Medical Plan Document and Disclosure Forms (MPDDs)

2016 PPO Plans – California

PPO 10 Platinum
PPO 15 Gold
PPO 25 Gold
PPO 35 Silver
PPO 40 Silver
PPO 45 Silver
PPO Saver Bronze
HSA 1500 PPO Silver
HSA 2500 PPO Silver
HSA 3500 PPO Bronze

2016 HMO Plans – California

HMO 100 Platinum
HMO 80 Gold

Please Note: The Summary Plan Description for each benefit design and the related rate filings filed with the California Department of Insurance for each design constitute the Group Insurance Trust Rating Manual. The Rating Manual contains information sufficient to verify that Health and related dental and vision plans satisfy the requirements of Section 419A(f)(6). The trustees are required to maintain a record of the Rating Manual for all years of operations. Upon written request addressed to the Trustees of the Group Insurance Trust, a participating employer, the representative of a participating employer, or the Commissioner of Internal Revenue may obtain access to view and copy any such records.