Plan Names, ID Card and Provider Directory Reference Guide

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1 Anthem Blue Cross of California Provider Directory: Plan name on CoveredCA.com Plan name on ID card Plan name on Anthem s website Anthem Platinum 90 PPO Anthem Gold 80 PPO, an MSP Anthem Silver 70 PPO, an MSP Anthem Silver 73 PPO, an MSP Anthem Silver 87 PPO, an MSP Anthem Silver 94 PPO, an MSP Anthem Bronze 60 PPO Anthem Bronze 60 HSA PPO Anthem Minimum Coverage PPO Anthem Platinum 90 EPO Anthem Gold 80 EPO, an MSP Anthem Silver 70 EPO, an MSP Anthem Platinum DirectAccess - ceab Anthem Gold DirectAccess, a Multi-State Plan Anthem Bronze DirectAccess - cacf Anthem Bronze DirectAccess w/hsa - cach Anthem Catastrophic DirectAccess Anthem Platinum DirectAccess - ceac Anthem Gold DirectAccess, a Multi-State Plan Exchange/Platinum DirectAccess Exchange/Gold DirectAccess Exchange/Bronze DirectAccess Exchange/Bronze DirectAccess w/hsa Exchange/Catastrophic DirectAccess Exchange/Platinum DirectAccess Exchange/Gold DirectAccess

2 Anthem Blue Cross of California Provider Directory: Plan name on CoveredCA.com Plan name on ID card Plan name on Anthem s website Anthem Silver 73 EPO, an MSP Anthem Silver 87 EPO, an MSP Anthem Silver 94 EPO, an MSP Anthem Bronze 60 EPO Anthem Bronze 60 HSA EPO Anthem Minimum Coverage EPO Anthem Platinum 90 HMO Anthem Gold 80 HMO, an MSP Anthem Silver 70 HMO Anthem Silver 73 HMO Anthem Silver 87 HMO Anthem Silver 94 HMO Anthem Bronze DirectAccess - cacg Anthem Bronze DirectAccess w/hsa - caci Anthem Catastrophic DirectAccess Anthem Platinum GuidedAccess - cead Anthem Gold GuidedAccess, a Multi-State Plan Anthem Silver GuidedAccess - cbmu Anthem Silver GuidedAccess - cbmv Anthem Silver GuidedAccess - cbmw Anthem Silver GuidedAccess - cbmx Exchange/Bronze DirectAccess Exchange/Bronze DirectAccess w/hsa Exchange/Catastrophic DirectAccess Pathway X-(HMO) Individual via Exchange/Platinum GuidedAccess Pathway X-(HMO) Individual via Exchange/Gold GuidedAccess Pathway X-(HMO) Individual via Exchange/Silver GuidedAccess Pathway X-(HMO) Individual via Exchange/Silver GuidedAccess Pathway X-(HMO) Individual via Exchange/Silver GuidedAccess Pathway X-(HMO) Individual via Exchange/Silver GuidedAccess

3 Blue Shield of California Provider Directory PPO: Provider Directory EPO: Plan name on CoveredCA.com Plan name on ID card Plan name on Blue Shield s website Blue Shield Platinum 90 EPO Ultimate EPO Ultimate EPO (Platinum level) Blue Shield Gold 80 EPO Preferred EPO Preferred EPO (Gold level) Blue Shield Silver 70 EPO Enhanced EPO Enhanced EPO (Silver level) Blue Shield Silver 73 EPO Enhanced EPO 250 Subsidy Enhanced EPO 250 Subsidy (Silver level) Blue Shield Silver 87 EPO Enhanced EPO 200 Subsidy Enhanced EPO 200 Subsidy (Silver level) Blue Shield Silver 94 EPO Enhanced EPO 150 Subsidy Enhanced EPO 150 Subsidy (Silver level) Blue Shield Bronze 60 EPO Basic EPO Basic EPO (Bronze level) Blue Shield Bronze 60 HSA EPO Basic EPO for HSA Basic EPO for HSA (Bronze level) Blue Shield Minimum Coverage EPO Get Covered EPO Get Covered EPO (Catastrophic) Blue Shield Platinum 90 PPO Ultimate PPO Ultimate PPO (Platinum level) Blue Shield Gold 80 PPO Preferred PPO Preferred PPO (Gold level) Blue Shield Silver 70 PPO Enhanced PPO Enhanced PPO (Silver level) Blue Shield Silver 73 PPO Enhanced PPO 250 Subsidy Enhanced PPO (Silver level) Blue Shield Silver 87 PPO Enhanced PPO 200 Subsidy Enhanced PPO (Silver level) Blue Shield Silver 94 PPO Enhanced PPO 150 Subsidy Enhanced PPO (Silver level) Blue Shield Bronze 60 PPO Basic PPO Basic PPO (Bronze level) Blue Shield Bronze 60 HSA PPO Basic PPO for HSA Basic PPO for HSA (Bronze level) Blue Shield Minimum Coverage PPO Get Covered PPO Get Covered PPO (Catastrophic)

4 Provider Directory: Contra Costa Health Plan Plan name on CoveredCA.com Contra Costa Health Plan Platinum 90 HMO Plan name on ID card Contra Costa Health Plan's Platinum Plan for Covered California Exchange Plans Plan name on Contra Costa Health Plan s website Contra Costa Health Plan's Platinum Plan for Covered California Exchange Plans Contra Costa Health Plan Gold 80 HMO Contra Costa Health Plan Silver 70 HMO Contra Costa Health Plan Silver 73 HMO Contra Costa Health Plan's Gold Plan for Covered California Exchange Plans Contra Costa Health Plan's Silver Standard Plan for Covered California Exchange Plans Contra Costa Health Plan's Silver 250 Plan for Covered California Exchange Plans Contra Costa Health Plan's Gold Plan for Covered California Exchange Plans Contra Costa Health Plan's Silver Standard Plan for Covered California Exchange Plans Contra Costa Health Plan's Silver 250 Plan for Covered California Exchange Plans Contra Costa Health Plan Silver 87 HMO Contra Costa Health Plan's Silver 200 Plan for Covered California Exchange Plans Contra Costa Health Plan's Silver 200 Plan for Covered California Exchange Plans Contra Costa Health Plan Silver 94 HMO Contra Costa Health Plan Bronze 60 HMO Contra Costa Health Plan Minimum Coverage HMO Contra Costa Health Plan's Silver 150 Plan for Covered California Exchange Plans Contra Costa Health Plan's Bronze Plan for Covered California Exchange Plans Contra Costa Health Plan's Minimum Coverage Plan for Covered California Exchange Plans Contra Costa Health Plan's Silver 150 Plan for Covered California Exchange Plans Contra Costa Health Plan's Bronze Plan for Covered California Exchange Plans Contra Costa Health Plan's Minimum Coverage Plan for Covered California Exchange Plans

5 Chinese Community Health Plan Provider Directory: Plan name on CoveredCA.com Plan name on ID card Plan name on Chinese Community Health Plan s website Chinese Community Platinum 90 HMO No plan name on ID card Platinum 90 HMO Chinese Community Gold 80 HMO No plan name on ID card Gold 80 HMO Chinese Community Silver 70 HMO No plan name on ID card Silver 70 HMO Chinese Community Silver 73 HMO No plan name on ID card Silver 73 HMO Chinese Community Silver 87 HMO No plan name on ID card Silver 87 HMO Chinese Community Silver 94 HMO No plan name on ID card Silver 94 HMO Chinese Community Bronze 60 HMO No plan name on ID card Bronze 60 HMO Chinese Community Minimum Coverage HMO No plan name on ID card Minimum Coverage HMO

6 Provider Directory: Health Net Plan name on CoveredCA.com Plan name on ID card Plan name on Health Net s website Health Net Platinum 90 PPO Health Net PPO Platinum $20/$0 Health Net PPO Platinum $20/$0 Health Net Gold 80 PPO Health Net PPO Gold $30/$0 Health Net PPO Gold $30/$0 Health Net Silver 70 PPO Health Net PPO Silver $45/$2000 Health Net PPO Silver $45/$2000 Health Net Silver 73 PPO Health Net PPO Silver $40/$1500 Health Net PPO Silver $40/$1500 Health Net Silver 87 PPO Health Net PPO Silver $15/$500 Health Net PPO Silver $15/$500 Health Net Silver 94 PPO Health Net PPO Silver $3/$0 Health Net PPO Silver $3/$0 Health Net Bronze 60 PPO Health Net PPO Bronze $60/$5000 Health Net PPO Bronze $60/$5000 Health Net Minimum Coverage PPO Health Net PPO Catastrophic $0/$6350 Health Net PPO Catastrophic $0/$6350 Health Net Platinum 90 HMO Health Net CommunityCare HMO Platinum $20/$0 Health Net CommunityCare HMO Platinum $20/$0 Health Net Gold 80 HMO Health Net CommunityCare Gold $30/$0 Health Net CommunityCare Gold $30/$0 Health Net Silver 70 HMO Health Net Silver 73 HMO Health Net Silver 87 HMO Health Net Silver 94 HMO $45/$2000 $40/$1500 $15/$500 $3/$0 $45/$2000 $40/$1500 $15/$500 $3/$0

7 Provider Directory: Kaiser Permanente Plan name on CoveredCA.com Plan name on ID card Plan name on Kaiser Permanente s website Kaiser Permanente Platinum 90 HMO KP CA Platinum 0/20 Copayment Platinum KP CA Platinum 0/20 Kaiser Permanente Gold 80 HMO KP CA Gold 0/30 Copayment Gold KP CA Platinum 0/30 Kaiser Permanente Silver 70 HMO KP CA Silver 2000/45 Copayment Silver KP CA Silver 2000/45 Kaiser Permanente Silver 73 HMO KP CA Silver 2000/45 Enhanced Silver 73 Kaiser Permanente Silver 87 HMO KP CA Silver 2000/45 Enhanced Silver 87 Kaiser Permanente Silver 94 HMO KP CA Silver 2000/45 Enhanced Silver 94 Kaiser Permanente Bronze 60 HMO KP CA Bronze 5000/60 Deductible Bronze KP CA Bronze 5000/60 Kaiser Permanente Bronze 60 HSA KP CA Bronze HSA 4500/40% HSA Bronze KP CA Bronze 4500/40% Kaiser Permanente Minimum Coverage HMO KP CA Catastrophic 6350/0 Deductible Catastrophic KP CA Catastrophic 6350/0

8 Provider Directory: L.A. Care Health Plan Plan name on CoveredCA.com Plan name on ID card Plan name on L.A. Care s website L.A. Care Platinum 90 HMO L.A. Care Covered Platinum HMO L.A. Care Covered Platinum HMO L.A. Care Gold 80 HMO L.A. Care Covered Gold HMO L.A. Care Covered Gold HMO L.A. Care Silver 70 HMO L.A. Care Covered Silver HMO L.A. Care Covered Silver HMO L.A. Care Silver 73 HMO L.A. Care Covered Silver 73 HMO L.A. Care Covered Silver 73 HMO L.A. Care Silver 87 HMO L.A. Care Covered Silver 87 HMO L.A. Care Covered Silver 87 HMO L.A. Care Silver 94 HMO L.A. Care Covered Silver 94 HMO L.A. Care Covered Silver 94 HMO L.A. Care Bronze 60 HMO L.A. Care Covered Bronze HMO L.A. Care Covered Bronze HMO L.A. Care Minimum Coverage HMO L.A. Care Covered Minimum Coverage HMO L.A. Care Covered Minimum Coverage HMO

9 Molina Healthcare Provider Directory: Plan name on CoveredCA.com Plan name on ID card Plan name on Molina s website Molina Healthcare Platinum 90 HMO Platinum 90 Molina Healthcare Platinum 90 HMO Molina Healthcare Gold 80 HMO Gold 80 Molina Healthcare Gold 80 HMO Molina Healthcare Silver 70 HMO Silver 70 Molina Healthcare Silver 70 HMO Molina Healthcare Silver 73 HMO Silver 73 Molina Healthcare Silver 73 HMO Molina Healthcare Silver 87 HMO Silver 87 Molina Healthcare Silver 87 HMO Molina Healthcare Silver 94 HMO Silver 94 Molina Healthcare Silver 94 HMO Molina Healthcare Bronze 60 HMO Bronze 60 Molina Healthcare Bronze 60 HMO Molina Healthcare Minimum Coverage HMO Minimum Coverage Molina Healthcare Minimum Coverage HMO

10 Sharp Health Plan* Provider Directory: *Sharp has two separate HMO networks. Network 1: HMO-1 or Premier Network: This network has copay. Network 2: HMO-2 or Performance Network: This network has coinsurance. Plan name on CoveredCA.com Plan name on ID card Plan name on Sharp s website Sharp Platinum 90 HMO - 1 Sharp Platinum 90 HMO Premier 0/20/250 Sharp Platinum 90 HMO Premier 0/20/250 Sharp Platinum 90 HMO - 2 Sharp Platinum 90 HMO Performance 0/20/10% Sharp Platinum 90 HMO Performance 0/20/10% Sharp Gold 80 HMO - 1 Sharp Gold 80 HMO Premier 0/30/600 Sharp Gold 80 HMO Premier 0/30/600 Sharp Gold 80 HMO - 2 Sharp Gold 80 HMO Performance 0/30/20% Sharp Gold 80 HMO Performance 0/30/20% Sharp Silver 70 HMO - 1 Sharp Silver 70 HMO Premier 2000/45/20% Sharp Silver 70 HMO Premier 2000/45/20% Sharp Silver 70 HMO - 2 Sharp Silver 70 HMO Performance 2000/45/20% Sharp Silver 70 HMO Performance 2000/45/20% Sharp Silver 73 HMO - 1 Sharp Silver 73 HMO Premier 1500/40/20% Sharp Silver 73 HMO Premier 1500/40/20% Sharp Silver 73 HMO - 2 Sharp Silver 73 HMO Performance 1500/40/20% Sharp Silver 73 HMO Performance 1500/40/20% Sharp Silver 87 HMO - 1 Sharp Silver 87 HMO Premier 500/15/15% Sharp Silver 87 HMO Premier 500/15/15% Sharp Silver 87 HMO - 2 Sharp Silver 87 HMO Performance 500/15/15% Sharp Silver 87 HMO Performance 500/15/15% Sharp Silver 94 HMO - 1 Sharp Silver 94 HMO Premier 0/3/10% Sharp Silver 94 HMO Premier 0/3/10% Sharp Silver 94 HMO - 2 Sharp Silver 94 HMO Performance 0/3/10% Sharp Silver 94 HMO Performance 0/3/10% Sharp Bronze 60 HMO Sharp Bronze 60 HMO Performance 5000/60/30% Sharp Bronze 60 HMO Performance 5000/60/30% Sharp Bronze 60 HSA HMO Sharp Bronze 60 HSA Premier 4500/40%/40% Sharp Bronze 60 HSA Premier 4500/40%/40% Sharp Minimum Coverage HMO Sharp Minimum Coverage HMO Performance 6350/0/0 Sharp Minimum Coverage HMO Performance 6350/0/0

11 Valley Health Plan Provider Directory: Plan name on CoveredCA.com Plan name on ID card Plan name on Valley Health Plan s website Valley Health Plan Platinum 90 HMO Platinum 90 Platinum 90 Valley Health Plan Gold 80 HMO Gold 80 Gold 80 Valley Health Plan Silver 70 HMO Silver 70 Silver 70 Valley Health Plan Silver 73 HMO Silver 73 Silver 73 Valley Health Plan Silver 87 HMO Silver 87 Silver 87 Valley Health Plan Silver 94 HMO Silver 94 Silver 94 Valley Health Plan Minimum Coverage HMO Minimum Coverage Plan Minimum Coverage Plan Valley Health Plan Bronze 60 HMO Bronze 60 Bronze 60

12 Western Health Advantage Provider Directory: Plan name on CoveredCA.com Plan name on ID card Plan name on Western Health Advantage s website Western Health Advantage Platinum 90 HMO Platinum 90 Advantage Platinum 90 Western Health Advantage Gold 80 HMO Gold 80 Advantage Gold 80 Western Health Advantage Silver 70 HMO Silver 70 Advantage Silver 70 Western Health Advantage Silver 73 HMO Silver 73 Cost Sharing Reduction Plan Silver 73 Western Health Advantage Silver 87 HMO Silver 87 Cost Sharing Reduction Plan Silver 87 Western Health Advantage Silver 94 HMO Silver 94 Cost Sharing Reduction Plan Silver 94 Western Health Advantage Bronze 60 HSA HMO Bronze 60B HSA Advantage Bronze 60B HSA Western Health Advantage Bronze 60 HMO Bronze 60 Advantage Bronze 60 Western Health Advantage Minimum Coverage HMO Minimum Coverage Advantage Minimum Coverage

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