Medical summaries of benefits and coverage (SBC)
Prescription drug coverage (provided by CVS Caremark)
Plan descriptions and summaries
Schedule of benefits
Benefit forms
Compliance notices
Medical summaries of benefits coverage (SBC)
Aetna
- Aetna HDHP Standard (Choice POS II) – 2021 [PDF]
- Aetna HDHP Premium (Choice POS II) – 2021 [PDF]
- Aetna EPO (Select) – 2021 [PDF]
- Aetna Indemnity (Traditional Choice) – 2021 [PDF]
HMSA
- HMSA (Hawaii) – 2021 [PDF]
Kaiser Permanente
- Kaiser Permanente HMO (California) – 2021 [PDF]
- Kaiser Permanente HMO (Georgia) – 2021 [PDF]
- Kaiser Permanente HMO (Northwest) – 2021 [PDF]
- Kaiser Permanente HMO (Washington) – 2021 [PDF]
UnitedHealthcare (UHC)
- UHC EPO (Choice) – 2021 [PDF]
- UHC HDHP Standard (Choice Plus) – 2021 [PDF]
- UHC HDHP Premium (Choice Plus) – 2021 [PDF]
- UHC PPO (Choice Plus) – 2021 [PDF]
Prescription drug coverage (provided by CVS Caremark)
Aetna
- Aetna HDHP Standard (Choice POS II) – 2018 [PDF]
- Aetna HDHP Premium (Choice POS II) – 2018 [PDF]
- Aetna PPO (Choice POS II) – 2018 [PDF]
- Aetna Indemnity (Traditional Choice) – 2018 [PDF]
- Aetna EPO (Select) – 2018 [PDF]
UnitedHealthcare (UHC)
- UHC HDHP Premium (Choice Plus) – 2018 [PDF]
- UHC HDHP Standard (Choice Plus) – 2018 [PDF]
- UHC EPO (Choice) – 2018 [PDF]
- UHC PPO (Choice Plus) – 2018 [PDF]
Plan descriptions and summaries
Medical: Aetna
- Aetna HDHP Standard – 2021 Schedule of Benefits [PDF]
- Aetna HDHP Premium – 2021 Schedule of Benefits [PDF]
- Aetna PPO – 2021 Schedule of Benefits [PDF]
- Aetna HDHP and PPO – 2021 booklet [PDF]
- Aetna EPO – 2021 Schedule of Benefits [PDF]
- Aetna EPO – 2021 booklet [PDF]
- Aetna Indemnity – 2021 Schedule of Benefits [PDF]
- Aetna Indemnity – 2021 booklet [PDF]
Medical: UnitedHealthcare (UHC)
- UHC EPO Summary Plan Description 2021 [PDF]
- UHC PPO Summary Plan Description 2021 [PDF]
- UHC Premium HDHP Summary Plan Description 2021 [PDF]
- UHC Standard HDHP Summary Plan Description 2021 [PDF]
Medical: Kaiser Permanente
- Kaiser Permanente (California) Acupuncture and Chiropractic – 2021 summary [PDF]
- Kaiser Permanente HMO (Northern and Southern California) – 2021 Summary [PDF]
- Kaiser Permanente HMO (Northern California) – 2021 Evidence of Coverage [PDF]
- Kaiser Permanente HMO (Southern California) – 2021 Evidence of Coverage [PDF]
- Kaiser Permanente HMO (Oregon) – 2021 summary [PDF]
- Kaiser Permanente HMO (Oregon) – 2021 Evidence of Coverage [PDF]
- Kaiser Permanente HMO (Washington) – 2021 Summary [PDF]
- Kaiser Permanente HMO (Washington) – 2021 Evidence of Coverage [PDF]
- Kaiser Permanente HMO (Georgia) – 2021 Summary [PDF]
- Kaiser Permanente HMO (Georgia) – 2021 Evidence of Coverage [PDF]
Medical: HMSA
- HMSA (Hawaii) – 2021 Acupuncture Booklet [PDF]
- HMSA (Hawaii) – 2021 Booklet [PDF]
- HMSA (Hawaii) – 2021 Prescription Booklet [PDF]
International
- Cigna International – 2017 booklet [PDF]
- Cigna International Benefits Summary [PDF]
- Cigna Medical Benefits Abroad (MBA) [PDF]
Dental
Vision
- VSP – 2021 summary [PDF]
- VSP – 2021 booklet [PDF]
Employee Assistance Program
- CONCERN – Evidence of coverage [PDF]
- CONCERN – 2019 summary [PDF]
Life and Accident
- Life and AD&D MetLife Certificate of Coverage [PDF]
- Business Travel Accident – 2018–2021 summary [PDF]
- BTA Renewal 2020 [PDF]
Disability
- Short-Term Disability Plan – 2021 booklet [PDF]
- Short-Term Disability Plan – 2021 summary [PDF]
- MetLife Long-Term-Disability booklet [PDF]
- MetLife Long-Term-Disability FAQ [PDF]
- CA Voluntary Disability Plan – 2021 booklet [PDF]
- CA Voluntary Disability Plan – 2021 summary [PDF]
401(k)
- 401(k) Summary Plan Description [PDF]
- Enrollment Guide [PDF]
Summary Plan Descriptions
Schedule of benefits
- Aetna HDHP Standard (Choice POS II) – 2019 [PDF]
- Aetna HDHP Premium (Choice POS II) – 2019 [PDF]
- Aetna EPO (Select) – 2019 [PDF]
- Aetna Indemnity (Traditional Choice) – 2019 [PDF]
- Aetna PPO (Choice POS II) – 2019 [PDF]
Benefit forms
- Affidavit of Dependent Status of Domestic Partner [PDF]
- Affidavit of Termination of Domestic Partner [PDF]
- Dependent Care Account Claim and Provider Documentation Form 2020 [PDF]
- Domestic Partner Declaration [PDF]
- Healthcare Security Ordinance Form (San Francisco Only) [PDF]
- HSA Rollover Form [PDF]
- Mail Order Pharmacy Form [PDF]
- Paid Family Leave Insurance Program 2020 [PDF]
Compliance notices
- Summary Annual Report—Salesforce.com [PDF]
- Summary Annual Report—Salesforce.org [PDF]
- Summary Annual Report—Vlocity [PDF]
- Tableau Summary Annual Report [PDF]
- CA VDI Rejection Notice [PDF]
- CHIP Model notice [PDF]
- Domestic Partner Benefits Status Memo [PDF]
- HIPAA Reminder Notice [PDF]
- Legal Notices [PDF]
- Medicare Part D [PDF]
- New Health Insurance Marketplace Coverage Options and Your Health Coverage [PDF]
- YOU HAVE COVERAGE THROUGH SALESFORCE THAT FAR EXCEEDS THE MINIMUM STANDARD. We are legally obligated to send this notice to you but suggest that you focus your limited time on making smart choices about your company benefits.
- Notice Privacy of Practices [PDF]
- Summary Annual Report—Exact Target [PDF]
- Summary Annual Report—Mulesoft [PDF]