2020 and 2021 California
Copayment Schedules and EOCs

Find Your Coverage Information

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Click on your plan below to view a PDF of your schedule and Evidence of Coverage.

2020

Family Dental HMO Individual (2020 CA Family Dental HMO IDP plan) Copayment Schedule EOC
Family Dental HMO CCSB (2020 CA Family Dental HMO CCSB plan 0520GC054) Copayment Schedule EOC
Children's Dental HMO CCSB (2020 CA Children's Dental HMO CCSB plan 0620GC053) Copayment Schedule EOC

 

2021

Family Dental HMO Individual (2021 CA Family Dental HMO Copays IDP 0320OM521) Copayment Schedule EOC
Family Dental HMO CCSB (2021 CA Family Dental HMO Copays CCSB 0320OM517) Copayment Schedule EOC

 

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