800-958-1129 (TTY: 711)
We are open M-F 8:00 a.m. – 8:00 p.m. PT. Between 10/1 and 3/31, we are open 7 days a week, except for the major year-end holidays. You can enroll beginning 10/15/2025.
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What is the
right plan for you?
Both plans are available in California, in Los Angeles, Riverside, and San Bernardino counties
Benefit information provided is a brief summary, not a complete description of benefits. For more information, contact Elite Health Plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, of each year.
For more comprehensive information, please see the Evidence of Coverage.
Type of care | Elite Health Plan Signature (HMO) | Elite Health Plan Core (HMO) |
|---|---|---|
Maximum Out-of-Pocket | $699.00 | $1,499.00 |
Primary Care Office Visits | $0.00 | $0.00 |
Specialist Office Visits | $0.00 | $0.00 |
Inpatient Hospital Care | $75.00 per day (1-5) | $100.00 per day (1-5) |
Outpatient Hospital Services | $0.00 | $0.00 |
Ambulatory Surgical Center | $0.00 | $0.00 |
Urgent Care Services | $0.00 | $125.00 |
Emergency Care | $95.00 (Waived if transferred to in-patient) | $150.00 (Waived if transferred to in-patient) |
PRESCRIPTION DRUGS | Elite Health Plan Signature (HMO) | Elite Health Plan Core (HMO) |
|---|---|---|
Tier 1: Preferred Generic | $0.00 | $0.00 |
Tier 2: Generic | $0.00 | $7.00 |
Tier 3: Preferred Brand | $35.00 | $47.00 |
Tier 4: Non-Preferred Drug | $98.00 | 25% |
Tier 5: Specialty Tier | 33% | 33% |
Tier 6: Select Care Drugs | $0.00 | $0.00 |
Insulin | Insulin is no more than 25% of the cost of the drug or $35 for a one-month supply. | Insulin is no more than 25% of the cost of the drug or $35 for a one-month supply. |
SUPPLEMENTAL BENEFIT | Elite Health Plan Signature (HMO) | Elite Health Plan Core (HMO) |
|---|---|---|
Routine Acupuncture, Chiropractic, Massage Therapy and Podiatry | 12 visits per year, $10 | 12 visits per year, $0 |
Dental | Included (Delta Dental) | Included (Delta Dental) |
Hearing | Included (Audicus) | Included (Audicus) |
Fitness | Online classes (Age Bold) | Online classes (Age Bold) |
Meals | 7 days, 2 meals per day, immediately post hospitalization | 7 days, 2 meals per day, immediately post hospitalization |
Over the Counter (OTC) | Your OTC benefit allows you to choose from products through our online catalog. You will receive $65 every quarter in OTC benefits. The $65 can not be rolled over to the next quarter. | Your OTC benefit allows you to choose from products through our online catalog. You will receive $90 every quarter in OTC benefits. The $90 can not be rolled over to the next quarter. |
Personal Emergency Response System (PERS) | PERS device, $0 | -- |
Transportation | 20 one-way trips | 10 one-way trips |
Worldwide Coverage | $10,000 allowance | $20,000 allowance |
Telehealth | Included | Included |
Vision | $250.00 allowance | $300.00 allowance |