Plan Materials - English
To view documents below in other languages click here: Spanish | Chinese | Korean | Vietnamese
-
2019 Summary of Benefits
View PDF Print PDF -
2019 Formulary (List of Covered Drugs)
View PDF Print PDF -
2019 Provider and Pharmacy Directory
View PDF Print PDF -
2019 Enrollment Form
View PDF Print PDF -
Low Income Subsidy (LIS) Premium Summary Chart
View PDF Print PDF -
2019 Dental Benefit Book - Vitality Choice
View PDF Print PDF -
2019 Dental Benefit Book -Vitality Plus
View PDF Print PDF -
2019 Over-The-Counter (OTC) Catalog
View PDF Print PDF -
2019 Evidence of Coverage - Vitality Choice Plan 001 - San Joaquin County
View PDF Print PDF -
2019 Evidence of Coverage - Vitality Choice Plan 002 - Santa Clara County
View PDF Print PDF -
2019 Evidence of Coverage - Vitality Plus Plan 003 - San Joaquin and Santa Clara County
View PDF Print PDF
To view the documents in other languages click here: Spanish | Chinese | Korean | Vietnamese