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2013-2014 Plan Documents

 

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Quick Facts about Plan Documents 2013-2014
Anthem PPO Plan Documents 2013-2014
Blue Shield PPO Plan Documents 2013-2014
Prescription Drug Co-Pay Reference Guide 2013-2014
Anthem HMO Plan Documents 2013-2014
Blue Shield HMO Plan Documents 2013-2014
Kaiser HMO Plan Documents 2013-2014
Dental Plan Documents 2013-2014
Vision Plan Documents 2013-2014
Basic Life Insurance Booklets 2013-2014
Frozen Plans 2013-2014

Quick Facts about Plan Documents

Quick Facts about Plan Documents

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Anthem PPO Plan Documents 2013-2014

Anthem PPO Benefit Booklets

100% PPO Benefit Booklet

2013_2014_Anthem_PPO_100_A_10_Benefit_Booklet                                                   2013_2014_Anthem_PPO_100_A_20_Benefit_Booklet                             2013_2014_Anthem_PPO_100_A_20_Select_Plan_Benefit_Booklet                            2013_2014_Anthem_PPO_100_B_20_Benefit_Booklet                                                   2013_2014_Anthem_PPO_100_C_20_Benefit_Booklet 2013_2014_Anthem_PPO_100_D_20_Benefit_Booklet                                                      

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90% PPO Benefit Booklet

2013_2014_Anthem_PPO_90_A_20_Benefit_Booklet                                2013_2014_Anthem_PPO_90_A_20_Select_Plan_Benefit_Booklet 2013_2014_Anthem_PPO_90_C_30_Benefit_Booklet                                                                                                                        

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80% PPO Benefit Booklet

2013_2014_Anthem_PPO_80_C_20_Benefit_Booklet                                                        2013_2014_Anthem_PPO_80_E_20_Benefit_Booklet                                                        2013_2014_Anthem_PPO_80_E_30_Benefit_Booklet                                                       2013_2014_Anthem_PPO_80_G_20_Benefit_Booklet                      2013_2014_Anthem_PPO_80_G_20_PPO_Select_Plan_Benefit_Booklet                     2013_2014_Anthem_PPO_80_G_30_Benefit_Booklet                       2013_2014_Anthem_PPO_80_G_30_PPO_Select_Plan_Benefit_Booklet                          2013_2014_Anthem_PPO_80_J_30_Benefit_Booklet                                                        2013_2014_Anthem_PPO_80_K_30_Benefit_Booklet                                                        2013_2014_Anthem_PPO_80_L_30_Benefit_Booklet                      2013_2014_Anthem_PPO_80_L_30_PPO_Select_Plan_Benefit_Booklet                     2013_2014_Anthem_PPO_80_M_40_Benefit_Booklet 2013_2014_Anthem_PPO_80_N_40_Benefit_Booklet                                                                                                             

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HSA Benefit Booklet

2013_2014_Anthem_HSA_A_Benefit_Booklet                                                       2013_2014_Anthem_HSA_A_PPO_SELECT_Benefit_Booklet                                                        2013_2014_Anthem_HSA_B_Benefit_Booklet                                                              2013_2014_Anthem_HSA_B_PPO_SELECT_Benefit_Booklet

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Anthem PPO Benefit Summary

100% PPO Benefit Summary

2013_2014_Anthem_PPO_100_A_10_Benefit_Summary                                           2013_2014_Anthem_PPO_100_A_20_Benefit_Summary                                             2013_2014_Anthem_PPO_100_B_20_Benefit_Summary                                           2013_2014_Anthem_PPO_100_C_20_Benefit_Summary 2013_2014_Anthem_PPO_100_D_20_Benefit_Summary                                          

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90% PPO Benefit Summary

2013_2014_Anthem_PPO_90_A_20_Benefit_Summary 2013_2014_Anthem_PPO_90_C_30_Benefit_Summary                                                

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80% PPO Benefit Summary

2013_2014_Anthem_PPO_80_C_20_Benefit_Summary                                                 2013_2014_Anthem_PPO_80_E_20_Benfit_Summary                                                    2013_2014_Anthem_PPO_80_E_30_Benfit_Summary                                                 2013_2014_Anthem_PPO_80_G_20_Benefit_Summary                                              2013_2014_Anthem_PPO_80_G_30_Benefit_Summary                                               2013_2014_Anthem_PPO_80_J_30_Benefit_Summary                                                2013_2014_Anthem_PPO_80_K_30_Benefit_Summary                                               2013_2014_Anthem_PPO_80_L_30_Benefit_Summary                                              2013_2014_Anthem_PPO_80_M_40_Benefit_Summary                                              2013_2014_Anthem_PPO_80_N_40_Benefit_Summary

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HSA Benefit Summary

2013_2014_Anthem_HSA_A_Benefit_Summary                                                                            2013_2014_Anthem_HSA_B_Benefit_Summary

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PPO Plan Document Riders

                                                                                                         2013_2014_Dependent_Overlay_Rider                                                                                                          2013_2014_Opposite_Sex_18DP_RIDER

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Blue Shield PPO Plan Documents 2013-2014

Blue Shield PPO Benefit Booklets – Add Attachment’s Below to Benefit Booklets

100% PPO Benefit Booklet

2013_2014_BlueShield_PPO_100_A_10_Benefit_Booklet    2013_2014_BlueShield_PPO_100_B_20_Benefit_Booklet                                                                                                     2013_2014_BlueShield_PPO_100_C_20_Benefit_Booklet                                                  2013_2014_BlueShield_PPO_100_D_20_Benefit_Booklet

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90% PPO Benefit Booklet

2013_2014_BlueShield_PPO_90_A_20_Benefit_Booklet 2013_2014_BlueShield_PPO_90_C_30_Benefit_Booklet                                              

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80% PPO Benefit Booklet

2013_2014_BlueShield_PPO_80_C_20_Benefit_Booklet                                               2013_2014_BlueShield_PPO_80_E_20_Benefit_Booklet                                                 2013_2014_BlueShield_PPO_80_E_30_Benefit_Booklet                                               2013_2014_BlueShield_PPO_80_G_20_Benefit_Booklet                                                2013_2014_BlueShield_PPO_80_G_30_Benefit_Booklet                                                 2013_2014_BlueShield_PPO_80_J_30_Benefit_Booklet                                                  2013_2014_BlueShield_PPO_80_K_30_Benefit_Booklet                                                       2013_2014_BlueShield_PPO_80_L_30_Benefit_Booklet                                                 2013_2014_BlueShield_PPO_80_M_40_Benefit_Booklet                                                     2013_2014_BlueShield_PPO_80_N_40_Benefit_Booklet

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HSA Benefit Booklet

2013_2014_BlueShield_HSA_A_Benefit_Booklet                                                                            2013_2014_BlueShield_HSA_B_Benefit_Booklet

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Attachment for Benefit Booklet’s (Attach Both)

Riders – Add each Rider to Blue Shield Plan

2013_2014_BlueShield_PPO_Residential_MH                                                                              2013_2014_BlueShield_PPO_Residential_SubAbu

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Blue Shield PPO Benefit Summary

100% PPO Benefit Summary

2013_2014_BlueShield_100_A_10_Benefit_Summary                                                       2013_2014_BlueShield_100_A_20_Benefit_Summary                                                          2013_2014_BlueShield_100_B_20_Benefit_Summary                                                         2013_2014_BlueShield_100_C_20_Benefit_Summary 2013_2014_BlueShield_100_D_20_Benefit_Summary                                                      

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90% PPO Benefit Summary

2013_2014_BlueShield_PPO_90_A_20_Benefit_Summary 2013_2014_BlueShield_PPO_90_C_30_Benefit_Summary                                                                                                         

80% PPO Benefit Summary

2013_2014_BlueShield_PPO_80_C_20_Benefit_Summary  2013_2014_BlueShield_PPO_80_E_20_Benefit_Summary                                       2013_2014_BlueShield_PPO_80_E_30_Benefit_Summary                                      2013_2014_BlueShield_PPO_80_G_20_Benefit_Summary                                      2013_2014_BlueShield_PPO_80_G_30_Benefit_Summary                                       2013_2014_BlueShield_PPO_80_J_30_Benefit_Summary                                         2013_2014_BlueShield_PPO_80_K_30_Benefit_Summary                                       2013_2014_BlueShield_PPO_80_L_30_Benefit_Summary                                      2013_2014_BlueShield_PPO_80_M_40_Benefit_Summary                                        2013_2014_BlueShield_PPO_80_N_40_Benefit_Summary

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HSA Benefit Summary

2013_2014_BlueShield_HSA_A_Benefit_Summary                                                                    2013_2014_BlueShield_HSA_B_Benefit_Summary

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Prescription Drug Co-Pay Reference Guide

                                                                                                                                                                                                                                                                      2013_2014_SISC_RX_flyer_Costco_Zero_Copay_Generics                                                                                                         2013_2014_RX_3_15                                                                                                                                                                           2013_2014_RX_5_20                                                                                                                                                                           2013_2014_RX_7_25                                                                                                                                                                            2013_2014_RX_9_35                                                                                                                                           2013_2014_RX_10_35_200_500_DED                                                                                                           2013_2014_RX_15_50_200_500_DED

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Anthem HMO Plan Documents 2013-2014

Anthem HMO Benefit Booklet

2013_2014_AnthemHMO_Classic_20_40_250_EOC                                                                 2013_2014_AnthemHMO_Premier_10_100_EOC                                                                                2013_2014_AnthemHMO_Premier_20_EOC                                                         2013_2014_AnthemHMO_Select_Plus_Premier_10_100_EOC                  2013_2014_AnthemHMO_Select_Plus_Value_30_40_500_3_day_EOC                          2013_2014_AnthemHMO_Select_Premier_10_EOC                                                               2013_2014_AnthemHMO_Select_Premier_20_EOC                                                 2013_2014_AnthemHMO_Value_30_40_500_3_day_EOC

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Anthem HMO Benefit Summary

2013_2014_AnthemHMO_Classic_20_40_250_125_Benefit_Summary               2013_2014_AnthemHMO_Premier_10_100_Benefit_Summary                              2013_2014_AnthemHMO_Premier_20_Benefit_Summary              2013_2014_AnthemHMO_PSH_Value_30_40_500_3_day_Benefit_Summary 2013_2014_AnthemHMO_Select_Plus_Premier_10_100_Benefit_Summary 2013_2014_AnthemHMO_Select_Plus_Value_30_40_500_3_day_Benefit_Summary 2013_2014_AnthemHMO_Select_Premier_10_100_Benefit_Summary      2013_2014_AnthemHMO_Select_Premier_20_Benefit_Summary 2013_2014_AnthemHMO_Value_30_40_500_3_day_Benefit_Summary

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Anthem HMO Rider

2013_2014_Anthem_HMO_CHIRO_10_30_Amendment_Rider                                                                                                               2013_2014_Anthem_HMO_DEPENDENT_OVERLAY_Rider                                                                                                   2013_2014_Anthem_HMO_OPPOSITE_SEX_18_DP_Rider

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Blue Shield HMO Plan Documents 2013-2014

Blue Shield HMO Benefit Booklet – Contact Your SISC Account Manager

Blue Shield HMO Benefit Summary

2013_2014_BlueShield_HMO_Zero_admit_10_copay_hearing                                                           2013_2014_BlueShield_HMO_20_250_hearing                                                                               2013_2014_BlueShield_HMO_25_500_hearing                                                                       2013_2014_BlueShield_HMO_30_20_Zero_hearing  2013_2014_BlueShield_HMO_SaveNet_20_250_hearing                                                     2013_2014_BlueShield_HMO_SaveNet_25_500_hearing                                            2013_2014_BlueShield_HMO_SaveNet_30_20_Zero_hearing                 2013_2014_BlueShield_HMO_SaveNet_Zero_admit_10_copay_hearing              

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Kaiser HMO Plan Documents 2013-2014

Kaiser Evidence of Coverage

225543 – Southern California

2013_2014_Kaiser_10_OV_10_RX_EOC                                                                                        2013_2014_Kaiser_10_OV_10_RX_Vision_EOC                                                                                 2013_2014_Kaiser_20_OV_10_20_Rx_EOC                                                                         2013_2014_Kaiser_20_OV_10_20_RX_Vision_EOC                                                                          2013_2014_Kaiser_30_OV_10_30_RX_EOC                                                                         2013_2014_Kaiser_30_OV_10_30_RX_Vision_EOC                                                                                      2013_2014_Kaiser_500_DHMO_EOC                                                                                                               2013_2014_Kaiser_1000_DHMO_EOC

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600115 – Northern California

2013_2014_Kaiser_10_OV_10_Rx_EOC                                                                                               2013_2014_Kaiser_20_OV_10_20_Rx_EOC                                                                                        2013_2014_Kaiser_30_OV_10_30_Rx_EOC                                                                           2013_2014_Kaiser_30_OV_10_30_Rx_Vision_EOC                                                                              2013_2014_Kaiser_500_Ded_DHMO_EOC

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Kaiser Benefit Summary

225543 – Southern California

2013_2014_KP_10_OV_10_Rx_100_ER_Benefit_Summary                2013_2014_KP_10_OV_10_Rx_100_ER_CHIRO_Benefit_Summary 2013_2014_KP_10_OV_10_Rx_100_ER_CHIRO_Vision_Benefit_Summary 2013_2014_KP_10_OV_10_Rx_100_ER_Vision_Benefit_Summary 2013_2014_KP_20_OV_10_20_Rx_100_ER_CHIRO_Benefit_Summary 2013_2014_KP_20_OV_10_20_Rx_100_ER_Chiro_Vision_Benefit_Summary 2013_2014_KP_20_OV_10_20_Rx_100_ER_Vision_Benefit_Summary                     2013_2014_KP_20_OV_10_20_Rx_Benefit_Summary                                  2013_2014_KP_30_OV_10_30_Rx_100_ER_Benefit_Summary 2013_2014_KP_30_OV_10_30_Rx_100_ER_CHIRO_Benefit_Summary 2013_2014_KP_30_OV_10_30_Rx_100_ER_CHIRO_Vision_Benefit_Summary 2013_2014_KP_500_Hospital_Only_Deductible_DHMO_Benefit_Summary 2013_2014_KP_500_Hospital_Only_Deductible_DHMO_CHIRO_Benefit_Summary 2013_2014_KP_1000_Hospital_Only_Deductible_DHMO_Benefit_Summary 2013_2014_KP_1000_Hospital_Only_Deductible_DHMO_CHIRO_Benefit_Summary

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600115 – Northern California

2013_2014_KP_10_OV_10_Rx_100_ER_Benefit_Summary                                                                                                                          2013_2014_KP_10_OV_10_Rx_100_ER_CHIRO_Benefit_Summary                        2013_2014_KP_20_OV_10_20_Rx_100_ER_Benefit_Summary  2013_2014_KP_20_OV_10_20_Rx_100_ER_CHIRO_Benefit_Summary  2013_2014_KP_30_OV_10_30_Rx_100_ER_Benefit_Summary  2013_2014_KP_30_OV_10_30_Rx_100_ER_CHIRO_Benefit_Summary  2013_2014_KP_500_Hospital_Only_Deductible_DHMO_Benefit_Summary  2013_2014_KP_500_Hospital_Only_Deductible_DHMO_CHIRO_Benefit_Summary

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Kaiser HMO Chiro Rider

2013_2014_Kaiser_225543_Chiro_EOC                                                                                                          2013_2014_Kaiser_600115_Chiro_EOC

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Dental Plan Documents

Delta Premier PPO Incentive

No Ortho

2013_2014_Delta_PPO_Incentive_1000_3Cleanings_no_Ortho                                                                2013_2014_Delta_PPO_Incentive_1000_no_Ortho                                                   2013_2014_Delta_PPO_Incentive_1500_3Cleanings_no_Ortho                                                      2013_2014_Delta_PPO_Incentive_1500_no_Ortho                                                      2013_2014_Delta_PPO_Incentive_2000_3Cleanings_no_Ortho                                                  2013_2014_Delta_PPO_Incentive_2000_no_Ortho                                                                      2013_2014_Delta_PPO_Incentive_Unlimited_no_Ortho                                     2013_2014_Delta_PPO_Incentive_Unlimited_no_Ortho_3Cleanings

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With Ortho Adult and Child

                                                                                                 2013_2014_Delta_PPO_Incentive_1000_with_Ortho_A_100_2000                                                                                                                                                                         2013_2014_Delta_PPO_Incentive_1500_with_Ortho_A_50_1500                                                                                                                                                                                         2013_2014_Delta_PPO_Incentive_2000_with_Ortho_A_100_1000                                                                                                                                         2013_2014_Delta_PPO_Incentive_1000_with_Ortho_A_50_500                           2013_2014_Delta_PPO_Incentive_1000_with_Ortho_A_50_1000                       2013_2014_Delta_PPO_Incentive_1000_with_Ortho_A_50_1500                  2013_2014_Delta_PPO_Incentive_1000_with_Ortho_A_50_2000                2013_2014_Delta_PPO_Incentive_1000_with_Ortho_A_100_1000                2013_2014_Delta_PPO_Incentive_1000_with_Ortho_A_100_3000                                       2013_2014_Delta_PPO_Incentive_1500_Ortho_A_100_2000                                                            2013_2014_Delta_PPO_Incentive_1500_with_Ortho_A_50_500                    2013_2014_Delta_PPO_Incentive_1500_with_Ortho_A_50_1000 2013_2014_Delta_PPO_Incentive_1500_with_Ortho_A_50_2000_3Cleanings 2013_2014_Delta_PPO_Incentive_1500_with_Ortho_A_100_2000                                                     2013_2014_Delta_PPO_Incentive_2000_Ortho_A_100_3000_3Cleanings 2013_2014_Delta_PPO_Incentive_2000_with_Ortho_A_50_2000                   2013_2014_Delta_PPO_Incentive_2000_with_Ortho_A_75_1500            2013_2014_Delta_PPO_Incentive_2000_with_Ortho_A_75_2250                2013_2014_Delta_PPO_Incentive_2000_with_Ortho_A_100_2000             2013_2014_Delta_PPO_Incentive_2000_with_Ortho_A_100_3000 2013_2014_Delta_PPO_Incentive_2000_with_Ortho_A_100_3000_3Cleanings 2013_2014_Delta_PPO_Incentive_Unlimited_with_Ortho_A_50_1000 2013_2014_Delta_PPO_Incentive_Unlimited_with_Ortho_A_100_2000 2013_2014_Delta_PPO_Incentive_Unlimited_with_Ortho_A_100_3000

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With Ortho Child Only

2013_2014_Delta_PPO_Incentive_1000_Ortho_C_50_500                                                                                                 2013_2014_Delta_PPO_Incentive_1000_with_Ortho_C_50_1000           2013_2014_Delta_PPO_Incentive_1000_with_Ortho_C_50_2000                 2013_2014_Delta_PPO_Incentive_1000_with_Ortho_C_100_1000             2013_2014_Delta_PPO_Incentive_1500_with_Ortho_C_100_2000                                                                                          2013_2014_Delta_PPO_Incentive_Unlimited_with_Ortho_C_50_500                                                                                  2013_2014_Delta_PPO_Incentive_Unlimited_with_Ortho_C_75_750         2013_2014_Delta_PPO_Incentive_1000_with_Ortho_C_50_1500                     2013_2014_Delta_PPO_Incentive_1500_Ortho_C_50_1500                           2013_2014_Delta_PPO_Incentive_1500_with_Ortho_C_50_500             2013_2014_Delta_PPO_Incentive_1500_with_Ortho_C_50_1000           2013_2014_Delta_PPO_Incentive_1500_with_Ortho_C_50_2000                2013_2014_Delta_PPO_Incentive_2000_with_Ortho_C_50_1000

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Delta PPO

No Ortho

2013_2014_Delta_PPO_1500_3Cleanings_no_Ortho                                                                                  2013_2014_Delta_PPO_1500_no_Ortho                                                                                  2013_2014_Delta_PPO_2000_3Cleanings_no_Ortho                                                                                 2013_2014_Delta_PPO_2000_no_Ortho                                                                                                      2013_2014_Delta_PPO_3000_no_Ortho                                                                                               2013_2014_Delta_PPO_Unlimited_no_Ortho

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With Ortho Adult and Child

2013_2014_Delta_PPO_1500_Ortho_A_50_1000                                                                    2013_2014_Delta_PPO_1500_Ortho_A_50_1500                                                                     2013_2014_Delta_PPO_1500_Ortho_A_75_1500                                                                      2013_2014_Delta_PPO_1500_Ortho_A_75_2250                                                                  2013_2014_Delta_PPO_1500_Ortho_A_100_3000                                                                 2013_2014_Delta_PPO_2000_Ortho_A_50_2000                                                       2013_2014_Delta_PPO_2000_Ortho_A_50_2000_3Cleanings                                              2013_2014_Delta_PPO_2000_Ortho_A_75_1500                                                                 2013_2014_Delta_PPO_2000_Ortho_A_100_2000                                        2013_2014_Delta_PPO_2000_Ortho_A_100_2000_3Cleanings                                          2013_2014_Delta_PPO_2000_Ortho_A_100_3000                                                                                                                        2013_2014_Delta_PPO_2000_with_Ortho_A_50_1500                                               2013_2014_Delta_PPO_2000_with_Ortho_A_75_2250                                                         2013_2014_Delta_PPO_3000_Ortho_A_50_1000                                                                   2013_2014_Delta_PPO_3000_Ortho_A_50_2000                                                                   2013_2014_Delta_PPO_3000_Ortho_A_75_1500                                                                     2013_2014_Delta_PPO_3000_Ortho_A_75_2250                                            2013_2014_Delta_PPO_3000_Ortho_A_100_1000_3Cleanings                                           2013_2014_Delta_PPO_3000_Ortho_A_100_2000                                                              2013_2014_Delta_PPO_3000_Ortho_A_100_3000                                        2013_2014_Delta_PPO_3000_Ortho_A_100_3000_3Cleanings                2013_2014_Delta_PPO_Unlimited_3Cleanings_Ortho_A_50_2000        2013_2014_Delta_PPO_Unlimited_3Cleanings_Ortho_A_100_1000                             2013_2014_Delta_PPO_Unlimited_Ortho_A_100_3000

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With Ortho Child Only

2013_2014_Delta_PPO_1500_Ortho_C_75_1500                                                             2013_2014_Delta_PPO_1500_with_Ortho_C_50_500                                                                                                                            2013_2014_Delta_PPO_2000_Ortho_C_100_1000                                                               2013_2014_Delta_PPO_2000_Ortho_C_100_2000                                                                   2013_2014_Delta_PPO_3000_Ortho_C_50_500                                                              2013_2014_Delta_PPO_Unlimited_Ortho_C_50_1000

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Vision Plan Documents

Medical Eye Service

2013_2014_MES_Vision_Plan_A_0                                                                                                                                  2013_2014_MES_Vision_Plan_A_5                                                                                                                                2013_2014_MES_Vision_Plan_A_10                                                                                                                          2013_2014_MES_Vision_Plan_A_20                                                                                                                          2013_2014_MES_Vision_Plan_B_0                                                                                                                          2013_2014_MES_Vision_Plan_B_10                                                                                                                                2013_2014_MES_Vision_Plan_B_15                                                                                                                          2013_2014_MES_Vision_Plan_C_0                                                                                                                                       2013_2014_MES_Vision_Plan_C_5                                                                                                                                  2013_2014_MES_Vision_Plan_C_10                                                                                                                       2013_2014_MES_Vision_Plan_C_20                                                                                                                             

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Vision Service Plan

2013_2014_VSP_Choice_Plan_A_20                                                                                                                             2013_2014_VSP_Choice_Plan_B_20                                                                                                                        2013_2014_VSP_SignaturePlan_A_0                                                                                                                    2013_2014_VSP_SignaturePlan_A_5_25                                                                                                                       2013_2014_VSP_SignaturePlan_A_10                                                                                                                    2013_2014_VSP_SignaturePlan_A_10_25                                                                                                                 2013_2014_VSP_SignaturePlan_A_15                                                                                                                  2013_2014_VSP_SignaturePlan_A_15_25                                                                                                                     2013_2014_VSP_SignaturePlan_A_20                                                                            2013_2014_VSP_SignaturePlan_A_20_2nd_pair_glasses_contacts                                                                    2013_2014_VSP_SignaturePlan_A_20_25                                                                                                                 2013_2014_VSP_SignaturePlan_B_0                                                                                                               2013_2014_VSP_SignaturePlan_B_0_25                                                                                                                      2013_2014_VSP_SignaturePlan_B_5                                                                                                                        2013_2014_VSP_SignaturePlan_B_5_25                                                                                                                        2013_2014_VSP_SignaturePlan_B_10                                                                                                                                2013_2014_VSP_SignaturePlan_B_15                                                                                                                 2013_2014_VSP_SignaturePlan_B_15_25                                                                                                            2013_2014_VSP_SignaturePlan_B_20                                                                                                                   2013_2014_VSP_SignaturePlan_B_20_25                                                                                                                     2013_2014_VSP_SignaturePlan_C_0                                                                                                                              2013_2014_VSP_SignaturePlan_C_5                                                                                          2013_2014_VSP_SignaturePlan_C_5_2nd_pair_Glasses                                                                                   2013_2014_VSP_SignaturePlan_C_5_25                                                                                                                       2013_2014_VSP_SignaturePlan_C_10                                                                                                                   2013_2014_VSP_SignaturePlan_C_10_25                                                                                                             2013_2014_VSP_SignaturePlan_C_15                                                                                                           2013_2014_VSP_SignaturePlan_C_15_25                                                                                                               2013_2014_VSP_SignaturePlan_C_20                                                                                                              2013_2014_VSP_SignaturePlan_C_20_25                                                                                                                              2013_2014_VSP_SignaturePlan_B_10_25

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Basic Life Insurance Booklets

2013_2014_Life_NO_Dep_Coverage_Booklet                                                                                     2013_2014_Life_with_Dep_Coverage_Booklet

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Frozen Plans

Anthem PPO Benefit Booklet

2013_2014_Anthem_PPO_100_A_0_Benefit_Booklet                                                    2013_2014_Anthem_PPO_100_A_30_Benefit_Booklet                                                    2013_2014_Anthem_PPO_100_B_0_Benefit_Booklet                                                       2013_2014_Anthem_PPO_100_B_10_Benefit_Booklet                                                      2013_2014_Anthem_PPO_100_C_0_Benefit_Booklet                                                     2013_2014_Anthem_PPO_100_D_10_Benefit_Booklet                                                  2013_2014_Anthem_PPO_100_D_30_Benefit_Booklet                                                                     2013_2014_Anthem_PPO_90_A_10_Benefit Booklet                                                          2013_2014_Anthem_PPO_90_C_10_Benefit_Booklet                                                        2013_2014_Anthem_PPO_90_C_20_Benefit_Booklet                                                        2013_2014_Anthem_PPO_90_D_10_Benefit_Booklet                                                        2013_2014_Anthem_PPO_90_E_20_Benefit_Booklet                                                        2013_2014_Anthem_PPO_80_A_20_Benefit_Booklet

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Anthem PPO Benefit Summary

2013_2014_Anthem_PPO_100_A_0_Benefit_Summary                                             2013_2014_Anthem_PPO_100_A_30_Benefit_Summary                                                2013_2014_Anthem_PPO_100_B_0_Benefit_Summary                                                 2013_2014_Anthem_PPO_100_B_10_Benefit_Summary                                             2013_2014_Anthem_PPO_100_C_0_Benefit_Summary                                             2013_2014_Anthem_PPO_100_D_10_Benefit_Summary                                           2013_2014_Anthem_PPO_100_D_30_Benefit_Summary                                             2013_2014_Anthem_PPO_90_A_10_Benefit_Summary                                                2013_2014_Anthem_PPO_90_C_10_Benefit_Summary                                                2013_2014_Anthem_PPO_90_C_20_Benefit_Summary                                                           2013_2014_Anthem_PPO_90_D_10_Benefit_Summary                                                   2013_2014_Anthem_PPO_90_E_20_Benefit_Summary                                               2013_2014_Anthem_PPO_80_A_20_Benefit_Summary

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Blue Shield PPO Benefit Booklet

2013_2014_BlueShield_PPO_100_A_0_Benefit_Booklet                                     2013_2014_BlueShield_PPO_100_A_30_Benefit_Booklet                                             2013_2014_BlueShield_PPO_90_A_10_Benefit_Booklet                                               2013_2014_BlueShield_PPO_90_D_10_Benefit_Booklet 2013_2014_BlueShield_PPO_90_E_20_Benefit_Booklet                                                                                     

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Blue Shield PPO Benefit Summary

2013_2014_BlueShield_PPO_100_A_0_Benefit_Summary                                    2013_2014_BlueShield_PPO_100_A_30_Benefit_Summary 2013_2014_BlueShield_PPO_100_B_10_Benefit_Summary                                  2013_2014_BlueShield_PPO_100_C_30_Benefit_Summary             2013_2014_BlueShield_PPO_100_D_30_Benefit_Summary                                      2013_2014_BlueShield_PPO_90_A_10_Benefit_Summary                                       2013_2014_BlueShield_PPO_90_A_30_Benefit_Summary                                       2013_2014_BlueShield_PPO_90_B_10_Benefit_Summary                                      2013_2014_BlueShield_PPO_90_C_10_Benefit_Summary                                       2013_2014_BlueShield_PPO_90_D_10_Benefit_Summary                                       2013_2014_BlueShield_PPO_90_E_10_Benefit_Summary                                      2013_2014_BlueShield_PPO_90_E_20_Benefit_Summary                                       2013_2014_BlueShield_PPO_80_A_20_Benefit_Summary                                            2013_2014_BlueShield_PPO_80_D_10_Benefit_Summary                                        2013_2014_BlueShield_PPO_80_D_20_Benefit_Summary                                      2013_2014_BlueShield_PPO_80_D_30_Benefit_Summary                                      2013_2014_BlueShield_PPO_80_G_10_Benefit_Summary 

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Prescription Drug

2013_2014_RX_0_0                                                                                                                                                                2013_2014_RX_5_10                                                  2013_2014_RX_3_15_25                                                                                                                                       2013_2014_RX_3_15_100_300_DED                                                                                                                                                     2013_2014_RX_5_5                                                                                                                                                                                    2013_2014_RX_5_7                                                                                                                                                                        2013_2014_RX_5_10_25                                                                                                                                                 2013_2014_RX_5_20_100_300_DED                                                                                                                                                2013_2014_RX_7_9                                                                                                                                                                              2013_2014_RX_10_10                                                                                                                                                                           2013_2014_RX_0_0                                                                                                                                                                             2013_2014_RX_5_10

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Anthem HMO Benefit Booklet

2013_2014_AnthemHMO_Modified_Premier_5_EOC                                         2013_2014_AnthemHMO_Value_30_45_20_Ded_2000_EOC                                      2013_2014_AnthemHMO_Value_30_45_1000_3_day_EOC

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Anthem HMO Benefit Summary

2013_2014_AnthemHMO_Value_30_45_1000_3_day_Benefit_Summary 2013_2014_AnthemHMO_Value_Ded_2000_30_45_20_Benefit_Summary

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Anthem HMO Rider

2013_2014_Anthem_HMO_CHIRO_5_40_Rider

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Blue Shield HMO Benefit Booklet

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Blue Shield HMO Benefit Summary

2013_2014_BlueShield_HMO_5_0_hearing                                                                                      2013_2014_BlueShield_HMO_20_500_hearing                                                 2013_2014_BlueShield_HMO_facility_coinsurance_15_20_hearing              2013_2014_BlueShield_HMO_facility_coinsurance_40_40_hearing                                        2013_2014_BlueShield_HMO_SaveNet_5_0_hearing                                                   2013_2014_BlueShield_HMO_SaveNet_20_500_hearing                 2013_2014_BlueShield_HMO_SaveNet_facility_coinsurance_15_20_hearing 2013_2014_BlueShield_HMO_SaveNet_facility_coinsurance_40_40_hearing

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Kaiser Evidence of Coverage

225543- Southern California

2013_2014_Kaiser_0_OV_5_RX_EOC                                                                                                 2013_2014_Kaiser_0_OV_5_RX_Vision_EOC                                                                                                 2013_2014_Kaiser_5_OV_5_RX_EOC                                                                                                           2013_2014_Kaiser_15_OV_15_RX_EOC                                                                                          2013_2014_Kaiser_15_OV_15_RX_Vision_EOC

600115 – Northern California

2013_2014_Kaiser_0_OV_5_Rx_EOC                                                                                                                2013_2014_Kaiser_5_OV_5_Rx_EOC                                                                                                            2013_2014_Kaiser_15_OV_15_Rx_EOC                                                                                                2013_2014_Kaiser_25_OV_10_25_Rx_EOC

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Kaiser Benefit Summary

225543-Southern California

2013_2014_KP_0_OV_5_Rx_Benefit_Summary                                                              2013_2014_KP_0_OV_5_Rx_Chiro_Benefit_Summary                                     2013_2014_KP_0_OV_5_Rx_Chiro_Vision_Benefit_Summary                                    2013_2014_KP_0_OV_5_Rx_Vision_Benefit_Summary                                             2013_2014_KP_5_OV_5_Rx_100_ER_Benefit_Summary                             2013_2014_KP_5_OV_5_Rx_100_ER_CHIRO_Benefit_Summary                2013_2014_KP_15_OV_15_Rx_100_ER_CHIRO_Benefit_Summary 2013_2014_KP_15_OV_15_Rx_100_ER_CHIRO_Vision_Benefit_Summary

600115-Northern California

2013_2014_KP_0_OV_5_Rx_100_ER_Benefit_Summary                                             2013_2014_KP_5_OV_5_Rx_Benefit_Summary                 2013_2014_KP_15_OV_15_Rx_Benefit_Summary                                                                   2013_2014_KP_25_OV_10_25_Rx_Benefit_Summary

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Our Philosophy – “Schools Helping Schools”

Our Goal is to provide the best coverage and service to our members while keeping costs affordable and stable.

SISC is a Joint Powers Authority administered by the Kern County Superintendent of Schools Office, Mary C. Barlow, Superintendent

SISC

2000 K Street Bakersfield, CA 93301

661.636.4710

661.636.4156