CaliforniaChoice
Employer eKit

The CaliforniaChoice Employer eKit provides you access to the various forms and resources, via the links below, to assist you with your group enrollment. Please review the Guidelines section for the pertinent details.

Once the items on the Case Submission Checklist(s) have been completed, please return the completed forms and applications to your broker.

A second email, the Employee eKit, will arrive shortly. When you forward it to your employees they too will have access to resources and enrollment materials.

STEP 1:
Open, print and read the CaliforniaChoice Case Submission Checklist - Medical.

If you are also purchasing Dental and/or Life coverage for your employees, you must review the Case Submission Checklist – Dental/Life to ensure all requirements are being completed.

STEP 2:
Complete the Employer Application.

• The Application includes Medical and optional benefits information.
• Please discuss any questions you may have with your broker.

STEP 3:
Review the Case Submission Checklist(s) to confirm you are completing all requirements.

• For example, the most recent DE-9C and a check payable to CaliforniaChoice Benefit Administrators should be submitted with all applications.

• Case Submission Checklist - Medical
• Case Submission Checklist - Dental/Life
• Employer Application
• Full FSA Election Form
• COBRA Billing Contract
• Case Submission Acknowledgment
• Sample Legal Documents (reference only)
• Owner/Partner Statement
• Employee Application
• Initial Payment Form (One-Time ACH)
• Prior Coverage Cancellation Letter

• Group Administrator Manual
• Find Your Network
• Find Your Provider
• Pharmacy Formulary
• www.calchoice.com
• Plan Benefit Summaries and/or Summaries of Benefits & Coverage (attached to email)
• Reply to this email if Explanation/Certificates of Coverage are needed.