CAN003","CAS054","CAF009","Existing","HMO","Gold","No","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No",,,,,"27603CA1150037-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,500","$500","$60","$0","$4,100","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","2","Individual","No",,"27603CA1150037","Gold 80 HMO","27603CA115",,"CAN003","CAS054","CAF009","Existing","HMO","Gold","No","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No",,,,,"27603CA1150037-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","2","Individual","No",,"27603CA1150037","Gold 80 HMO","27603CA115",,"CAN003","CAS054","CAF009","Existing","HMO","Gold","No","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No",,,,,"27603CA1150037-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,500","$500","$60","$0","$4,100","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","2","Individual","No",,"27603CA1500005","Gold 80 EPO","27603CA150",,"CAN001","CAS053","CAF009","Existing","EPO","Gold","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500005-01","Standard Gold On Exchange Plan",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$2,300","$60","$0","$4,100","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","2","Individual","No",,"27603CA1500005","Gold 80 EPO","27603CA150",,"CAN001","CAS053","CAF009","Existing","EPO","Gold","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","2","Individual","No",,"27603CA1500005","Gold 80 EPO","27603CA150",,"CAN001","CAS053","CAF009","Existing","EPO","Gold","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500005-03","Limited Cost Sharing Plan Variation",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$2,300","$60","$0","$4,100","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","2","Individual","Yes",,"27603CA1560001","Family Dental HMO","27603CA156",,"CAN005","CAS023",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"27603CA1560001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","3","Individual","No",,"27603CA1150036","Silver 70 HMO","27603CA115",,"CAN003","CAS054","CAF008","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No",,,,,"27603CA1150036-01","Standard Silver On Exchange Plan","70.50%","0.798155393","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$900","$2,300","$60","$300","$4,400","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","3","Individual","No",,"27603CA1150036","Silver 70 HMO","27603CA115",,"CAN003","CAS054","CAF008","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No",,,,,"27603CA1150036-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","3","Individual","No",,"27603CA1150036","Silver 70 HMO","27603CA115",,"CAN003","CAS054","CAF008","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No",,,,,"27603CA1150036-03","Limited Cost Sharing Plan Variation","70.50%","0.798155393","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$900","$2,300","$60","$300","$4,400","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","3","Individual","No",,"27603CA1150036","Silver 70 HMO","27603CA115",,"CAN003","CAS054","CAF008","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No",,,,,"27603CA1150036-04","73% AV Level Silver Plan","73.30%","0.808995553","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,500","$800","$2,300","$60","$300","$4,200","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","3","Individual","No",,"27603CA1150036","Silver 70 HMO","27603CA115",,"CAN003","CAS054","CAF008","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No",,,,,"27603CA1150036-05","87% AV Level Silver Plan","87.80%","0.916797371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$1,800","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","3","Individual","No",,"27603CA1150036","Silver 70 HMO","27603CA115",,"CAN003","CAS054","CAF008","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No",,,,,"27603CA1150036-06","94% AV Level Silver Plan","94.10%","0.965247324","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$100","$800","$60","$0","$700","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","3","Individual","No",,"27603CA1500006","Silver 70 EPO","27603CA150",,"CAN001","CAS053","CAF008","Existing","EPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500006-01","Standard Silver On Exchange Plan","70.50%","0.798155393","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$900","$2,300","$60","$300","$4,400","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","3","Individual","No",,"27603CA1500006","Silver 70 EPO","27603CA150",,"CAN001","CAS053","CAF008","Existing","EPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","3","Individual","No",,"27603CA1500006","Silver 70 EPO","27603CA150",,"CAN001","CAS053","CAF008","Existing","EPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500006-03","Limited Cost Sharing Plan Variation","70.50%","0.798155393","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$900","$2,300","$60","$300","$4,400","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","3","Individual","No",,"27603CA1500006","Silver 70 EPO","27603CA150",,"CAN001","CAS053","CAF008","Existing","EPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500006-04","73% AV Level Silver Plan","73.30%","0.808995553","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,500","$800","$2,300","$60","$300","$4,200","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","3","Individual","No",,"27603CA1500006","Silver 70 EPO","27603CA150",,"CAN001","CAS053","CAF008","Existing","EPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500006-05","87% AV Level Silver Plan","87.80%","0.916797371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$1,800","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","3","Individual","No",,"27603CA1500006","Silver 70 EPO","27603CA150",,"CAN001","CAS053","CAF008","Existing","EPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500006-06","94% AV Level Silver Plan","94.10%","0.965247324","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$100","$800","$60","$0","$700","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","4","Individual","No",,"27603CA1150039","Bronze 60 HMO","27603CA115",,"CAN003","CAS054","CAF004","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No",,,,,"27603CA1150039-01","Standard Bronze On Exchange Plan","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,900","$700","$4,600","$60","$500","$1,900","$2,100","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","4","Individual","No",,"27603CA1150039","Bronze 60 HMO","27603CA115",,"CAN003","CAS054","CAF004","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No",,,,,"27603CA1150039-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","4","Individual","No",,"27603CA1150039","Bronze 60 HMO","27603CA115",,"CAN003","CAS054","CAF004","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No",,,,,"27603CA1150039-03","Limited Cost Sharing Plan Variation","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,900","$700","$4,600","$60","$500","$1,900","$2,100","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","4","Individual","No",,"27603CA1500009","Bronze 60 EPO","27603CA150",,"CAN001","CAS053","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500009-01","Standard Bronze On Exchange Plan","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,900","$700","$4,600","$60","$500","$1,900","$2,100","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","4","Individual","No",,"27603CA1500009","Bronze 60 EPO","27603CA150",,"CAN001","CAS053","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","4","Individual","No",,"27603CA1500009","Bronze 60 EPO","27603CA150",,"CAN001","CAS053","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500009-03","Limited Cost Sharing Plan Variation","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,900","$700","$4,600","$60","$500","$1,900","$2,100","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","5","Individual","No",,"27603CA1500010","Bronze 60 HDHP EPO","27603CA150",,"CAN001","CAS053","CAF001","Existing","EPO","Expanded Bronze","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500010-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$7,000","$0","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","5","Individual","No",,"27603CA1500010","Bronze 60 HDHP EPO","27603CA150",,"CAN001","CAS053","CAF001","Existing","EPO","Expanded Bronze","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0","$0","$60","$0","$0","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","5","Individual","No",,"27603CA1500010","Bronze 60 HDHP EPO","27603CA150",,"CAN001","CAS053","CAF001","Existing","EPO","Expanded Bronze","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500010-03","Limited Cost Sharing Plan Variation",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$7,000","$0","$0","$60"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","6","Individual","No",,"27603CA1150040","Minimum Coverage HMO","27603CA115",,"CAN003","CAS054","CAF001","Existing","HMO","Catastrophic","No","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN",,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","TRAD/PAR network","No",,,,,"27603CA1150040-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$4,700","$0","$0","$20"
"2021","CA","Blue Cross of California(Anthem BC)","27603","SERFF","1","3/8/2021 8:38","6","Individual","No",,"27603CA1500007","Minimum Coverage EPO","27603CA150",,"CAN001","CAS053","CAF001","Existing","EPO","Catastrophic","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,,,,,,"1/1/2021","12/31/2021","No","Urgent/Emergency Coverage Only","No","Standard Bluecard PPO Network","No",,,,,"27603CA1500007-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$4,700","$0","$0","$20"
"2021","CA","Access Dental Plan","40269","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"40269CA0010014","Family Dental HMO","40269CA001",,"CAN001","CAS001",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40269CA0010014-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","1","Individual","No",,"40513CA0380001","Platinum 90 HMO","40513CA038",,"CAN001","CAS002","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380001-01","Standard Platinum On Exchange Plan",,"0.892777756","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$500","$0","$50","$0","$600","$50","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","1","Individual","No",,"40513CA0380001","Platinum 90 HMO","40513CA038",,"CAN001","CAS002","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$50","$0","$0","$0","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","1","Individual","No",,"40513CA0380001","Platinum 90 HMO","40513CA038",,"CAN001","CAS002","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380001-03","Limited Cost Sharing Plan Variation",,"0.892777756","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$500","$0","$50","$0","$600","$50","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","No",,"40513CA0400001","Platinum 90 HMO 0/20","40513CA040",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400001-01","Standard Platinum On Exchange Plan",,"0.886359923","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$500","$0","$50","$0","$700","$50","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"40513CA0400002","Gold 80 HMO 250/35","40513CA040",,"CAN001","CAS001","CAF002","Existing","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400002-01","Standard Gold On Exchange Plan",,"0.806711729","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,800","$15600 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$250","$800","$0","$50","$0","$1,100","$100","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","3","Individual","No",,"40513CA0380003","Silver 70 HMO","40513CA038",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380003-01","Standard Silver On Exchange Plan","70.50%","0.798317044","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$300","$900","$50","$300","$1,400","$100","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","3","Individual","No",,"40513CA0380003","Silver 70 HMO","40513CA038",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$50","$0","$0","$0","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","3","Individual","No",,"40513CA0380003","Silver 70 HMO","40513CA038",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380003-03","Limited Cost Sharing Plan Variation","70.50%","0.798317044","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$300","$900","$50","$300","$1,400","$100","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","3","Individual","No",,"40513CA0380003","Silver 70 HMO","40513CA038",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380003-04","73% AV Level Silver Plan","73.30%","0.809114518","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$300","$1,000","$50","$275","$1,300","$100","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","3","Individual","No",,"40513CA0380003","Silver 70 HMO","40513CA038",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380003-05","87% AV Level Silver Plan","87.80%","0.916871271","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$200","$1,100","$50","$100","$600","$80","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","3","Individual","No",,"40513CA0380003","Silver 70 HMO","40513CA038",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380003-06","94% AV Level Silver Plan","94.10%","0.965318839","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$50","$800","$50","$0","$300","$50","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","3","SHOP (Small Group)","No",,"40513CA0400004","Silver 70 HMO 2250/55","40513CA040",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400004-01","Standard Silver On Exchange Plan","71.47%","0.713570107","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$400","$1,900","$50","$300","$1,800","$200","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","3","SHOP (Small Group)","No",,"40513CA0400021","Silver 70 HDHP HMO 2500/20%","40513CA040",,"CAN001","CAS001","CAF006","Existing","HMO","Silver","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400021-01","Standard Silver On Exchange Plan",,"0.716665009","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,850","$13700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,800","$0","$1,400","$50","$2,800","$0","$500","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","4","Individual","No",,"40513CA0380004","Bronze 60 HMO","40513CA038",,"CAN001","CAS002","CAF007","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380004-01","Standard Bronze On Exchange Plan","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$100","$1,000","$50","$1,800","$400","$1,200","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","4","Individual","No",,"40513CA0380004","Bronze 60 HMO","40513CA038",,"CAN001","CAS002","CAF007","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$50","$0","$0","$0","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","4","Individual","No",,"40513CA0380004","Bronze 60 HMO","40513CA038",,"CAN001","CAS002","CAF007","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380004-03","Limited Cost Sharing Plan Variation","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$100","$1,000","$50","$1,800","$400","$1,200","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"40513CA0400009","Bronze 60 HDHP HMO 7000/0%","40513CA040",,"CAN001","CAS001","CAF008","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400009-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$50","$4,600","$0","$0","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","5","Individual","No",,"40513CA0380005","Bronze 60 HDHP HMO","40513CA038",,"CAN001","CAS002","CAF008","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380005-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$50","$5,100","$0","$0","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","5","Individual","No",,"40513CA0380005","Bronze 60 HDHP HMO","40513CA038",,"CAN001","CAS002","CAF008","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0","$0","$50","$0","$0","$0","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","5","Individual","No",,"40513CA0380005","Bronze 60 HDHP HMO","40513CA038",,"CAN001","CAS002","CAF008","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380005-03","Limited Cost Sharing Plan Variation",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$50","$5,100","$0","$0","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","5","SHOP (Small Group)","No",,"40513CA0400007","Bronze 60 HMO 6300/65","40513CA040",,"CAN001","CAS001","CAF007","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400007-01","Standard Bronze On Exchange Plan","64.83%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","$6,300","$12600 per group","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$100","$1,000","$50","$1,800","$100","$1,300","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","6","Individual","No",,"40513CA0380006","Minimum Coverage HMO","40513CA038",,"CAN001","CAS002","CAF009","Existing","HMO","Catastrophic","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"40513CA0380006-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,550","$0","$0","$50","$5,100","$0","$0","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"40513CA0400023","Platinum 90 HMO 0/20 INF","40513CA040",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400023-01","Standard Platinum On Exchange Plan",,"0.886359923","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$500","$0","$50","$0","$700","$50","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","7","SHOP (Small Group)","No",,"40513CA0400024","Gold 80 HMO 250/35 INF","40513CA040",,"CAN001","CAS001","CAF002","Existing","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400024-01","Standard Gold On Exchange Plan",,"0.806711729","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,800","$15600 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$250","$800","$0","$50","$0","$1,100","$100","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","8","SHOP (Small Group)","No",,"40513CA0400026","Silver 70 HDHP HMO 2500/20% INF","40513CA040",,"CAN001","CAS001","CAF006","Existing","HMO","Silver","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400026-01","Standard Silver On Exchange Plan",,"0.716665009","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,850","$13700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,800","$0","$1,400","$50","$2,800","$0","$500","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","8","SHOP (Small Group)","No",,"40513CA0400027","Silver 70 HMO 2250/55 INF","40513CA040",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400027-01","Standard Silver On Exchange Plan","71.47%","0.713570107","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$400","$1,900","$50","$300","$1,800","$200","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"40513CA0400030","Bronze 60 HDHP HMO 7000/0% INF","40513CA040",,"CAN001","CAS001","CAF008","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400030-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$50","$4,600","$0","$0","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","10","SHOP (Small Group)","No",,"40513CA0400029","Bronze 60 HMO 6300/65 INF","40513CA040",,"CAN001","CAS001","CAF007","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400029-01","Standard Bronze On Exchange Plan","64.83%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","$6,300","$12600 per group","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$100","$1,000","$50","$1,800","$100","$1,300","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"40513CA0400020","Platinum 90 HMO 0/10 Alt","40513CA040",,"CAN001","CAS001","CAF016","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400020-01","Standard Platinum On Exchange Plan",,"0.895158019","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$50","$0","$500","$50","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","12","SHOP (Small Group)","No",,"40513CA0400033","Gold 80 HMO 0/30 Alt","40513CA040",,"CAN001","CAS001","CAF002","New","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400033-01","Standard Gold On Exchange Plan",,"0.818443398","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$50","$0","$1,100","$100","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","12","SHOP (Small Group)","No",,"40513CA0400035","Gold 80 HMO 1000/40 Alt","40513CA040",,"CAN001","CAS001","CAF013","New","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400035-01","Standard Gold On Exchange Plan",,"0.785843857","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,800","$15600 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,000","$2000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,000","$800","$0","$50","$250","$1,300","$100","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"40513CA0400005","Silver 70 HMO 1650/55 Alt","40513CA040",,"CAN001","CAS001","CAF012","Existing","HMO","Silver","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400005-01","Standard Silver On Exchange Plan",,"0.718344466","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,650","$3300 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$350","$700 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,700","$300","$2,700","$50","$350","$1,700","$200","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"40513CA0400031","Silver 70 HMO 2100/55 Alt","40513CA040",,"CAN001","CAS001","CAF012","Existing","HMO","Silver","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400031-01","Standard Silver On Exchange Plan",,"0.707047158","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,100","$4200 per group","45.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,100","$0","$3,500","$50","$600","$1,600","$200","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"40513CA0400039","Silver 70 HMO 2600/55 Alt","40513CA040",,"CAN001","CAS001","CAF014","New","HMO","Silver","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400039-01","Standard Silver On Exchange Plan",,"0.693979909","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$2,600","$5200 per group","45.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,600","$300","$2,600","$50","$0","$1,800","$200","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","14","SHOP (Small Group)","No",,"40513CA0400037","Bronze 60 HMO 5400/60 Alt","40513CA040",,"CAN001","CAS001","CAF015","New","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400037-01","Standard Bronze On Exchange Plan",,"0.648917977","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$5,400","$10800 per group","50.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$5,400","$100","$1,700","$50","$1,300","$1,100","$0","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","15","SHOP (Small Group)","No",,"40513CA0400022","Platinum 90 HMO 0/10 Alt INF","40513CA040",,"CAN001","CAS001","CAF016","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400022-01","Standard Platinum On Exchange Plan",,"0.895158019","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$50","$0","$500","$50","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","16","SHOP (Small Group)","No",,"40513CA0400034","Gold 80 HMO 0/30 Alt INF","40513CA040",,"CAN001","CAS001","CAF002","New","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400034-01","Standard Gold On Exchange Plan",,"0.818443398","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$50","$0","$1,100","$100","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","16","SHOP (Small Group)","No",,"40513CA0400036","Gold 80 HMO 1000/40 Alt INF","40513CA040",,"CAN001","CAS001","CAF013","New","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400036-01","Standard Gold On Exchange Plan",,"0.785843857","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,800","$15600 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,000","$2000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,000","$800","$0","$50","$250","$1,300","$100","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","17","SHOP (Small Group)","No",,"40513CA0400028","Silver 70 HMO 1650/55 Alt INF","40513CA040",,"CAN001","CAS001","CAF012","Existing","HMO","Silver","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400028-01","Standard Silver On Exchange Plan",,"0.718344466","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,650","$3300 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$350","$700 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,700","$300","$2,700","$50","$350","$1,700","$200","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","17","SHOP (Small Group)","No",,"40513CA0400032","Silver 70 HMO 2100/55 Alt INF","40513CA040",,"CAN001","CAS001","CAF012","Existing","HMO","Silver","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400032-01","Standard Silver On Exchange Plan",,"0.707047158","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,100","$4200 per group","45.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,100","$0","$3,500","$50","$600","$1,600","$200","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","17","SHOP (Small Group)","No",,"40513CA0400040","Silver 70 HMO 2600/55 Alt INF","40513CA040",,"CAN001","CAS001","CAF014","New","HMO","Silver","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400040-01","Standard Silver On Exchange Plan",,"0.693979909","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$2,600","$5200 per group","45.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,600","$300","$2,600","$50","$0","$1,800","$200","$0"
"2021","CA","Kaiser Foundation Health Plan, Inc.","40513","SERFF","1","3/8/2021 8:38","18","SHOP (Small Group)","No",,"40513CA0400038","Bronze 60 HMO 5400/60 Alt INF","40513CA040",,"CAN001","CAS001","CAF015","New","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"40513CA0400038-01","Standard Bronze On Exchange Plan",,"0.648917977","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$5,400","$10800 per group","50.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$5,400","$100","$1,700","$50","$1,300","$1,100","$0","$0"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","1","Individual","No",,"47579CA0180001","Platinum 90 HMO","47579CA018",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0180001-01","Standard Platinum On Exchange Plan",,"0.891739517","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$800","$200","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","1","Individual","No",,"47579CA0180001","Platinum 90 HMO","47579CA018",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0180001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","1","Individual","No",,"47579CA0180001","Platinum 90 HMO","47579CA018",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0180001-03","Limited Cost Sharing Plan Variation",,"0.891739517","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$800","$200","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","1","Individual","No",,"47579CA0270001","Platinum 90 HMO","47579CA027",,"CAN001","CAS002","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0270001-01","Standard Platinum On Exchange Plan",,"0.891739517","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$800","$200","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","1","Individual","No",,"47579CA0270001","Platinum 90 HMO","47579CA027",,"CAN001","CAS002","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0270001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","1","Individual","No",,"47579CA0270001","Platinum 90 HMO","47579CA027",,"CAN001","CAS002","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0270001-03","Limited Cost Sharing Plan Variation",,"0.891739517","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$800","$200","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","2","Individual","No",,"47579CA0200001","Gold 80 HMO","47579CA020",,"CAN001","CAS001","CAF002","Existing","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0200001-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,500","$0","$60","$0","$2,200","$300","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","2","Individual","No",,"47579CA0200001","Gold 80 HMO","47579CA020",,"CAN001","CAS001","CAF002","Existing","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0200001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","2","Individual","No",,"47579CA0200001","Gold 80 HMO","47579CA020",,"CAN001","CAS001","CAF002","Existing","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0200001-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,500","$0","$60","$0","$2,200","$300","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","2","Individual","No",,"47579CA0290001","Gold 80 HMO","47579CA029",,"CAN001","CAS002","CAF002","Existing","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0290001-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,500","$0","$60","$0","$2,200","$300","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","2","Individual","No",,"47579CA0290001","Gold 80 HMO","47579CA029",,"CAN001","CAS002","CAF002","Existing","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0290001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","2","Individual","No",,"47579CA0290001","Gold 80 HMO","47579CA029",,"CAN001","CAS002","CAF002","Existing","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0290001-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,500","$0","$60","$0","$2,200","$300","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","3","Individual","No",,"47579CA0220001","Silver 70 HMO","47579CA022",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0220001-01","Standard Silver On Exchange Plan","70.50%","0.78992739","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$900","$1,800","$60","$300","$2,400","$300","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","3","Individual","No",,"47579CA0220001","Silver 70 HMO","47579CA022",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0220001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","3","Individual","No",,"47579CA0220001","Silver 70 HMO","47579CA022",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0220001-03","Limited Cost Sharing Plan Variation","70.50%","0.78992739","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$900","$1,800","$60","$300","$2,400","$300","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","3","Individual","No",,"47579CA0220001","Silver 70 HMO","47579CA022",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0220001-04","73% AV Level Silver Plan","73.30%","0.80898432","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$900","$1,800","$60","$300","$2,300","$300","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","3","Individual","No",,"47579CA0220001","Silver 70 HMO","47579CA022",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0220001-05","87% AV Level Silver Plan","87.80%","0.916797371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,000","$400","$1,300","$60","$100","$1,000","$300","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","3","Individual","No",,"47579CA0220001","Silver 70 HMO","47579CA022",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0220001-06","94% AV Level Silver Plan","94.10%","0.965247324","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$100","$900","$60","$0","$400","$200","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","3","Individual","No",,"47579CA0310001","Silver 70 HMO","47579CA031",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0310001-01","Standard Silver On Exchange Plan","70.50%","0.78992739","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$900","$1,800","$60","$300","$2,400","$300","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","3","Individual","No",,"47579CA0310001","Silver 70 HMO","47579CA031",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0310001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","3","Individual","No",,"47579CA0310001","Silver 70 HMO","47579CA031",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0310001-03","Limited Cost Sharing Plan Variation","70.50%","0.78992739","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$900","$1,800","$60","$300","$2,400","$300","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","3","Individual","No",,"47579CA0310001","Silver 70 HMO","47579CA031",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0310001-04","73% AV Level Silver Plan","73.30%","0.80898432","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$900","$1,800","$60","$300","$2,300","$300","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","3","Individual","No",,"47579CA0310001","Silver 70 HMO","47579CA031",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0310001-05","87% AV Level Silver Plan","87.80%","0.916797371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,000","$400","$1,300","$60","$100","$1,000","$300","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","3","Individual","No",,"47579CA0310001","Silver 70 HMO","47579CA031",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0310001-06","94% AV Level Silver Plan","94.10%","0.965247324","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$100","$900","$60","$0","$400","$200","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","4","Individual","No",,"47579CA0240001","Bronze 60 HMO","47579CA024",,"CAN001","CAS001","CAF007","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0240001-01","Standard Bronze On Exchange Plan","64.80%","0.663315969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,500","$700","$3,700","$60","$1,500","$1,800","$2,100","$200"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","4","Individual","No",,"47579CA0240001","Bronze 60 HMO","47579CA024",,"CAN001","CAS001","CAF007","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0240001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","4","Individual","No",,"47579CA0240001","Bronze 60 HMO","47579CA024",,"CAN001","CAS001","CAF007","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0240001-03","Limited Cost Sharing Plan Variation","64.80%","0.663315969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,500","$700","$3,700","$60","$1,500","$1,800","$2,100","$200"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","4","Individual","No",,"47579CA0330001","Bronze 60 HMO","47579CA033",,"CAN001","CAS002","CAF007","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0330001-01","Standard Bronze On Exchange Plan","64.80%","0.663315969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,500","$700","$3,700","$60","$1,500","$1,800","$2,100","$200"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","4","Individual","No",,"47579CA0330001","Bronze 60 HMO","47579CA033",,"CAN001","CAS002","CAF007","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0330001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","4","Individual","No",,"47579CA0330001","Bronze 60 HMO","47579CA033",,"CAN001","CAS002","CAF007","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0330001-03","Limited Cost Sharing Plan Variation","64.80%","0.663315969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,500","$700","$3,700","$60","$1,500","$1,800","$2,100","$200"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","5","Individual","No",,"47579CA0520001","Bronze 60 HDHP HMO","47579CA052",,"CAN001","CAS001","CAF008","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0520001-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,900","$0","$0","$60","$6,900","$0","$0","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","5","Individual","No",,"47579CA0520001","Bronze 60 HDHP HMO","47579CA052",,"CAN001","CAS001","CAF008","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0520001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","5","Individual","No",,"47579CA0520001","Bronze 60 HDHP HMO","47579CA052",,"CAN001","CAS001","CAF008","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0520001-03","Limited Cost Sharing Plan Variation",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,900","$0","$0","$60","$6,900","$0","$0","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","5","Individual","No",,"47579CA0540001","Bronze 60 HDHP HMO","47579CA054",,"CAN001","CAS002","CAF008","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0540001-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,900","$0","$0","$60","$6,900","$0","$0","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","5","Individual","No",,"47579CA0540001","Bronze 60 HDHP HMO","47579CA054",,"CAN001","CAS002","CAF008","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0540001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","5","Individual","No",,"47579CA0540001","Bronze 60 HDHP HMO","47579CA054",,"CAN001","CAS002","CAF008","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0540001-03","Limited Cost Sharing Plan Variation",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,900","$0","$0","$60","$6,900","$0","$0","$60"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","6","Individual","No",,"47579CA0630001","Minimum Coverage HMO","47579CA063",,"CAN001","CAS001","CAF009","New","HMO","Catastrophic","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0630001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,150","$0","$0","$60","$6,400","$0","$0","$200"
"2021","CA","Chinese Community Health Plan","47579","SERFF","1","3/8/2021 8:38","6","Individual","No",,"47579CA0640001","Minimum Coverage HMO","47579CA064",,"CAN001","CAS002","CAF009","New","HMO","Catastrophic","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"47579CA0640001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,150","$0","$0","$60","$6,400","$0","$0","$200"
"2021","CA","The Guardian Life Insurance Company","47911","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"47911CA0210001","Family Dental PPO","47911CA021",,"CAN001","CAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"Yes","Coverage is allowed outside of the Service Area.","Yes",,,,,"47911CA0210001-01","Standard High On Exchange Plan","86.20%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"$75","$150 per group",,,,,"$75","$150 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","Delta Dental of California","62683","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"62683CA0010004","Family Dental PPO","62683CA001",,"CAN001","CAS001",,"Existing","PPO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"Yes","Nationwide Network","Yes",,,,,"62683CA0010004-01","Standard High On Exchange Plan","86.20%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"$75","$150 per group",,,,,"$75","$150 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","Delta Dental of California","62683","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"62683CA0020004","Family Dental PPO","62683CA002",,"CAN001","CAS001",,"Existing","PPO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"Yes","Nationwide Network","Yes",,,,,"62683CA0020004-01","Standard High On Exchange Plan","86.20%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"$75","$150 per group",,,,,"$75","$150 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","Delta Dental of California","62683","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","Yes",,"62683CA0020002","ChildrenÆs Dental PPO","62683CA002",,"CAN001","CAS001",,"Existing","PPO","High",,"On the Exchange",,,,,,,,"Allows Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"Yes","Nationwide Network","Yes",,,,,"62683CA0020002-01","Standard High On Exchange Plan","86.20%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"$75","$150 per group",,,,,"$75","$150 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","Delta Dental of California","62683","SERFF","1","3/8/2021 8:38","2","Individual","Yes",,"62683CA0030004","Family Dental HMO","62683CA003",,"CAN002","CAS002",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"62683CA0030004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","Delta Dental of California","62683","SERFF","1","3/8/2021 8:38","3","SHOP (Small Group)","Yes",,"62683CA0040004","Family Dental HMO","62683CA004",,"CAN002","CAS002",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"62683CA0040004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","Delta Dental of California","62683","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","Yes",,"62683CA0040002","ChildrenÆs Dental HMO","62683CA004",,"CAN002","CAS002",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"62683CA0040002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520004","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS002","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520004-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$600","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520004","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS002","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520004","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS002","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520004-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$600","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520005","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS003","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520005-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$600","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520005","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS003","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520005","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS003","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520005-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$600","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520006","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS004","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520006-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$600","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520006","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS004","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520006","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS004","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520006-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$600","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520007","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS005","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520007-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$600","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520007","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS005","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520007","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS005","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520007-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$600","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520008","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS006","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520008-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$600","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520008","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS006","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520008","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS006","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520008-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$600","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520019","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520019-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$600","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520019","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520019-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$60","$0","$0","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","1","Individual","No",,"67138CA0520019","Platinum 90 CommunityCare HMO","67138CA052",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520019-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$600","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520009","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS002","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520009-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$60","$0","$1,400","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520009","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS002","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520009","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS002","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520009-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$60","$0","$1,400","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520010","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS003","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520010-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$60","$0","$1,400","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520010","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS003","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520010","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS003","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520010-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$60","$0","$1,400","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520011","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS004","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520011-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$60","$0","$1,400","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520011","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS004","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520011","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS004","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520011-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$60","$0","$1,400","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520012","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS005","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520012-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$60","$0","$1,400","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520012","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS005","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520012","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS005","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520012-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$60","$0","$1,400","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520013","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS006","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520013-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$60","$0","$1,400","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520013","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS006","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520013-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520013","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS006","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520013-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$60","$0","$1,400","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520020","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS001","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520020-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$60","$0","$1,400","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520020","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS001","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520020-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","2","Individual","No",,"67138CA0520020","Gold 80 CommunityCare HMO","67138CA052",,"CAN001","CAS001","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520020-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$60","$0","$1,400","$0","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520014","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520014-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520014","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520014-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520014","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520014-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520014","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520014-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520014","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520014-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520014","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS002","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520014-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520015","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS003","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520015-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520015","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS003","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520015-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520015","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS003","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520015-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520015","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS003","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520015-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520015","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS003","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520015-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520015","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS003","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520015-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520016","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS004","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520016-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520016","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS004","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520016-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520016","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS004","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520016-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520016","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS004","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520016-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520016","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS004","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520016-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520016","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS004","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520016-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520017","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS005","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520017-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520017","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS005","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520017-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520017","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS005","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520017-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520017","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS005","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520017-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520017","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS005","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520017-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520017","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS005","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520017-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520018","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS006","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520018-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520018","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS006","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520018-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520018","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS006","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520018-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520018","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS006","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520018-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520018","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS006","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520018-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520018","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS006","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520018-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520021","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520021-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090017","Family Dental HMO","67819CA009",,"CAN001","CAS017",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090017-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090018","Family Dental HMO","67819CA009",,"CAN001","CAS018",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090018-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090019","Family Dental HMO","67819CA009",,"CAN001","CAS019",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090019-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA1250001","Platinum 90 PPO","70285CA125",,"CAN001","CAS001","CAF001","Existing","PPO","Platinum","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1250001-01","Standard Platinum On Exchange Plan",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$20,000","$40000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA1250001","Platinum 90 PPO","70285CA125",,"CAN001","CAS001","CAF001","Existing","PPO","Platinum","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1250001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA1250001","Platinum 90 PPO","70285CA125",,"CAN001","CAS001","CAF001","Existing","PPO","Platinum","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1250001-03","Limited Cost Sharing Plan Variation",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$20,000","$40000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050001","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS011","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050001-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050001","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS011","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050001","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS011","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050001-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050002","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS012","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050002-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050002","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS012","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520021","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520021-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520021","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520021-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520021","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520021-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520021","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520021-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","3","Individual","No",,"67138CA0520021","Silver 70 CommunityCare HMO","67138CA052",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All specialists require referral by PCP except Obstetrics and Gynecology",,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0520021-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","4","Individual","No",,"67138CA0630001","Bronze 60 PureCare HSP","67138CA063",,"CAN002","CAS007","CAF004","Existing","HMO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0630001-01","Standard Bronze On Exchange Plan","64.80%","0.655690093","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$900","$1,200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","4","Individual","No",,"67138CA0630001","Bronze 60 PureCare HSP","67138CA063",,"CAN002","CAS007","CAF004","Existing","HMO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0630001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","4","Individual","No",,"67138CA0630001","Bronze 60 PureCare HSP","67138CA063",,"CAN002","CAS007","CAF004","Existing","HMO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0630001-03","Limited Cost Sharing Plan Variation","64.80%","0.655690093","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$900","$1,200","$20"
"2021","CA","Health Net of California, Inc","67138","SERFF","1","3/8/2021 8:38","5","Individual","No",,"67138CA0630002","Minimum Coverage PureCare HSP","67138CA063",,"CAN002","CAS007","CAF005","Existing","HMO","Catastrophic","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"67138CA0630002-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"67819CA0080002","Family Dental HMO","67819CA008",,"CAN001","CAS002",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0080002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"67819CA0080003","Family Dental HMO","67819CA008",,"CAN001","CAS003",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0080003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"67819CA0080004","Family Dental HMO","67819CA008",,"CAN001","CAS004",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0080004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"67819CA0080005","Family Dental HMO","67819CA008",,"CAN001","CAS005",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0080005-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"67819CA0080006","Family Dental HMO","67819CA008",,"CAN001","CAS006",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0080006-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"67819CA0080007","Family Dental HMO","67819CA008",,"CAN001","CAS007",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0080007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"67819CA0080008","Family Dental HMO","67819CA008",,"CAN001","CAS008",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0080008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"67819CA0080009","Family Dental HMO","67819CA008",,"CAN001","CAS009",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0080009-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"67819CA0080010","Family Dental HMO","67819CA008",,"CAN001","CAS010",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0080010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"67819CA0080011","Family Dental HMO","67819CA008",,"CAN001","CAS011",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0080011-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"67819CA0080014","Family Dental HMO","67819CA008",,"CAN001","CAS014",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0080014-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"67819CA0080015","Family Dental HMO","67819CA008",,"CAN001","CAS015",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0080015-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"67819CA0080016","Family Dental HMO","67819CA008",,"CAN001","CAS016",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0080016-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"67819CA0080017","Family Dental HMO","67819CA008",,"CAN001","CAS017",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0080017-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"67819CA0080018","Family Dental HMO","67819CA008",,"CAN001","CAS018",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0080018-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"67819CA0080019","Family Dental HMO","67819CA008",,"CAN001","CAS019",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0080019-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090001","Family Dental HMO","67819CA009",,"CAN001","CAS001",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090002","Family Dental HMO","67819CA009",,"CAN001","CAS002",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090003","Family Dental HMO","67819CA009",,"CAN001","CAS003",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090004","Family Dental HMO","67819CA009",,"CAN001","CAS004",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090005","Family Dental HMO","67819CA009",,"CAN001","CAS005",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090005-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090006","Family Dental HMO","67819CA009",,"CAN001","CAS006",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090006-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090007","Family Dental HMO","67819CA009",,"CAN001","CAS007",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090007-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090008","Family Dental HMO","67819CA009",,"CAN001","CAS008",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090008-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090009","Family Dental HMO","67819CA009",,"CAN001","CAS009",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090009-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090010","Family Dental HMO","67819CA009",,"CAN001","CAS010",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090010-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090011","Family Dental HMO","67819CA009",,"CAN001","CAS011",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090011-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090012","Family Dental HMO","67819CA009",,"CAN001","CAS012",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090012-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090013","Family Dental HMO","67819CA009",,"CAN001","CAS013",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090013-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090014","Family Dental HMO","67819CA009",,"CAN001","CAS014",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090014-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090015","Family Dental HMO","67819CA009",,"CAN001","CAS015",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090015-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","LIBERTY Dental Plan of California, Inc.","67819","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"67819CA0090016","Family Dental HMO","67819CA009",,"CAN001","CAS016",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"67819CA0090016-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050002","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS012","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050002-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050003","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS013","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050003-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050003","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS013","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050003","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS013","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050003-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050004","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS014","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050004-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050004","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS014","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050004","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS014","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050004-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050005","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS015","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050005-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120054","Family Dental HMO","70285CA812",,"CAN003","CAS054",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120054-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120055","Family Dental HMO","70285CA812",,"CAN003","CAS055",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120055-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120056","Family Dental HMO","70285CA812",,"CAN003","CAS056",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120056-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120057","Family Dental HMO","70285CA812",,"CAN003","CAS057",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120057-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120058","Family Dental HMO","70285CA812",,"CAN003","CAS058",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120058-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120059","Family Dental HMO","70285CA812",,"CAN003","CAS059",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120059-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120060","Family Dental HMO","70285CA812",,"CAN003","CAS060",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120060-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120061","Family Dental HMO","70285CA812",,"CAN003","CAS061",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120061-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120062","Family Dental HMO","70285CA812",,"CAN003","CAS062",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120062-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120063","Family Dental HMO","70285CA812",,"CAN003","CAS063",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120063-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120064","Family Dental HMO","70285CA812",,"CAN003","CAS064",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120064-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120065","Family Dental HMO","70285CA812",,"CAN003","CAS065",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120065-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050005","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS015","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050005","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS015","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050005-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050006","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS016","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050006-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050006","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS016","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050006","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS016","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050006-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050007","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS017","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050007-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050007","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS017","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050007","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS017","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050007-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050008","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS018","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050008-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050008","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS018","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050008","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS018","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050008-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050009","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS019","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050009-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050009","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS019","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050009","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS019","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050009-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050010","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS020","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050010-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050010","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS020","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050010","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS020","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050010-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050011","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS021","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050011-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050011","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS021","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050011","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS021","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050011-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050012","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS022","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050012-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050012","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS022","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050012","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS022","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050012-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050014","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS024","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050014-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050014","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS024","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050014-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050014","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS024","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050014-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050015","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS025","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050015-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050015","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS025","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050015-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050015","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS025","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050015-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050016","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS026","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050016-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050016","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS026","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050016-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050016","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS026","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050016-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050017","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS027","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050017-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050017","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS027","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050017-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050017","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS027","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050017-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050018","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS028","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050018-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050018","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS028","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050018-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050018","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS028","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050018-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050019","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS029","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050019-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050019","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS029","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050019-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","No",,"70285CA8050019","Platinum 90 Trio HMO","70285CA805",,"CAN011","CAS029","CAF011","Existing","HMO","Platinum","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8050019-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120052","Family Dental HMO","70285CA812",,"CAN003","CAS052",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120052-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120053","Family Dental HMO","70285CA812",,"CAN003","CAS053",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120053-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120066","Family Dental HMO","70285CA812",,"CAN003","CAS066",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120066-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120067","Family Dental HMO","70285CA812",,"CAN003","CAS067",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120067-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120068","Family Dental HMO","70285CA812",,"CAN003","CAS068",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120068-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"70285CA8120069","Family Dental HMO","70285CA812",,"CAN003","CAS069",,"New","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8120069-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","No",,"70285CA8150002","Platinum 90 PPO 0/15 + Child Dental INF","70285CA815",,"CAN009","CAS009","CAF001","Existing","PPO","Platinum","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"Yes","Mirror in-state administration of benefit","No",,,,,"70285CA8150002-01","Standard Platinum On Exchange Plan",,"0.904747055","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$9,000","$18000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$1,000","$2000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$700","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA1270001","Gold 80 PPO","70285CA127",,"CAN001","CAS001","CAF002","Existing","PPO","Gold","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1270001-01","Standard Gold On Exchange Plan",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$20,000","$40000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA1270001","Gold 80 PPO","70285CA127",,"CAN001","CAS001","CAF002","Existing","PPO","Gold","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1270001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA1270001","Gold 80 PPO","70285CA127",,"CAN001","CAS001","CAF002","Existing","PPO","Gold","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1270001-03","Limited Cost Sharing Plan Variation",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$20,000","$40000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040001","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS011","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040001-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040001","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS011","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040001","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS011","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040001-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040017","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS027","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040017-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040017","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS027","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040017-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040017","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS027","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040017-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040018","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS028","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040018-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060005","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS015","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060005-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060005","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS015","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060005-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040002","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS012","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040002-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040002","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS012","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040002","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS012","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040002-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040003","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS013","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040003-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040003","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS013","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040003","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS013","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040003-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040004","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS014","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040004-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040004","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS014","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040004","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS014","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040004-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040005","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS015","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040005-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040005","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS015","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040005","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS015","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040005-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040006","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS016","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040006-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040006","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS016","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040006","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS016","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040006-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040007","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS017","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040007-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040007","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS017","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040007","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS017","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040007-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040008","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS018","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040008-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040008","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS018","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040008","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS018","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040008-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040009","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS019","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040009-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040009","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS019","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040009","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS019","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040009-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040010","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS020","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040010-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040010","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS020","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040010","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS020","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040010-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040011","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS021","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040011-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040011","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS021","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040011","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS021","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040011-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040012","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS022","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040012-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040012","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS022","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040012","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS022","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040012-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040014","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS024","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040014-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040014","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS024","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040014-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040014","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS024","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040014-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040015","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS025","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040015-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040015","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS025","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040015-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040015","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS025","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040015-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040016","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS026","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040016-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040016","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS026","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040016-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040016","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS026","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040016-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040018","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS028","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040018-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040018","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS028","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040018-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040019","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS029","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040019-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040019","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS029","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040019-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","No",,"70285CA8040019","Gold 80 Trio HMO","70285CA804",,"CAN011","CAS029","CAF010","Existing","HMO","Gold","No","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8040019-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","Individual","Yes",,"70285CA8130051","Family Dental PPO","70285CA813",,"CAN002","CAS070",,"New","PPO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8130051-01","Standard High On Exchange Plan","86.20%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"$75","$150 per group",,,,,"$75","$150 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230018","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS031","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230018-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230019","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS032","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230019-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230020","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS033","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230020-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230021","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS034","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230021-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230022","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS035","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230022-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230023","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS036","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230023-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230024","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS037","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230024-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230025","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS038","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230025-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230026","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS039","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230026-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230027","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS040","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230027-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230028","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS042","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230028-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230029","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS044","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230029-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230030","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS045","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230030-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230031","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS046","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230031-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230032","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS047","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230032-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230033","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS048","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230033-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230034","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS049","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230034-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"70285CA8230103","Trio Platinum 90 HMO 0/20 + Child Dental INF","70285CA823",,"CAN010","CAS041","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230103-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA1290001","Silver 70 PPO","70285CA129",,"CAN001","CAS001","CAF003","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1290001-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$20,000","$40000 per group","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"$6,500","$13000 per group","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA1290001","Silver 70 PPO","70285CA129",,"CAN001","CAS001","CAF003","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1290001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA1290001","Silver 70 PPO","70285CA129",,"CAN001","CAS001","CAF003","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1290001-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$20,000","$40000 per group","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"$6,500","$13000 per group","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA1290001","Silver 70 PPO","70285CA129",,"CAN001","CAS001","CAF003","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1290001-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"$20,000","$40000 per group","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"$6,500","$13000 per group","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA1290001","Silver 70 PPO","70285CA129",,"CAN001","CAS001","CAF003","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1290001-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"$20,000","$40000 per group","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"$6,500","$13000 per group","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA1290001","Silver 70 PPO","70285CA129",,"CAN001","CAS001","CAF003","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1290001-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"$20,000","$40000 per group","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"$6,500","$13000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060001","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS011","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060001-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060001","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS011","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060001","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS011","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060001-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060001","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS011","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060001-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060001","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS011","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060001-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060001","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS011","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060001-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060002","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS012","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060002-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060002","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS012","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060002","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS012","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060002-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060002","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS012","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060002-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060002","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS012","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060002-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060002","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS012","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060002-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060003","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS013","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060003-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060003","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS013","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060003","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS013","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060003-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060003","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS013","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060003-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060003","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS013","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060003-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060003","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS013","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060003-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060004","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS014","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060004-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060004","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS014","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060004","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS014","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060004-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060004","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS014","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060004-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060004","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS014","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060004-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060004","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS014","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060004-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060005","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS015","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060005-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060005","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS015","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060005-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060005","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS015","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060005-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060005","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS015","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060005-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060006","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS016","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060006-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060006","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS016","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060006-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060006","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS016","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060006-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060006","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS016","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060006-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060006","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS016","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060006-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060006","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS016","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060006-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060015","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS025","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060015-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060015","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS025","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060015-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060015","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS025","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060015-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060015","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS025","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060015-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230039","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS035","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230039-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230040","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS036","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230040-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230041","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS037","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230041-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230042","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS038","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230042-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060007","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS017","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060007-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060007","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS017","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060007","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS017","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060007-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060007","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS017","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060007-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060007","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS017","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060007-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060007","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS017","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060007-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060008","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS018","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060008-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060008","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS018","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060008","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS018","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060008-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060008","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS018","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060008-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060008","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS018","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060008-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060008","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS018","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060008-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060009","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS019","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060009-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060009","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS019","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060009-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060009","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS019","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060009-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060009","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS019","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060009-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060009","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS019","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060009-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060009","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS019","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060009-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060010","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS020","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060010-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060010","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS020","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060010-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060010","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS020","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060010-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060010","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS020","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060010-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060010","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS020","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060010-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060010","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS020","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060010-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060011","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS021","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060011-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060011","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS021","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060011-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060011","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS021","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060011-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060011","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS021","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060011-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060011","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS021","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060011-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060011","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS021","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060011-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060012","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS022","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060012-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060012","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS022","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060012-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060012","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS022","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060012-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060012","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS022","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060012-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060012","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS022","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060012-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060012","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS022","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060012-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060014","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS024","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060014-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060014","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS024","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060014-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060014","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS024","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060014-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060014","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS024","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060014-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060014","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS024","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060014-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060014","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS024","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060014-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060015","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS025","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060015-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060015","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS025","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060015-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060016","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS026","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060016-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060016","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS026","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060016-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060016","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS026","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060016-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060016","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS026","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060016-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060016","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS026","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060016-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060016","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS026","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060016-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060017","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS027","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060017-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060017","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS027","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060017-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060017","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS027","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060017-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060017","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS027","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060017-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060017","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS027","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060017-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060017","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS027","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060017-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060018","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS028","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060018-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060018","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS028","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060018-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060018","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS028","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060018-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060018","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS028","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060018-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060018","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS028","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060018-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060018","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS028","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060018-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060019","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS029","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060019-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060019","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS029","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060019-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060019","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS029","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060019-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$700","$1,400","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060019","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS029","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060019-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$700","$1,500","$60","$3,500","$600","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060019","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS029","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060019-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$1,400","$600","$100","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","Individual","No",,"70285CA8060019","Silver 70 Trio HMO","70285CA806",,"CAN011","CAS029","CAF012","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8060019-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$80","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","3","SHOP (Small Group)","No",,"70285CA8150004","Gold 80 PPO 350/25 + Child Dental INF","70285CA815",,"CAN009","CAS009","CAF002","Existing","PPO","Gold","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"Yes","Mirror in-state administration of benefit","No",,,,,"70285CA8150004-01","Standard Gold On Exchange Plan","78.19%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,800","$15600 per group",,,"$12,850","$25700 per group","Not Applicable","per group not applicable","$350","$700 per group","20.00%",,,,"$1,000","$2000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$400","$500","$2,100","$60","$0","$1,200","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","Individual","No",,"70285CA1310001","Bronze 60 PPO","70285CA131",,"CAN001","CAS001","CAF007","Existing","PPO","Expanded Bronze","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1310001-01","Standard Bronze On Exchange Plan","64.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$20,000","$40000 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$12,600","$25200 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$5,100","$100","$0","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","Individual","No",,"70285CA1310001","Bronze 60 PPO","70285CA131",,"CAN001","CAS001","CAF007","Existing","PPO","Expanded Bronze","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1310001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","Individual","No",,"70285CA1310001","Bronze 60 PPO","70285CA131",,"CAN001","CAS001","CAF007","Existing","PPO","Expanded Bronze","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1310001-03","Limited Cost Sharing Plan Variation","64.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$20,000","$40000 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$12,600","$25200 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$5,100","$100","$0","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230001","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS031","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230001-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230002","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS032","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230002-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230003","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS033","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230003-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230004","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS034","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230004-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230005","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS035","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230005-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230006","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS036","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230006-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230007","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS037","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230007-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230008","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS038","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230008-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230009","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS039","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230009-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230010","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS040","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230010-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230011","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS042","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230011-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230012","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS044","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230012-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230013","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS045","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230013-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230014","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS046","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230014-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230015","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS047","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230015-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230016","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS048","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230016-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230017","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS049","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230017-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"70285CA8230104","Trio Gold 80 HMO 250/35 + Child Dental INF","70285CA823",,"CAN010","CAS041","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230104-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","5","Individual","No",,"70285CA1320001","Bronze 60 HDHP PPO","70285CA132",,"CAN001","CAS001","CAF017","Existing","PPO","Expanded Bronze","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1320001-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$20,000","$40000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"$14,000","$28000 per group","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","5","Individual","No",,"70285CA1320001","Bronze 60 HDHP PPO","70285CA132",,"CAN001","CAS001","CAF017","Existing","PPO","Expanded Bronze","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1320001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","5","Individual","No",,"70285CA1320001","Bronze 60 HDHP PPO","70285CA132",,"CAN001","CAS001","CAF017","Existing","PPO","Expanded Bronze","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1320001-03","Limited Cost Sharing Plan Variation",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$20,000","$40000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"$14,000","$28000 per group","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","5","SHOP (Small Group)","No",,"70285CA8150006","Silver 70 PPO 2250/50 + Child Dental INF","70285CA815",,"CAN009","CAS009","CAF003","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"Yes","Mirror in-state administration of benefit","No",,,,,"70285CA8150006-01","Standard Silver On Exchange Plan","71.59%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$13,250","$26500 per group","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,,"$4,500","$9000 per group","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$60","$2,300","$1,100","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","Individual","No",,"70285CA1350001","Minimum Coverage PPO","70285CA135",,"CAN001","CAS001","CAF009","Existing","PPO","Catastrophic","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA1350001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"$20,000","$40000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"$17,100","$34200 per group","Not Applicable","per group not applicable","$8,600","$0","$0","$60","$5,200","$0","$0","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230035","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS031","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230035-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230036","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS032","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230036-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230037","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS033","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230037-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230038","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS034","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230038-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230043","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS039","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230043-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230044","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS040","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230044-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230045","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS042","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230045-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230046","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS044","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230046-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230047","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS045","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230047-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230048","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS046","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230048-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230049","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS047","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230049-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230050","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS048","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230050-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230086","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS031","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230086-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230087","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS032","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230087-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230088","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS033","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230088-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230089","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS034","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230089-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230090","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS035","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230090-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230091","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS036","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230091-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","4","Individual","No",,"92499CA0020008","Bronze 60 Performance HMO","92499CA002",,"CAN002","CAS001","CAF001","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020008-01","Standard Bronze On Exchange Plan","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$2,300","$200","$1,200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","4","Individual","No",,"92499CA0020008","Bronze 60 Performance HMO","92499CA002",,"CAN002","CAS001","CAF001","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230051","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS049","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230051-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"70285CA8230105","Trio Silver 70 HMO 2250/55 + Child Dental INF","70285CA823",,"CAN010","CAS041","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230105-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","7","SHOP (Small Group)","No",,"70285CA8150008","Bronze 60 PPO 6300/65 + Child Dental INF","70285CA815",,"CAN009","CAS009","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"Yes","Mirror in-state administration of benefit","No",,,,,"70285CA8150008-01","Standard Bronze On Exchange Plan","64.83%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$13,250","$26500 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$6,300","$12600 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$5,100","$100","$0","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","8","SHOP (Small Group)","No",,"70285CA8150001","Platinum 90 PPO 0/15 + Child Dental","70285CA815",,"CAN009","CAS009","CAF001","Existing","PPO","Platinum","No","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"Yes","Mirror in-state administration of benefit","No",,,,,"70285CA8150001-01","Standard Platinum On Exchange Plan",,"0.904747055","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$9,000","$18000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$1,000","$2000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$700","$80","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230069","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS031","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230069-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230070","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS032","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230070-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230071","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS033","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230071-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230072","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS034","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230072-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230073","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS035","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230073-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230074","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS036","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230074-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230075","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS037","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230075-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230076","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS038","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230076-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230077","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS039","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230077-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230078","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS040","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230078-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230079","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS042","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230079-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230080","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS044","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230080-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230081","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS045","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230081-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230082","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS046","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230082-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230083","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS047","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230083-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230084","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS048","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230084-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230085","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS049","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230085-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"70285CA8230106","Trio Platinum 90 HMO 0/20 + Child Dental","70285CA823",,"CAN010","CAS041","CAF005","Existing","HMO","Platinum","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230106-01","Standard Platinum On Exchange Plan","88.29%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$4,500","$9000 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,"10.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$900","$0","$70","$0","$300","$80","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","10","SHOP (Small Group)","No",,"70285CA8150003","Gold 80 PPO 350/25 + Child Dental","70285CA815",,"CAN009","CAS009","CAF002","Existing","PPO","Gold","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"Yes","Mirror in-state administration of benefit","No",,,,,"70285CA8150003-01","Standard Gold On Exchange Plan","78.19%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,800","$15600 per group",,,"$12,850","$25700 per group","Not Applicable","per group not applicable","$350","$700 per group","20.00%",,,,"$1,000","$2000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$400","$500","$2,100","$60","$0","$1,200","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230052","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS031","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230052-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230053","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS032","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230053-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230054","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS033","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230054-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230055","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS034","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230055-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230056","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS035","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230056-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230057","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS036","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230057-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230058","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS037","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230058-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230059","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS038","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230059-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230060","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS039","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230060-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230061","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS040","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230061-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230062","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS042","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230062-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230063","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS044","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230063-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230064","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS045","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230064-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230065","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS046","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230065-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230066","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS047","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230066-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230067","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS048","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230067-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230068","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS049","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230068-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"70285CA8230107","Trio Gold 80 HMO 250/35 + Child Dental","70285CA823",,"CAN010","CAS041","CAF006","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230107-01","Standard Gold On Exchange Plan","79.43%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$7,800","$15600 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,"20.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$300","$1,800","$0","$70","$0","$500","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","12","SHOP (Small Group)","No",,"70285CA8150005","Silver 70 PPO 2250/50 + Child Dental","70285CA815",,"CAN009","CAS009","CAF003","Existing","PPO","Silver","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"Yes","Mirror in-state administration of benefit","No",,,,,"70285CA8150005-01","Standard Silver On Exchange Plan","71.59%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$13,250","$26500 per group","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,,"$4,500","$9000 per group","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$60","$2,300","$1,100","$200","$20"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230092","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS037","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230092-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230093","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS038","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230093-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230094","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS039","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230094-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230095","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS040","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230095-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230096","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS042","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230096-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230097","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS044","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230097-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230098","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS045","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230098-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230099","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS046","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230099-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230100","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS047","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230100-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230101","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS048","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230101-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230102","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS049","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230102-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"70285CA8230108","Trio Silver 70 HMO 2250/55 + Child Dental","70285CA823",,"CAN010","CAS041","CAF007","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","Other than Primary Care Physician, Family Practice, General Practice, Internal Medicine, Obstetrician/Gynecologist or Pediatrician.",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"70285CA8230108-01","Standard Silver On Exchange Plan","70.94%",,"No","Yes","Yes","100%","0%",,,,,,,,,,,,,,,,,"$8,200","$16400 per group","$0","$0 per group","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,"30.00%","Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,300","$700","$2,600","$70","$0","$700","$200","$3,500"
"2021","CA","CA Physician's Service dba Blue Shield of CA","70285","SERFF","1","3/8/2021 8:38","14","SHOP (Small Group)","No",,"70285CA8150007","Bronze 60 PPO 6300/65 + Child Dental","70285CA815",,"CAN009","CAS009","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","No","No",,,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"Yes","Mirror in-state administration of benefit","No",,,,,"70285CA8150007-01","Standard Bronze On Exchange Plan","64.83%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$13,250","$26500 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$6,300","$12600 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$5,100","$100","$0","$20"
"2021","CA","County of Santa Clara","84014","SERFF","1","3/8/2021 8:38","1","Individual","No",,"84014CA0010001","Platinum 90 HMO","84014CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84014CA0010001-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$600","$80","$20"
"2021","CA","County of Santa Clara","84014","SERFF","1","3/8/2021 8:38","1","Individual","No",,"84014CA0010001","Platinum 90 HMO","84014CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84014CA0010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","County of Santa Clara","84014","SERFF","1","3/8/2021 8:38","1","Individual","No",,"84014CA0010001","Platinum 90 HMO","84014CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","Yes","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84014CA0010001-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$600","$80","$20"
"2021","CA","County of Santa Clara","84014","SERFF","1","3/8/2021 8:38","2","Individual","No",,"84014CA0010002","Gold 80 HMO","84014CA001",,"CAN001","CAS001","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84014CA0010002-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$60","$0","$1,400","$200","$20"
"2021","CA","County of Santa Clara","84014","SERFF","1","3/8/2021 8:38","2","Individual","No",,"84014CA0010002","Gold 80 HMO","84014CA001",,"CAN001","CAS001","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84014CA0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","County of Santa Clara","84014","SERFF","1","3/8/2021 8:38","2","Individual","No",,"84014CA0010002","Gold 80 HMO","84014CA001",,"CAN001","CAS001","CAF002","Existing","HMO","Gold","No","On the Exchange","Yes","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84014CA0010002-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$60","$0","$1,400","$200","$20"
"2021","CA","County of Santa Clara","84014","SERFF","1","3/8/2021 8:38","3","Individual","No",,"84014CA0010003","Silver 70 HMO","84014CA001",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84014CA0010003-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$600","$60","$300","$1,500","$200","$20"
"2021","CA","County of Santa Clara","84014","SERFF","1","3/8/2021 8:38","3","Individual","No",,"84014CA0010003","Silver 70 HMO","84014CA001",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84014CA0010003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","County of Santa Clara","84014","SERFF","1","3/8/2021 8:38","3","Individual","No",,"84014CA0010003","Silver 70 HMO","84014CA001",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84014CA0010003-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$600","$60","$300","$1,500","$200","$20"
"2021","CA","County of Santa Clara","84014","SERFF","1","3/8/2021 8:38","3","Individual","No",,"84014CA0010003","Silver 70 HMO","84014CA001",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84014CA0010003-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$700","$60","$275","$1,400","$200","$20"
"2021","CA","County of Santa Clara","84014","SERFF","1","3/8/2021 8:38","3","Individual","No",,"84014CA0010003","Silver 70 HMO","84014CA001",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84014CA0010003-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$400","$1,000","$60","$100","$700","$100","$20"
"2021","CA","County of Santa Clara","84014","SERFF","1","3/8/2021 8:38","3","Individual","No",,"84014CA0010003","Silver 70 HMO","84014CA001",,"CAN001","CAS001","CAF003","Existing","HMO","Silver","Yes","On the Exchange","Yes","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84014CA0010003-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$0","$500","$80","$20"
"2021","CA","County of Santa Clara","84014","SERFF","1","3/8/2021 8:38","4","Individual","No",,"84014CA0010004","Bronze 60 HMO","84014CA001",,"CAN001","CAS001","CAF007","Existing","HMO","Expanded Bronze","Yes","On the Exchange","Yes","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84014CA0010004-01","Standard Bronze On Exchange Plan","64.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$400","$60","$1,300","$700","$1,200","$20"
"2021","CA","County of Santa Clara","84014","SERFF","1","3/8/2021 8:38","4","Individual","No",,"84014CA0010004","Bronze 60 HMO","84014CA001",,"CAN001","CAS001","CAF007","Existing","HMO","Expanded Bronze","Yes","On the Exchange","Yes","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84014CA0010004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","County of Santa Clara","84014","SERFF","1","3/8/2021 8:38","4","Individual","No",,"84014CA0010004","Bronze 60 HMO","84014CA001",,"CAN001","CAS001","CAF007","Existing","HMO","Expanded Bronze","Yes","On the Exchange","Yes","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84014CA0010004-03","Limited Cost Sharing Plan Variation","64.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$400","$60","$1,300","$700","$1,200","$20"
"2021","CA","County of Santa Clara","84014","SERFF","1","3/8/2021 8:38","5","Individual","No",,"84014CA0010005","Minimum Coverage HMO","84014CA001",,"CAN001","CAS001","CAF008","Existing","HMO","Catastrophic","No","On the Exchange","Yes","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84014CA0010005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","Dental Health Services","84138","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"84138CA0040001","Family Dental HMO","84138CA004",,"CAN001","CAS001",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84138CA0040001-01","Standard High On Exchange Plan",,,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","Dental Health Services","84138","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"84138CA0050001","Family Dental HMO","84138CA005",,"CAN001","CAS001",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"84138CA0050001-01","Standard High On Exchange Plan",,,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","No",,"92499CA0010001","Performance Platinum 90 HMO 0/15 + Child Dental","92499CA001",,"CAN002","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010001-01","Standard Platinum On Exchange Plan",,"0.904747055","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","No",,"92499CA0010002","Premier Platinum 90 HMO 0/20+ Child Dental","92499CA001",,"CAN001","CAS002","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010002-01","Standard Platinum On Exchange Plan",,"0.882935144","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$700","$80","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","1","Individual","No",,"92499CA0020001","Platinum 90 Performance HMO","92499CA002",,"CAN002","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020001-01","Standard Platinum On Exchange Plan",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","1","Individual","No",,"92499CA0020001","Platinum 90 Performance HMO","92499CA002",,"CAN002","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","1","Individual","No",,"92499CA0020001","Platinum 90 Performance HMO","92499CA002",,"CAN002","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020001-03","Limited Cost Sharing Plan Variation",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","1","Individual","No",,"92499CA0020002","Platinum 90 Premier HMO","92499CA002",,"CAN001","CAS002","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020002-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","1","Individual","No",,"92499CA0020002","Platinum 90 Premier HMO","92499CA002",,"CAN001","CAS002","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","1","Individual","No",,"92499CA0020002","Platinum 90 Premier HMO","92499CA002",,"CAN001","CAS002","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020002-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$800","$0","$60","$0","$600","$80","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"92499CA0010003","Performance Gold 80 HMO 350/25 + Child Dental","92499CA001",,"CAN002","CAS001","CAF001","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010003-01","Standard Gold On Exchange Plan","78.20%","0.841144658","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,800","$15600 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$350","$700 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$350","$500","$2,100","$60","$0","$1,200","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"92499CA0010004","Premier Gold 80 HMO 250/35 + Child Dental","92499CA001",,"CAN001","CAS002","CAF001","Existing","HMO","Gold","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010004-01","Standard Gold On Exchange Plan",,"0.794329718","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,800","$15600 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$0","$0","$1,200","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","2","Individual","No",,"92499CA0020003","Gold 80 Performance HMO","92499CA002",,"CAN002","CAS001","CAF001","Existing","HMO","Gold","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020003-01","Standard Gold On Exchange Plan",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","2","Individual","No",,"92499CA0020003","Gold 80 Performance HMO","92499CA002",,"CAN002","CAS001","CAF001","Existing","HMO","Gold","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","2","Individual","No",,"92499CA0020003","Gold 80 Performance HMO","92499CA002",,"CAN002","CAS001","CAF001","Existing","HMO","Gold","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020003-03","Limited Cost Sharing Plan Variation",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","2","Individual","No",,"92499CA0020004","Gold 80 Premier HMO","92499CA002",,"CAN001","CAS002","CAF001","Existing","HMO","Gold","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020004-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","2","Individual","No",,"92499CA0020004","Gold 80 Premier HMO","92499CA002",,"CAN001","CAS002","CAF001","Existing","HMO","Gold","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","2","Individual","No",,"92499CA0020004","Gold 80 Premier HMO","92499CA002",,"CAN001","CAS002","CAF001","Existing","HMO","Gold","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020004-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,800","$0","$60","$0","$1,400","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","3","SHOP (Small Group)","No",,"92499CA0010005","Performance Silver 70 HMO 2250/50 + Child Dental","92499CA001",,"CAN002","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010005-01","Standard Silver On Exchange Plan","71.60%","0.744609489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,250","$700","$2,600","$60","$300","$1,600","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","3","SHOP (Small Group)","No",,"92499CA0010006","Premier Silver 70 HMO 2250/55 + Child Dental","92499CA001",,"CAN001","CAS002","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010006-01","Standard Silver On Exchange Plan","70.90%","0.738372838","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,250","$700","$2,600","$60","$300","$1,800","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","3","SHOP (Small Group)","No",,"92499CA0010007","Premier Silver 70 HDHP HMO 2500/20% + Child Dental","92499CA001",,"CAN001","CAS002","CAF001","Existing","HMO","Silver","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010007-01","Standard Silver On Exchange Plan",,"0.716665009","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,850","$13700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,500","$0","$2,000","$60","$2,500","$0","$600","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92499CA0020005","Silver 70 Performance HMO","92499CA002",,"CAN002","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020005-01","Standard Silver On Exchange Plan","70.50%","0.790007795","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92499CA0020005","Silver 70 Performance HMO","92499CA002",,"CAN002","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92499CA0020005","Silver 70 Performance HMO","92499CA002",,"CAN002","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020005-03","Limited Cost Sharing Plan Variation","70.50%","0.790007795","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92499CA0020005","Silver 70 Performance HMO","92499CA002",,"CAN002","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020005-04","73% AV Level Silver Plan","73.30%","0.808995553","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92499CA0020005","Silver 70 Performance HMO","92499CA002",,"CAN002","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020005-05","87% AV Level Silver Plan","87.80%","0.916797371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$900","$60","$100","$700","$100","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92499CA0020005","Silver 70 Performance HMO","92499CA002",,"CAN002","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020005-06","94% AV Level Silver Plan","94.10%","0.965247324","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92499CA0020006","Silver 70 Premier HMO","92499CA002",,"CAN001","CAS002","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020006-01","Standard Silver On Exchange Plan","70.50%","0.790007795","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92499CA0020006","Silver 70 Premier HMO","92499CA002",,"CAN001","CAS002","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92499CA0020006","Silver 70 Premier HMO","92499CA002",,"CAN001","CAS002","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020006-03","Limited Cost Sharing Plan Variation","70.50%","0.790007795","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92499CA0020006","Silver 70 Premier HMO","92499CA002",,"CAN001","CAS002","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020006-04","73% AV Level Silver Plan","73.30%","0.808995553","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92499CA0020006","Silver 70 Premier HMO","92499CA002",,"CAN001","CAS002","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020006-05","87% AV Level Silver Plan","87.80%","0.916797371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$900","$60","$100","$700","$100","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92499CA0020006","Silver 70 Premier HMO","92499CA002",,"CAN001","CAS002","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020006-06","94% AV Level Silver Plan","94.10%","0.965247324","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$0","$300","$80","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"92499CA0010008","Performance Bronze 60 HMO 6300/65 + Child Dental","92499CA001",,"CAN002","CAS001","CAF001","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010008-01","Standard Bronze On Exchange Plan","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$900","$1,200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","4","Individual","No",,"92499CA0020008","Bronze 60 Performance HMO","92499CA002",,"CAN002","CAS001","CAF001","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020008-03","Limited Cost Sharing Plan Variation","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$2,300","$200","$1,200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","5","SHOP (Small Group)","No",,"92499CA0010009","Premier Bronze 60 HDHP HMO 7000/0% + Child Dental","92499CA001",,"CAN001","CAS002","CAF001","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010009-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,420","$0","$0","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","5","Individual","No",,"92499CA0020009","Bronze 60 HDHP Premier HMO","92499CA002",,"CAN001","CAS002","CAF001","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020009-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","5","Individual","No",,"92499CA0020009","Bronze 60 HDHP Premier HMO","92499CA002",,"CAN001","CAS002","CAF001","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","5","Individual","No",,"92499CA0020009","Bronze 60 HDHP Premier HMO","92499CA002",,"CAN001","CAS002","CAF001","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020009-03","Limited Cost Sharing Plan Variation",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"92499CA0010110","Performance Platinum 90 HMO 0/15 + Child Dental INF","92499CA001",,"CAN002","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010110-01","Standard Platinum On Exchange Plan",,"0.904747055","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"92499CA0010111","Premier Platinum 90 HMO 0/20+ Child Dental INF","92499CA001",,"CAN001","CAS002","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010111-01","Standard Platinum On Exchange Plan",,"0.882935144","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$700","$80","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","6","Individual","No",,"92499CA0020010","Minimum Coverage Performance HMO","92499CA002",,"CAN002","CAS001","CAF001","Existing","HMO","Catastrophic","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0020010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$5,600","$0","$0","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","7","SHOP (Small Group)","No",,"92499CA0010112","Performance Gold 80 HMO 350/25 + Child Dental INF","92499CA001",,"CAN002","CAS001","CAF001","Existing","HMO","Gold","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010112-01","Standard Gold On Exchange Plan","78.20%","0.841144658","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,800","$15600 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$350","$700 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$350","$500","$2,100","$60","$0","$1,200","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","7","SHOP (Small Group)","No",,"92499CA0010113","Premier Gold 80 HMO 250/35 + Child Dental INF","92499CA001",,"CAN001","CAS002","CAF001","Existing","HMO","Gold","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010113-01","Standard Gold On Exchange Plan",,"0.794329718","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,800","$15600 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$250","$500 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$0","$0","$1,200","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","8","SHOP (Small Group)","No",,"92499CA0010114","Performance Silver 70 HMO 2250/50 + Child Dental INF","92499CA001",,"CAN002","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010114-01","Standard Silver On Exchange Plan","71.60%","0.744609489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,250","$700","$2,600","$60","$300","$1,600","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","8","SHOP (Small Group)","No",,"92499CA0010115","Premier Silver 70 HMO 2250/55 + Child Dental INF","92499CA001",,"CAN001","CAS002","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010115-01","Standard Silver On Exchange Plan","70.90%","0.738372838","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,250","$4500 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,250","$700","$2,600","$60","$300","$1,800","$200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","8","SHOP (Small Group)","No",,"92499CA0010116","Premier Silver 70 HDHP HMO 2500/20% + Child Dental INF","92499CA001",,"CAN001","CAS002","CAF001","Existing","HMO","Silver","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010116-01","Standard Silver On Exchange Plan",,"0.716665009","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,850","$13700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$2,500","$0","$2,000","$60","$2,500","$0","$600","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"92499CA0010117","Performance Bronze 60 HMO 6300/65 + Child Dental INF","92499CA001",,"CAN002","CAS001","CAF001","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010117-01","Standard Bronze On Exchange Plan","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$900","$1,200","$20"
"2021","CA","Sharp Health Plan","92499","SERFF","1","3/8/2021 8:38","10","SHOP (Small Group)","No",,"92499CA0010118","Premier Bronze 60 HDHP HMO 7000/0% + Child Dental INF","92499CA001",,"CAN001","CAS002","CAF001","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All Except OB",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"92499CA0010118-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,420","$0","$0","$20"
"2021","CA","Local Initiative Health Authority for Los Angeles County","92815","SERFF","1","3/8/2021 8:38","1","Individual","No",,"92815CA0010006","Platinum 90 HMO","92815CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"92815CA0010006-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$600","$80","$20"
"2021","CA","Local Initiative Health Authority for Los Angeles County","92815","SERFF","1","3/8/2021 8:38","1","Individual","No",,"92815CA0010006","Platinum 90 HMO","92815CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"92815CA0010006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Local Initiative Health Authority for Los Angeles County","92815","SERFF","1","3/8/2021 8:38","1","Individual","No",,"92815CA0010006","Platinum 90 HMO","92815CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"92815CA0010006-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$0","$60","$0","$600","$80","$20"
"2021","CA","Local Initiative Health Authority for Los Angeles County","92815","SERFF","1","3/8/2021 8:38","2","Individual","No",,"92815CA0010007","Gold 80 HMO","92815CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"92815CA0010007-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$60","$0","$1,400","$200","$20"
"2021","CA","Local Initiative Health Authority for Los Angeles County","92815","SERFF","1","3/8/2021 8:38","2","Individual","No",,"92815CA0010007","Gold 80 HMO","92815CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"92815CA0010007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Local Initiative Health Authority for Los Angeles County","92815","SERFF","1","3/8/2021 8:38","2","Individual","No",,"92815CA0010007","Gold 80 HMO","92815CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Gold","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"92815CA0010007-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,200","$0","$60","$0","$1,400","$200","$20"
"2021","CA","Local Initiative Health Authority for Los Angeles County","92815","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92815CA0010008","Silver 70 HMO","92815CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"92815CA0010008-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$900","$60","$300","$1,500","$200","$20"
"2021","CA","Local Initiative Health Authority for Los Angeles County","92815","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92815CA0010008","Silver 70 HMO","92815CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"92815CA0010008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Local Initiative Health Authority for Los Angeles County","92815","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92815CA0010008","Silver 70 HMO","92815CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"92815CA0010008-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$900","$60","$300","$1,500","$200","$20"
"2021","CA","Local Initiative Health Authority for Los Angeles County","92815","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92815CA0010008","Silver 70 HMO","92815CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"92815CA0010008-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,000","$60","$275","$1,400","$200","$20"
"2021","CA","Local Initiative Health Authority for Los Angeles County","92815","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92815CA0010008","Silver 70 HMO","92815CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"92815CA0010008-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Local Initiative Health Authority for Los Angeles County","92815","SERFF","1","3/8/2021 8:38","3","Individual","No",,"92815CA0010008","Silver 70 HMO","92815CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"92815CA0010008-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$800","$60","$0","$300","$80","$20"
"2021","CA","Local Initiative Health Authority for Los Angeles County","92815","SERFF","1","3/8/2021 8:38","4","Individual","No",,"92815CA0010004","Bronze 60 HMO","92815CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"92815CA0010004-01","Standard Bronze On Exchange Plan","64.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,000","$60","$2,100","$200","$1,200","$20"
"2021","CA","Local Initiative Health Authority for Los Angeles County","92815","SERFF","1","3/8/2021 8:38","4","Individual","No",,"92815CA0010004","Bronze 60 HMO","92815CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"92815CA0010004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Local Initiative Health Authority for Los Angeles County","92815","SERFF","1","3/8/2021 8:38","4","Individual","No",,"92815CA0010004","Bronze 60 HMO","92815CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"92815CA0010004-03","Limited Cost Sharing Plan Variation","64.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,000","$60","$2,100","$200","$1,200","$20"
"2021","CA","Local Initiative Health Authority for Los Angeles County","92815","SERFF","1","3/8/2021 8:38","5","Individual","No",,"92815CA0010005","Minimum Coverage HMO","92815CA001",,"CAN001","CAS001","CAF001","Existing","HMO","Catastrophic","No","On the Exchange","No","Yes","All",,,,,"Allows Adult and Child-Only",,"Yes",,,,,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"92815CA0010005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$5,200","$0","$0","$20"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","1","Individual","No",,"93689CA0110001","Platinum 90 HMO","93689CA011",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0110001-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$500","$0","$30","$0","$800","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","1","Individual","No",,"93689CA0110001","Platinum 90 HMO","93689CA011",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0110001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","1","Individual","No",,"93689CA0110001","Platinum 90 HMO","93689CA011",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0110001-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$500","$0","$30","$0","$800","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","1","Individual","No",,"93689CA0150001","Platinum 90 HMO","93689CA015",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0150001-01","Standard Platinum On Exchange Plan",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$500","$0","$30","$0","$800","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","1","Individual","No",,"93689CA0150001","Platinum 90 HMO","93689CA015",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0150001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","1","Individual","No",,"93689CA0150001","Platinum 90 HMO","93689CA015",,"CAN001","CAS001","CAF001","Existing","HMO","Platinum","No","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0150001-03","Limited Cost Sharing Plan Variation",,"0.892512191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$500","$0","$30","$0","$800","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","2","Individual","No",,"93689CA0110002","Gold 80 HMO","93689CA011",,"CAN001","CAS001","CAF001","Existing","HMO","Gold","No","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0110002-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,300","$0","$30","$0","$1,800","$10","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","2","Individual","No",,"93689CA0110002","Gold 80 HMO","93689CA011",,"CAN001","CAS001","CAF001","Existing","HMO","Gold","No","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0110002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","2","Individual","No",,"93689CA0110002","Gold 80 HMO","93689CA011",,"CAN001","CAS001","CAF001","Existing","HMO","Gold","No","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0110002-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,300","$0","$30","$0","$1,800","$10","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","2","Individual","No",,"93689CA0150002","Gold 80 HMO","93689CA015",,"CAN001","CAS001","CAF001","Existing","HMO","Gold","No","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0150002-01","Standard Gold On Exchange Plan",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,300","$0","$30","$0","$1,800","$10","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","2","Individual","No",,"93689CA0150002","Gold 80 HMO","93689CA015",,"CAN001","CAS001","CAF001","Existing","HMO","Gold","No","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0150002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","2","Individual","No",,"93689CA0150002","Gold 80 HMO","93689CA015",,"CAN001","CAS001","CAF001","Existing","HMO","Gold","No","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0150002-03","Limited Cost Sharing Plan Variation",,"0.780124133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$1,300","$0","$30","$0","$1,800","$10","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","3","Individual","No",,"93689CA0120001","Silver 70 HMO","93689CA012",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0120001-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$80","$900","$30","$300","$1,900","$10","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","3","Individual","No",,"93689CA0120001","Silver 70 HMO","93689CA012",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0120001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","3","Individual","No",,"93689CA0120001","Silver 70 HMO","93689CA012",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0120001-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$80","$900","$30","$300","$1,900","$10","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","3","Individual","No",,"93689CA0120001","Silver 70 HMO","93689CA012",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0120001-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$80","$1,000","$30","$300","$1,800","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","3","Individual","No",,"93689CA0120001","Silver 70 HMO","93689CA012",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0120001-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$40","$1,100","$30","$100","$1,000","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","3","Individual","No",,"93689CA0120001","Silver 70 HMO","93689CA012",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0120001-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$20","$800","$30","$0","$500","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","3","Individual","No",,"93689CA0160001","Silver 70 HMO","93689CA016",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0160001-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$80","$900","$30","$300","$1,900","$10","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","3","Individual","No",,"93689CA0160001","Silver 70 HMO","93689CA016",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0160001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","3","Individual","No",,"93689CA0160001","Silver 70 HMO","93689CA016",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0160001-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$80","$900","$30","$300","$1,900","$10","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","3","Individual","No",,"93689CA0160001","Silver 70 HMO","93689CA016",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0160001-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$80","$1,000","$30","$300","$1,800","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","3","Individual","No",,"93689CA0160001","Silver 70 HMO","93689CA016",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0160001-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$40","$1,100","$30","$100","$1,000","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","3","Individual","No",,"93689CA0160001","Silver 70 HMO","93689CA016",,"CAN001","CAS001","CAF001","Existing","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0160001-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$20","$900","$30","$0","$500","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","4","Individual","No",,"93689CA0120004","Bronze 60 HMO","93689CA012",,"CAN001","CAS001","CAF001","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0120004-01","Standard Bronze On Exchange Plan","64.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$100","$900","$30","$1,300","$300","$1,500","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","4","Individual","No",,"93689CA0120004","Bronze 60 HMO","93689CA012",,"CAN001","CAS001","CAF001","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0120004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","4","Individual","No",,"93689CA0120004","Bronze 60 HMO","93689CA012",,"CAN001","CAS001","CAF001","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0120004-03","Limited Cost Sharing Plan Variation","64.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$100","$900","$30","$1,300","$300","$1,500","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","4","Individual","No",,"93689CA0160002","Bronze 60 HMO","93689CA016",,"CAN001","CAS001","CAF001","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0160002-01","Standard Bronze On Exchange Plan","64.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$100","$900","$30","$1,300","$300","$1,500","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","4","Individual","No",,"93689CA0160002","Bronze 60 HMO","93689CA016",,"CAN001","CAS001","CAF001","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0160002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","4","Individual","No",,"93689CA0160002","Bronze 60 HMO","93689CA016",,"CAN001","CAS001","CAF001","Existing","HMO","Expanded Bronze","Yes","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0160002-03","Limited Cost Sharing Plan Variation","64.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$100","$900","$30","$1,300","$300","$1,500","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","5","Individual","No",,"93689CA0130002","Bronze 60 HDHP HMO","93689CA013",,"CAN001","CAS001","CAF001","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All Specialties",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0130002-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$30","$5,400","$0","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","5","Individual","No",,"93689CA0130002","Bronze 60 HDHP HMO","93689CA013",,"CAN001","CAS001","CAF001","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All Specialties",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0130002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","5","Individual","No",,"93689CA0130002","Bronze 60 HDHP HMO","93689CA013",,"CAN001","CAS001","CAF001","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All Specialties",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0130002-03","Limited Cost Sharing Plan Variation",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$30","$5,400","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400013","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400013-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400013","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400013-03","Limited Cost Sharing Plan Variation",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","5","Individual","No",,"93689CA0170001","Bronze 60 HDHP HMO","93689CA017",,"CAN001","CAS001","CAF001","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All Specialties",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0170001-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$30","$5,400","$0","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","5","Individual","No",,"93689CA0170001","Bronze 60 HDHP HMO","93689CA017",,"CAN001","CAS001","CAF001","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All Specialties",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0170001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","5","Individual","No",,"93689CA0170001","Bronze 60 HDHP HMO","93689CA017",,"CAN001","CAS001","CAF001","Existing","HMO","Expanded Bronze","No","On the Exchange","No","Yes","All Specialties",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, High Blood Pressure & High Cholesterol",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0170001-03","Limited Cost Sharing Plan Variation",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$7,000","$0","$0","$30","$5,400","$0","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","6","Individual","No",,"93689CA0120005","Minimum Coverage HMO","93689CA012",,"CAN001","CAS001","CAF001","Existing","HMO","Catastrophic","No","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0120005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,550","$0","$0","$30","$5,200","$0","$0","$0"
"2021","CA","Western Health Advantage","93689","SERFF","1","3/8/2021 8:38","6","Individual","No",,"93689CA0160003","Minimum Coverage HMO","93689CA016",,"CAN001","CAS001","CAF001","Existing","HMO","Catastrophic","No","On the Exchange","No","Yes","All Specialists",,,,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"93689CA0160003-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,550","$0","$0","$30","$5,200","$0","$0","$0"
"2021","CA","California Dental Network, Inc.","97389","SERFF","1","3/8/2021 8:38","1","Individual","Yes",,"97389CA0010002","Family Dental HMO","97389CA001",,"CAN001","CAS001",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"97389CA0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","California Dental Network, Inc.","97389","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","Yes",,"97389CA0040001","Family Dental HMO","97389CA004",,"CAN001","CAS001",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Adult and Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"97389CA0040001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","California Dental Network, Inc.","97389","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","Yes",,"97389CA0030001","Children's Dental HMO","97389CA003",,"CAN001","CAS001",,"Existing","HMO","High",,"On the Exchange",,,,,,,,"Allows Child-Only",,,,"1","Guaranteed Rate",,,,,"1/1/2021","12/31/2021","No",,"No",,"No",,,,,"97389CA0030001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$350","$700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,"Not Applicable","per group not applicable",,,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","SHOP (Small Group)","No",,"99110CA0300001","Health Net Platinum 90 PPO 0/15 + Child Dental","99110CA030",,"CAN002","CAS001","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"Yes","Travel Network Applies","No",,,,,"99110CA0300001-01","Standard Platinum On Exchange Plan",,"0.904747055","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$9,000","$18000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$1,000","$2000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$1,100","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340006","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS007","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340006-01","Standard Platinum On Exchange Plan",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340006","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS007","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340006","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS007","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340006-03","Limited Cost Sharing Plan Variation",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340007","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS008","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340007-01","Standard Platinum On Exchange Plan",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340007","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS008","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340007","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS008","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340007-03","Limited Cost Sharing Plan Variation",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340008","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS009","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340008-01","Standard Platinum On Exchange Plan",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340008","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS009","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340008","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS009","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340008-03","Limited Cost Sharing Plan Variation",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340009","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS010","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340009-01","Standard Platinum On Exchange Plan",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340009","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS010","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340009","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS010","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340009-03","Limited Cost Sharing Plan Variation",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340010","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS011","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340010-01","Standard Platinum On Exchange Plan",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340010","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS011","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340010","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS011","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340010-03","Limited Cost Sharing Plan Variation",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340011","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS012","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340011-01","Standard Platinum On Exchange Plan",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340011","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS012","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0340011","Platinum 90 PureCare One EPO","99110CA034",,"CAN001","CAS012","CAF001","Existing","EPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340011-03","Limited Cost Sharing Plan Variation",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400003","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400003-01","Standard Platinum On Exchange Plan",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400003","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400003","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400003-03","Limited Cost Sharing Plan Variation",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400006","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400006-01","Standard Platinum On Exchange Plan",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400006","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400006","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400006-03","Limited Cost Sharing Plan Variation",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400007","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400007-01","Standard Platinum On Exchange Plan",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400007","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400007","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400007-03","Limited Cost Sharing Plan Variation",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400008","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400008-01","Standard Platinum On Exchange Plan",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400008","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400008","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400008-03","Limited Cost Sharing Plan Variation",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400009","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400009-01","Standard Platinum On Exchange Plan",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400009","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400009","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400009-03","Limited Cost Sharing Plan Variation",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400010","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400010-01","Standard Platinum On Exchange Plan",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400010","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","1","Individual","No",,"99110CA0400010","Platinum 90 EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400010-03","Limited Cost Sharing Plan Variation",,"0.915946885","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$600","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","SHOP (Small Group)","No",,"99110CA0300009","Health Net Platinum 90 PPO 0/15 + Child Dental INF","99110CA030",,"CAN002","CAS001","CAF001","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"Yes","Travel Network Applies","No",,,,,"99110CA0300009-01","Standard Platinum On Exchange Plan",,"0.904747055","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9000 per group",,,"$9,000","$18000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"$1,000","$2000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$300","$1,100","$60","$0","$1,100","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340012","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS007","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340012-01","Standard Gold On Exchange Plan",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340012","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS007","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340012","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS007","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340012-03","Limited Cost Sharing Plan Variation",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340013","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS008","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340013-01","Standard Gold On Exchange Plan",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340013","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS008","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340013-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340013","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS008","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340013-03","Limited Cost Sharing Plan Variation",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340014","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS009","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340014-01","Standard Gold On Exchange Plan",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340014","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS009","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340014-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340014","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS009","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340014-03","Limited Cost Sharing Plan Variation",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340015","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS010","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340015-01","Standard Gold On Exchange Plan",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340015","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS010","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340015-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340015","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS010","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340015-03","Limited Cost Sharing Plan Variation",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340016","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS011","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340016-01","Standard Gold On Exchange Plan",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340016","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS011","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340016-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340016","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS011","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340016-03","Limited Cost Sharing Plan Variation",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340017","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS012","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340017-01","Standard Gold On Exchange Plan",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340017","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS012","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340017-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0340017","Gold 80 PureCare One EPO","99110CA034",,"CAN001","CAS012","CAF002","Existing","EPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340017-03","Limited Cost Sharing Plan Variation",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400013","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400013-01","Standard Gold On Exchange Plan",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400016","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400016-01","Standard Gold On Exchange Plan",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400016","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400016-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400016","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400016-03","Limited Cost Sharing Plan Variation",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400017","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400017-01","Standard Gold On Exchange Plan",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400017","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400017-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400017","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400017-03","Limited Cost Sharing Plan Variation",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400018","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400018-01","Standard Gold On Exchange Plan",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400018","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400018-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400018","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400018-03","Limited Cost Sharing Plan Variation",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400019","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400019-01","Standard Gold On Exchange Plan",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400019","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400019-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400019","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400019-03","Limited Cost Sharing Plan Variation",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400020","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400020-01","Standard Gold On Exchange Plan",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400020","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400020-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","2","Individual","No",,"99110CA0400020","Gold 80 EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF002","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400020-03","Limited Cost Sharing Plan Variation",,"0.819013218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$600","$2,200","$60","$0","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","SHOP (Small Group)","No",,"99110CA0300002","Health Net Gold 80 PPO 350/25 + Child Dental","99110CA030",,"CAN002","CAS001","CAF002","Existing","PPO","Gold","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"Yes","Travel Network Applies","No",,,,,"99110CA0300002-01","Standard Gold On Exchange Plan","78.19%","0.841144658","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,800","$15600 per group",,,"$15,600","$31200 per group","Not Applicable","per group not applicable","$350","$700 per group","20.00%",,,,"$2,000","$4000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$350","$500","$2,100","$60","$0","$1,200","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400023","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400023-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"$8,000","$16000 per group","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400023","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400023-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400023","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400023-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"$8,000","$16000 per group","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400023","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400023-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"$7,400","$14800 per group","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400023","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400023-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400023","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400023-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$75","$300","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400026","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400026-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"$8,000","$16000 per group","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400026","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400026-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400026","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400026-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"$8,000","$16000 per group","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400026","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400026-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"$7,400","$14800 per group","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400026","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400026-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400026","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400026-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$75","$300","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400027","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400027-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"$8,000","$16000 per group","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400027","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400027-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400027","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400027-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"$8,000","$16000 per group","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400027","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400027-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"$7,400","$14800 per group","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400027","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400027-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400027","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400027-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$75","$300","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400028","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400028-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"$8,000","$16000 per group","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400028","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400028-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400028","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400028-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"$8,000","$16000 per group","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400028","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400028-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"$7,400","$14800 per group","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400028","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400028-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400028","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400028-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$75","$300","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400029","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400029-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"$8,000","$16000 per group","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400029","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400029-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400029","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400029-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"$8,000","$16000 per group","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400029","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400029-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"$7,400","$14800 per group","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400029","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400029-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400029","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400029-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$75","$300","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400030","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400030-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"$8,000","$16000 per group","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400030","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400030-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400030","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400030-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"$8,000","$16000 per group","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400030","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400030-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"$7,400","$14800 per group","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400030","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400030-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","3","Individual","No",,"99110CA0400030","Silver 70 EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400030-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"$5,000","$10000 per group","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$75","$300","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","SHOP (Small Group)","No",,"99110CA0300010","Health Net Gold 80 PPO 350/25 + Child Dental INF","99110CA030",,"CAN002","CAS001","CAF002","Existing","PPO","Gold","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"Yes","Travel Network Applies","No",,,,,"99110CA0300010-01","Standard Gold On Exchange Plan","78.19%","0.841144658","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,800","$15600 per group",,,"$15,600","$31200 per group","Not Applicable","per group not applicable","$350","$700 per group","20.00%",,,,"$2,000","$4000 per group","Not Applicable","per group not applicable","$0","$0 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$350","$500","$2,100","$60","$0","$1,200","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340018","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS007","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340018-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340018","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS007","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340018-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340018","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS007","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340018-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340018","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS007","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340018-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340018","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS007","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340018-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340018","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS007","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340018-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$75","$300","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340019","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS008","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340019-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340019","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS008","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340019-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340019","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS008","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340019-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340019","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS008","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340019-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340019","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS008","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340019-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340019","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS008","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340019-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$75","$300","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340020","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS009","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340020-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340020","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS009","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340020-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340020","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS009","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340020-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340020","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS009","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340020-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340020","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS009","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340020-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340020","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS009","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340020-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$75","$300","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340021","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS010","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340021-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340021","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS010","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340021-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340021","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS010","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340021-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340021","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS010","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340021-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340021","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS010","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340021-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340021","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS010","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340021-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$75","$300","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340022","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS011","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340022-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340022","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS011","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340022-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340022","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS011","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340022-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340022","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS011","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340022-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340022","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS011","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340022-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340022","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS011","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340022-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$75","$300","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340023","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS012","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340023-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340023","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS012","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340023-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340023","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS012","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340023-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$4,000","$8000 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$300","$600 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$4,000","$600","$1,400","$60","$300","$1,500","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340023","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS012","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340023-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,500","$13000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$3,700","$7400 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$275","$550 per group","20.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$3,700","$600","$1,500","$60","$275","$1,400","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340023","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS012","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340023-05","87% AV Level Silver Plan","87.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,850","$5700 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$1,400","$2800 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$100","$200 per group","15.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,400","$400","$1,100","$60","$100","$700","$100","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","4","Individual","No",,"99110CA0340023","Silver 70 PureCare One EPO","99110CA034",,"CAN001","CAS012","CAF003","Existing","EPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340023-06","94% AV Level Silver Plan","94.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2000 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$75","$150 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$75","$200","$700","$60","$75","$300","$80","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","SHOP (Small Group)","No",,"99110CA0300003","Health Net Silver 70 PPO 2250/50 + Child Dental","99110CA030",,"CAN002","CAS001","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"Yes","Travel Network Applies","No",,,,,"99110CA0300003-01","Standard Silver On Exchange Plan","71.59%","0.747785461","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$16,400","$32800 per group","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,,"$4,500","$9000 per group","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,250","$900","$2,300","$60","$300","$2,600","$300","$60"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340024","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS007","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340024-01","Standard Bronze On Exchange Plan","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340024","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS007","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340024-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340024","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS007","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340024-03","Limited Cost Sharing Plan Variation","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340025","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS008","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340025-01","Standard Bronze On Exchange Plan","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340025","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS008","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340025-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340025","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS008","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340025-03","Limited Cost Sharing Plan Variation","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340026","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS009","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340026-01","Standard Bronze On Exchange Plan","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340026","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS009","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340026-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340026","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS009","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340026-03","Limited Cost Sharing Plan Variation","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340027","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS010","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340027-01","Standard Bronze On Exchange Plan","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340027","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS010","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340027-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340027","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS010","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340027-03","Limited Cost Sharing Plan Variation","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340028","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS011","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340028-01","Standard Bronze On Exchange Plan","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340028","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS011","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340028-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340028","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS011","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340028-03","Limited Cost Sharing Plan Variation","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340029","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS012","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340029-01","Standard Bronze On Exchange Plan","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340029","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS012","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340029-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0340029","Bronze 60 PureCare One EPO","99110CA034",,"CAN001","CAS012","CAF004","Existing","EPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340029-03","Limited Cost Sharing Plan Variation","64.80%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400033","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400033-01","Standard Bronze On Exchange Plan","64.80%","0.655690093","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$12,600","$25200 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400033","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400033-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400033","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400033-03","Limited Cost Sharing Plan Variation","64.80%","0.655690093","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$12,600","$25200 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400036","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400036-01","Standard Bronze On Exchange Plan","64.80%","0.655690093","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$12,600","$25200 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400036","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400036-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400036","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400036-03","Limited Cost Sharing Plan Variation","64.80%","0.655690093","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$12,600","$25200 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400037","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400037-01","Standard Bronze On Exchange Plan","64.80%","0.655690093","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$12,600","$25200 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400037","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400037-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400037","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400037-03","Limited Cost Sharing Plan Variation","64.80%","0.655690093","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$12,600","$25200 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400038","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400038-01","Standard Bronze On Exchange Plan","64.80%","0.655690093","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$12,600","$25200 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400038","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400038-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400038","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400038-03","Limited Cost Sharing Plan Variation","64.80%","0.655690093","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$12,600","$25200 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400039","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400039-01","Standard Bronze On Exchange Plan","64.80%","0.655690093","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$12,600","$25200 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400039","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400039-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400039","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400039-03","Limited Cost Sharing Plan Variation","64.80%","0.655690093","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$12,600","$25200 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400040","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400040-01","Standard Bronze On Exchange Plan","64.80%","0.655690093","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$12,600","$25200 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400040","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400040-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","5","Individual","No",,"99110CA0400040","Bronze 60 EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400040-03","Limited Cost Sharing Plan Variation","64.80%","0.655690093","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$12,600","$25200 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$1,300","$700","$1,200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","6","SHOP (Small Group)","No",,"99110CA0300011","Health Net Silver 70 PPO 2250/50 + Child Dental INF","99110CA030",,"CAN002","CAS001","CAF003","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"Yes","Travel Network Applies","No",,,,,"99110CA0300011-01","Standard Silver On Exchange Plan","71.59%","0.747785461","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$16,400","$32800 per group","Not Applicable","per group not applicable","$2,250","$4500 per group","30.00%",,,,"$4,500","$9000 per group","Not Applicable","per group not applicable","$300","$600 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,250","$900","$2,300","$60","$300","$2,600","$300","$60"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","6","Individual","No",,"99110CA0340030","Minimum Coverage PureCare One EPO","99110CA034",,"CAN001","CAS007","CAF005","Existing","EPO","Catastrophic","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340030-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$8,550","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","6","Individual","No",,"99110CA0340031","Minimum Coverage PureCare One EPO","99110CA034",,"CAN001","CAS008","CAF005","Existing","EPO","Catastrophic","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340031-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$8,550","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","6","Individual","No",,"99110CA0340032","Minimum Coverage PureCare One EPO","99110CA034",,"CAN001","CAS009","CAF005","Existing","EPO","Catastrophic","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340032-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$8,550","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","6","Individual","No",,"99110CA0340033","Minimum Coverage PureCare One EPO","99110CA034",,"CAN001","CAS010","CAF005","Existing","EPO","Catastrophic","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340033-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$8,550","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","6","Individual","No",,"99110CA0340034","Minimum Coverage PureCare One EPO","99110CA034",,"CAN001","CAS011","CAF005","Existing","EPO","Catastrophic","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340034-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$8,550","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","6","Individual","No",,"99110CA0340035","Minimum Coverage PureCare One EPO","99110CA034",,"CAN001","CAS012","CAF005","Existing","EPO","Catastrophic","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0340035-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$8,550","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","6","Individual","No",,"99110CA0400043","Minimum Coverage EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF005","Existing","PPO","Catastrophic","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400043-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"$17,100","$34200 per group","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$8,550","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","6","Individual","No",,"99110CA0400046","Minimum Coverage EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF005","Existing","PPO","Catastrophic","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400046-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"$17,100","$34200 per group","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$8,550","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","6","Individual","No",,"99110CA0400047","Minimum Coverage EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF005","Existing","PPO","Catastrophic","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400047-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"$17,100","$34200 per group","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$8,550","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","6","Individual","No",,"99110CA0400048","Minimum Coverage EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF005","Existing","PPO","Catastrophic","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400048-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"$17,100","$34200 per group","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$8,550","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","6","Individual","No",,"99110CA0400049","Minimum Coverage EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF005","Existing","PPO","Catastrophic","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400049-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"$17,100","$34200 per group","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$8,550","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","6","Individual","No",,"99110CA0400050","Minimum Coverage EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF005","Existing","PPO","Catastrophic","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400050-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,550","$17100 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$8,550","$17100 per group","0.00%",,,,"$17,100","$34200 per group","Not Applicable","per group not applicable","$8,550","$0","$0","$60","$8,550","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","SHOP (Small Group)","No",,"99110CA0300004","Health Net Bronze 60 PPO 6300/65 + Child Dental","99110CA030",,"CAN002","CAS001","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"Yes","Travel Network Applies","No",,,,,"99110CA0300004-01","Standard Bronze On Exchange Plan","64.83%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$16,400","$32800 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$12,600","$25200 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$500","$700","$1,500","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400069","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400069-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"$14,000","$28000 per group","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400069","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400069-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400069","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS001","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400069-03","Limited Cost Sharing Plan Variation",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"$14,000","$28000 per group","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400070","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400070-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"$14,000","$28000 per group","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400070","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400070-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400070","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS002","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400070-03","Limited Cost Sharing Plan Variation",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"$14,000","$28000 per group","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400071","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400071-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"$14,000","$28000 per group","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400071","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400071-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400071","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS003","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400071-03","Limited Cost Sharing Plan Variation",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"$14,000","$28000 per group","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400072","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400072-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"$14,000","$28000 per group","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400072","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400072-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400072","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS004","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400072-03","Limited Cost Sharing Plan Variation",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"$14,000","$28000 per group","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400073","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400073-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"$14,000","$28000 per group","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400073","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400073-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400073","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS005","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400073-03","Limited Cost Sharing Plan Variation",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"$14,000","$28000 per group","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400074","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400074-01","Standard Bronze On Exchange Plan",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"$14,000","$28000 per group","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400074","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400074-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0 per group",,,"$0","$0 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0 per group","0.00%",,,,"$0","$0 per group","Not Applicable","per group not applicable","$0","$0","$0","$0","$0","$0","$0","$0"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","7","Individual","No",,"99110CA0400074","Bronze 60 HDHP EnhancedCare PPO","99110CA040",,"CAN003","CAS006","CAF006","Existing","PPO","Expanded Bronze","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"No",,"No",,,,,"99110CA0400074-03","Limited Cost Sharing Plan Variation",,"0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$25,000","$50000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"$14,000","$28000 per group","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$5,400","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","8","SHOP (Small Group)","No",,"99110CA0300012","Health Net Bronze 60 PPO 6300/65 + Child Dental INF","99110CA030",,"CAN002","CAS001","CAF004","Existing","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"Yes","Travel Network Applies","No",,,,,"99110CA0300012-01","Standard Bronze On Exchange Plan","64.83%","0.65216666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,200","$16400 per group",,,"$16,400","$32800 per group","Not Applicable","per group not applicable","$6,300","$12600 per group","40.00%",,,,"$12,600","$25200 per group","Not Applicable","per group not applicable","$500","$1000 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$6,300","$500","$1,400","$60","$500","$700","$1,500","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","9","SHOP (Small Group)","No",,"99110CA0300049","Health Net Bronze 60 HDHP PPO 7000/0% + Child Dental","99110CA030",,"CAN002","CAS001","CAF005","New","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"Yes","Travel Network Applies","No",,,,,"99110CA0300049-01","Standard Bronze On Exchange Plan","64.60%","0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$14,000","$28000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"$14,000","$28000 per group","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$7,000","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","10","SHOP (Small Group)","No",,"99110CA0300050","Health Net Bronze 60 HDHP PPO 7000/0% + Child Dental INF","99110CA030",,"CAN002","CAS001","CAF005","New","PPO","Expanded Bronze","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"No",,"Yes","Travel Network Applies","No",,,,,"99110CA0300050-01","Standard Bronze On Exchange Plan","64.60%","0.6459965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$14,000","$28000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$7,000","$14000 per group","0.00%",,,,"$14,000","$28000 per group","Not Applicable","per group not applicable","$7,000","$0","$0","$60","$7,000","$0","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"99110CA0410009","Health Net EnhancedCare Platinum 90 PPO 250/15 + Child Dental Alt","99110CA041",,"CAN004","CAS015","CAF006","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0410009-01","Standard Platinum On Exchange Plan",,"0.884724083","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7600 per group",,,"$9,000","$18000 per group","Not Applicable","per group not applicable","$250","$500 per group","10.00%",,,,"$1,000","$2000 per group","Not Applicable","per group not applicable","$0","per group not applicable","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$750","$300","$3,200","$60","$750","$800","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","11","SHOP (Small Group)","No",,"99110CA0410010","Health Net EnhancedCare Platinum 90 PPO 250/15 + Child Dental Alt","99110CA041",,"CAN004","CAS016","CAF006","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0410010-01","Standard Platinum On Exchange Plan",,"0.884724083","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7600 per group",,,"$9,000","$18000 per group","Not Applicable","per group not applicable","$250","$500 per group","10.00%",,,,"$1,000","$2000 per group","Not Applicable","per group not applicable","$0","per group not applicable","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$750","$300","$3,200","$60","$750","$800","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","12","SHOP (Small Group)","No",,"99110CA0410015","Health Net EnhancedCare Platinum 90 PPO 250/15 + Child Dental Alt INF","99110CA041",,"CAN004","CAS015","CAF006","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0410015-01","Standard Platinum On Exchange Plan",,"0.884724083","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7600 per group",,,"$9,000","$18000 per group","Not Applicable","per group not applicable","$250","$500 per group","10.00%",,,,"$1,000","$2000 per group","Not Applicable","per group not applicable","$0","per group not applicable","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$750","$300","$3,200","$60","$750","$800","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","12","SHOP (Small Group)","No",,"99110CA0410016","Health Net EnhancedCare Platinum 90 PPO 250/15 + Child Dental Alt INF","99110CA041",,"CAN004","CAS016","CAF006","Existing","PPO","Platinum","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0410016-01","Standard Platinum On Exchange Plan",,"0.884724083","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7600 per group",,,"$9,000","$18000 per group","Not Applicable","per group not applicable","$250","$500 per group","10.00%",,,,"$1,000","$2000 per group","Not Applicable","per group not applicable","$0","per group not applicable","10.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$750","$300","$3,200","$60","$750","$800","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"99110CA0300015","Health Net Gold 80 Value PPO 750/15 + Child Dental Alt","99110CA030",,"CAN002","CAS001","CAF008","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0300015-01","Standard Gold On Exchange Plan",,"0.811171035","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,800","$15600 per group",,,"$15,600","$31200 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1500 per group","30.00%",,,,"$2,250","$4500 per group","Not Applicable","per group not applicable","$750","$300","$3,200","$60","$750","$800","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"99110CA0300039","Health Net Gold 80 PPO 0/30 + Child Dental Alt","99110CA030",,"CAN002","CAS001","CAF007","Existing","PPO","Gold","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0300039-01","Standard Gold On Exchange Plan","81.37%","0.820359511","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,600","$15200 per group",,,"$15,200","$30400 per group","Not Applicable","per group not applicable","$0","$0 per group","30.00%",,,,"$2,000","$4000 per group","Not Applicable","per group not applicable","$0","$0 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$500","$3,300","$60","$0","$1,100","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"99110CA0410011","Health Net EnhancedCare Gold 80 PPO 1000/30 + Child Dental Alt","99110CA041",,"CAN004","CAS015","CAF008","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0410011-01","Standard Gold On Exchange Plan",,"0.792416128","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,600","$15200 per group",,,"$15,200","$30400 per group","Not Applicable","per group not applicable","$1,000","$2000 per group","30.00%",,,,"$2,000","$4000 per group","Not Applicable","per group not applicable","$250","$500 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,000","$500","$3,000","$60","$1,000","$1,100","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","13","SHOP (Small Group)","No",,"99110CA0410012","Health Net EnhancedCare Gold 80 PPO 1000/30 + Child Dental Alt","99110CA041",,"CAN004","CAS016","CAF008","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0410012-01","Standard Gold On Exchange Plan",,"0.792416128","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,600","$15200 per group",,,"$15,200","$30400 per group","Not Applicable","per group not applicable","$1,000","$2000 per group","30.00%",,,,"$2,000","$4000 per group","Not Applicable","per group not applicable","$250","$500 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,000","$500","$3,000","$60","$1,000","$1,100","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","14","SHOP (Small Group)","No",,"99110CA0300017","Health Net Gold 80 Value PPO 750/15 + Child Dental Alt INF","99110CA030",,"CAN002","CAS001","CAF008","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0300017-01","Standard Gold On Exchange Plan",,"0.811171035","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,800","$15600 per group",,,"$15,600","$31200 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1500 per group","30.00%",,,,"$2,250","$4500 per group","Not Applicable","per group not applicable","$750","$300","$3,200","$60","$750","$800","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","14","SHOP (Small Group)","No",,"99110CA0300043","Health Net Gold 80 PPO 0/30 + Child Dental Alt INF","99110CA030",,"CAN002","CAS001","CAF007","Existing","PPO","Gold","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0300043-01","Standard Gold On Exchange Plan","81.37%","0.820359511","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,600","$15200 per group",,,"$15,200","$30400 per group","Not Applicable","per group not applicable","$0","$0 per group","30.00%",,,,"$2,000","$4000 per group","Not Applicable","per group not applicable","$0","$0 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$0","$500","$3,300","$60","$0","$1,100","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","14","SHOP (Small Group)","No",,"99110CA0410051","Health Net EnhancedCare Gold 80 PPO 1000/30 + Child Dental Alt INF","99110CA041",,"CAN004","CAS015","CAF008","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0410051-01","Standard Gold On Exchange Plan",,"0.792416128","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,600","$15200 per group",,,"$15,200","$30400 per group","Not Applicable","per group not applicable","$1,000","$2000 per group","30.00%",,,,"$2,000","$4000 per group","Not Applicable","per group not applicable","$250","$500 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,000","$500","$3,000","$60","$1,000","$1,100","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","14","SHOP (Small Group)","No",,"99110CA0410052","Health Net EnhancedCare Gold 80 PPO 1000/30 + Child Dental Alt INF","99110CA041",,"CAN004","CAS016","CAF008","Existing","PPO","Gold","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0410052-01","Standard Gold On Exchange Plan",,"0.792416128","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,600","$15200 per group",,,"$15,200","$30400 per group","Not Applicable","per group not applicable","$1,000","$2000 per group","30.00%",,,,"$2,000","$4000 per group","Not Applicable","per group not applicable","$250","$500 per group","30.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$1,000","$500","$3,000","$60","$1,000","$1,100","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","15","SHOP (Small Group)","No",,"99110CA0300041","Health Net Silver 70 HDHP PPO 1400/40% + Child Dental Alt","99110CA030",,"CAN002","CAS001","CAF012","Existing","PPO","Silver","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0300041-01","Standard Silver On Exchange Plan",,"0.719460007","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$14,000","$28000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per group","40.00%",,,,"$2,800","$5600 per group","Not Applicable","per group not applicable","$1,400","$10","$4,500","$60","$1,400","$1,100","$400","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","15","SHOP (Small Group)","No",,"99110CA0300042","Health Net Silver 70 Value PPO 1700/50 + Child Dental Alt","99110CA030",,"CAN002","CAS001","CAF011","Existing","PPO","Silver","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0300042-01","Standard Silver On Exchange Plan",,"0.713043231","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,000","$16000 per group",,,"$16,000","$32000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per group","40.00%",,,,"$3,400","$6800 per group","Not Applicable","per group not applicable","$1,700","$400","$3,800","$60","$1,700","$1,100","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","15","SHOP (Small Group)","No",,"99110CA0410013","Health Net EnhancedCare Silver 70 PPO 2250/55 + Child Dental Alt","99110CA041",,"CAN004","CAS015","CAF010","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0410013-01","Standard Silver On Exchange Plan","70.96%","0.717124323","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,000","$16000 per group",,,"$16,000","$32000 per group","Not Applicable","per group not applicable","$2,250","$4500 per group","40.00%",,,,"$4,500","$9000 per group","Not Applicable","per group not applicable","$300","$600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,250","$600","$3,500","$60","$1,100","$1,600","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","15","SHOP (Small Group)","No",,"99110CA0410014","Health Net EnhancedCare Silver 70 PPO 2250/55 + Child Dental Alt","99110CA041",,"CAN004","CAS016","CAF010","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0410014-01","Standard Silver On Exchange Plan","70.96%","0.717124323","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,000","$16000 per group",,,"$16,000","$32000 per group","Not Applicable","per group not applicable","$2,250","$4500 per group","40.00%",,,,"$4,500","$9000 per group","Not Applicable","per group not applicable","$300","$600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,250","$600","$3,500","$60","$1,100","$1,600","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","15","SHOP (Small Group)","No",,"99110CA0410057","Health Net EnhancedCare Silver 70 HDHP PPO 1400/40% + Child Dental Alt","99110CA041",,"CAN004","CAS015","CAF012","Existing","PPO","Silver","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0410057-01","Standard Silver On Exchange Plan",,"0.719460007","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$14,000","$28000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per group","40.00%",,,,"$2,800","$5600 per group","Not Applicable","per group not applicable","$1,400","$10","$4,500","$60","$1,400","$1,100","$400","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","15","SHOP (Small Group)","No",,"99110CA0410061","Health Net EnhancedCare Silver 70 HDHP PPO 1400/40% + Child Dental Alt","99110CA041",,"CAN004","CAS016","CAF012","Existing","PPO","Silver","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0410061-01","Standard Silver On Exchange Plan",,"0.719460007","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$14,000","$28000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per group","40.00%",,,,"$2,800","$5600 per group","Not Applicable","per group not applicable","$1,400","$10","$4,500","$60","$1,400","$1,100","$400","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","16","SHOP (Small Group)","No",,"99110CA0300045","Health Net Silver 70 HDHP PPO 1400/40% + Child Dental Alt INF","99110CA030",,"CAN002","CAS001","CAF012","Existing","PPO","Silver","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0300045-01","Standard Silver On Exchange Plan",,"0.719460007","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$14,000","$28000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per group","40.00%",,,,"$2,800","$5600 per group","Not Applicable","per group not applicable","$1,400","$10","$4,500","$60","$1,400","$1,100","$400","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","16","SHOP (Small Group)","No",,"99110CA0300046","Health Net Silver 70 Value PPO 1700/50 + Child Dental Alt  INF","99110CA030",,"CAN002","CAS001","CAF011","Existing","PPO","Silver","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0300046-01","Standard Silver On Exchange Plan",,"0.713043231","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,000","$16000 per group",,,"$16,000","$32000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$1,700","$3400 per group","40.00%",,,,"$3,400","$6800 per group","Not Applicable","per group not applicable","$1,700","$400","$3,800","$60","$1,700","$1,100","$200","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","16","SHOP (Small Group)","No",,"99110CA0410053","Health Net EnhancedCare Silver 70 PPO 2250/55 + Child Dental Alt INF","99110CA041",,"CAN004","CAS015","CAF010","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0410053-01","Standard Silver On Exchange Plan","70.96%","0.717124323","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,000","$16000 per group",,,"$16,000","$32000 per group","Not Applicable","per group not applicable","$2,250","$4500 per group","40.00%",,,,"$4,500","$9000 per group","Not Applicable","per group not applicable","$300","$600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,250","$600","$3,500","$60","$1,100","$1,600","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","16","SHOP (Small Group)","No",,"99110CA0410054","Health Net EnhancedCare Silver 70 PPO 2250/55 + Child Dental Alt INF","99110CA041",,"CAN004","CAS016","CAF010","Existing","PPO","Silver","Yes","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0410054-01","Standard Silver On Exchange Plan","70.96%","0.717124323","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$8,000","$16000 per group",,,"$16,000","$32000 per group","Not Applicable","per group not applicable","$2,250","$4500 per group","40.00%",,,,"$4,500","$9000 per group","Not Applicable","per group not applicable","$300","$600 per group","40.00%",,,,"Not Applicable","per group not applicable","Not Applicable","per group not applicable",,,,,,,,,,,"$2,250","$600","$3,500","$60","$1,100","$1,600","$0","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","16","SHOP (Small Group)","No",,"99110CA0410065","Health Net EnhancedCare Silver 70 HDHP PPO 1400/40% + Child Dental Alt INF","99110CA041",,"CAN004","CAS015","CAF012","Existing","PPO","Silver","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0410065-01","Standard Silver On Exchange Plan",,"0.719460007","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$14,000","$28000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per group","40.00%",,,,"$2,800","$5600 per group","Not Applicable","per group not applicable","$1,400","$10","$4,500","$60","$1,400","$1,100","$400","$20"
"2021","CA","Health Net Life Insurance Company","99110","SERFF","1","3/8/2021 8:38","16","SHOP (Small Group)","No",,"99110CA0410069","Health Net EnhancedCare Silver 70 HDHP PPO 1400/40% + Child Dental Alt INF","99110CA041",,"CAN004","CAS016","CAF012","Existing","PPO","Silver","No","On the Exchange","Yes","No",,,,,,"Allows Adult and Child-Only",,"No",,,,,,,,"1/1/2021",,"Yes","Emergency Only","Yes","Travel Network Applies","No",,,,,"99110CA0410069-01","Standard Silver On Exchange Plan",,"0.719460007","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$7,000","$14000 per group",,,"$14,000","$28000 per group","Not Applicable","per group not applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2800 per group","40.00%",,,,"$2,800","$5600 per group","Not Applicable","per group not applicable","$1,400","$10","$4,500","$60","$1,400","$1,100","$400","$20"
