Members Download Center
Download these important documents for your reference.
For more information about your health plan, please contact Member Services directly at 415-834-2118 (TTY: 1-877-681-8898 for hearing impaired), Monday thru Friday, 8:30 AM - 5:00 PM.
CCHP Group Plan Downloads (PDF)
- Ruby & Opal Group Plans Benefit Matrix (English and Chinese)
- Group Plans A to E Benefit Matrix (English) (Chinese)
- Active Choice Small Group Benefit Matrix (English) (Chinese)
- 2012 List of Covered Drugs (Formulary) (English)
- Pharmacy Directory (English and Chinese)
- Provider Directory (English and Chinese)
- Employer Enrollment Form (English)
- Employee Enrollment Form (English)
Dental Plan Rider:
Vision Plan Rider:
CCHP Individual/Family Plan Downloads (PDF)
- Jade & Amber Summary of Benefits (English and Chinese)
- Copay25 & Active Choice Summary of Benefits (English and Chinese)
- Copay25 & Active Choice Plans Rate Sheet (English and Chinese)
- 2012 List of Covered Drugs (Formulary) (English)
- Pharmacy Directory (English and Chinese)
- Provider Directory (English and Chinese)
- Application for Enrollment (English and Chinese)
- Enrollment Guidelines (English and Chinese)
- Member Rights and Responsibilities (English)
- VSP Vision Rider Enrollment Application
- VSP Vision Rider Provider Directory
- VSP Vision Rider Rates & Summary of Benefit
- HIPAA GI Plan Benefit Matrix
- HIPAA GI Plan Enrollment Application
- HIPAA GI Plan & Conversion Plan San Francisco Rates
- HIPAA GI Plan & Conversion Plan San Mateo Rates
- Conversion Plan Benefit Matrix
- Conversion Plan Enrollment Application