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) – 2020 [PDF]
- Aetna HDHP Standard (Choice POS II) – 2021 [PDF]
- Aetna HDHP Premium (Choice POS II) – 2020 [PDF]
- Aetna HDHP Premium (Choice POS II) – 2021 [PDF]
- Aetna EPO (Select) – 2020 [PDF]
- Aetna EPO (Select) – 2021 [PDF]
- Aetna Indemnity (Traditional Choice) – 2020 [PDF]
- Aetna Indemnity (Traditional Choice) – 2021 [PDF]
HMSA
- HMSA (Hawaii) – 2020 [PDF]
- HMSA (Hawaii) – 2021 [PDF]
Kaiser Permanente
- Kaiser Permanente HMO (California) – 2020 [PDF]
- Kaiser Permanente HMO (Northwest) – 2020 [PDF]
- 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) – 2020 [PDF]
- UHC EPO (Choice) – 2021 [PDF]
- UHC HDHP Standard (Choice Plus) – 2020 [PDF]
- UHC HDHP Standard (Choice Plus) – 2021 [PDF]
- UHC HDHP Premium (Choice Plus) – 2020 [PDF]
- UHC HDHP Premium (Choice Plus) – 2021 [PDF]
- UHC PPO (Choice Plus) – 2020 [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 – 2020 summary [PDF]
- Aetna HDHP Premium – 2020 summary [PDF]
- Aetna PPO – 2020 summary [PDF]
- Aetna HDHP and PPO – 2020 booklet [PDF]
- Aetna EPO – 2020 summary [PDF]
- Aetna EPO – 2020 booklet [PDF]
- Aetna Indemnity – 2020 summary [PDF]
- Aetna Indemnity – 2020 booklet [PDF]
Medical: UnitedHealthcare (UHC)
- UHC EPO Summary Plan Description 2020 [PDF]
- UHC PPO Summary Plan Description 2020 [PDF]
- UHC Premium HDHP Summary Plan Description 2020 [PDF]
- UHC Standard HDHP Summary Plan Description 2020 [PDF]
Medical: Kaiser Permanente
- Kaiser Permanente (California) Acupuncture and Chiropractic – 2019 summary [PDF]
- Kaiser Permanente HMO (California) – 2019 summary [PDF]
- Kaiser Permanente HMO (California) – 2019 Evidence of Coverage [PDF]
- Kaiser Permanente HMO (Northwest) – 2019 summary [PDF]
- Kaiser Permanente HMO (Northwest) – 2019 Evidence of Coverage [PDF]
Medical: HMSA
- HMSA (Hawaii) – 2017 Acupuncture Booklet [PDF]
- HMSA (Hawaii) – 2017 Booklet [PDF]
- HMSA 2020 plan changes [PDF]
International
- Cigna International – 2017 booklet [PDF]
- Cigna International Benefits Summary [PDF]
- Cigna Medical Benefits Abroad (MBA) [PDF]
Dental
- Delta Dental – 2020 booklet [PDF]
- Dental plan highlights - 2020 [PDF]
- Dental plan highlights - 2021 [PDF]
Vision
- VSP Standard – 2020 summary [PDF]
- VSP Premium – 2020 summary [PDF]
- 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 – 2020 booklet [PDF]
- Short-Term Disability Plan – 2020 summary [PDF]
- MetLife Long-Term-Disability booklet [PDF]
- MetLife Long-Term-Disability FAQ [PDF]
- CA Voluntary Disability Plan – 2020 booklet [PDF]
- CA Voluntary Disability Plan – 2020 summary [PDF]
401(k)
- 401(k) Summary Plan Description [PDF]
- Enrollment Guide [PDF]
Summary Plan Descriptions
- Summary Plan Description (Cafeteria Plan) 2016-2017 [PDF]
- Summary Plan Description (Wrap) – 2016-2017 [PDF]
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]
- FSA-HSA Transition Flyer [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—Health and Welfare Plan [PDF]
- Summary Annual Report—Health and Welfare Plan (2018 plan year) [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]