CaliforniaChoice® Small Group Advantage PPO three-tier network

With the CaliforniaChoice Advantage PPO plans, you have a choice of tiers (or levels) of to visit. Tier one hospitals offer the greatest savings to you. Tier two hospitals have the second best level of savings. Tier three hospitals — or out-of-network hospitals — offer the least out-of-pocket savings, but you’ll still be covered. Keep in mind that the tier levels aren’t based on the quality of care given at each hospital. They’re based on which hospitals have shown they’re better able to give quality care that’s also cost effective.

Our three-tier levels* are: }}Tier 1 — PPO network hospitals with lower-negotiated hospital reimbursement rates. }}Tier 2 — the remaining PPO network hospitals. }}Tier 3 — non-network hospitals.

* The tier levels are not based on the quality of care given at each hospital. Instead, each level stands for the hospitals that show 19685CABENABC 08/15 the best use of health care dollars. CaliforniaChoice® Small Group Advantage PPO three-tier hospital network Here is a list of the Tier-1 and Tier-2 hospitals included in the network. Any hospital not listed is considered out of network.

Hospital County Tier St Rose Hospital Alameda 1 Alameda Hospital Alameda 1 Children’s Hospital Oakland Alameda 2 Valleycare Medical Center Alameda 2 Washington Hospital Alameda 2 Sutter Amador Health Center Pioneer 1 Sutter Amador Health Center Plymouth 1 Sutter Amador Hospital Amador 1 & Medical Center Butte 1 Feather River Hospital Butte 1 Enloe Medical Center Inc Butte 2 Biggs Gridley Memorial Hospital Butte 1 Mark Twain St Joseph’s Hospital Calaveras 1 Colusa Regional Medical Center Colusa 1 Doctors Medical Center – San Pablo/Pinole Contra Costa 1 San Ramon Regional Medical Center Contra Costa 1 John Muir Medical Center – Walnut Creek Contra Costa 2 John Muir Medical Center – Concord Campus Contra Costa 2 Sutter Coast Health Center Del Norte 1 Sutter Coast Hospital Del Norte 1 Marshall Medical Center El Dorado 1 Barton Memorial Hospital El Dorado 2 Sierra Kings District Hospital Fresno 1 Coalinga Regional Medical Center Fresno 1 San Joaquin Valley Rehabilitation Hospital Fresno 1 Fresno Surgical Hospital Fresno 1 Fresno Heart Hospital Fresno 1 St Agnes Medical Center Fresno 1 Clovis Community Hospital Fresno 1 Kingsburg District Hospital Fresno 2 Community Medical Center – Fresno Fresno 1 Glenn Medical Center Glenn 1 Mad River Community Hospital Humboldt 1 St Joseph Hospital – Eureka Humboldt 2 Jerold Phelps Community Hospital Humboldt 2 Redwood Memorial Hospital Humboldt 2 El Centro Regional Medical Center Imperial 1 Pioneers Memorial Healthcare District Imperial 1 Southern Inyo Hospital Inyo 1 Northern Inyo Hospital Inyo 1 Healthsouth Bakersfield Rehabilitation Hospital Kern 1 Tehachapi Hospital Kern 2 Hospital County Tier Good Samaritan Hospital Kern 1 Kern Valley Healthcare District Kern 1 San Joaquin Community Hospital Kern 1 Bakersfield Memorial Hospital Kern 2 Mercy Healthcare Bakersfield Kern 2 Delano Regional Medical Center Kern 2 Ridgecrest Regional Hospital Kern 2 Central Valley General Hospital Kings 1 Hanford Community Medical Center Kings 1 Corcoran District Hospital Kings 1 St Helena Hospital Clearlake Lake 1 Sutter Lakeside Community Clinic Lake 1 Sutter Lakeside Family Medicine Clinic Lake 1 Sutter Lakeside Hospital Lake 1 Banner Lassen Medical Center Lassen 1 Bellflower Medical Center Los Angeles 1 Pacifica Hospital Of The Valley Los Angeles 1 Pacific Alliance Medical Center Los Angeles 1 Alhambra Hospital Medical Center Los Angeles 1 Verdugo Hills Hospital Los Angeles 1 Mission Community Hospital – Panorama Campus Los Angeles 1 Barlow Hospital Los Angeles 1 Beverly Hospital Los Angeles 1 Hollywood Presbyterian Medical Center Los Angeles 1 Doctors Hospital Of West Covina Los Angeles 1 Greater El Monte Community Hospital Los Angeles 1 Orthopaedic Hospital Los Angeles 1 Downey Regional Medical Center Los Angeles 1 Providence Little Company Of Mary Medical Ctr Los Angeles 1 Valley Presbyterian Hospital Los Angeles 1 Olympia Medical Center Los Angeles 1 Monterey Park Hospital Los Angeles 1 White Memorial Medical Center Los Angeles 1 Tri-City Regional Medical Center Los Angeles 1 Lancaster Community Hospital Los Angeles 1 Whittier Hospital Medical Center Los Angeles 1 Good Samaritan Hospital Los Angeles 1 Kindred Hospital Of La Mirada Los Angeles 2 Providence Little Company Of Mary Medical Los Angeles 1 Childrens Hospital Los Angeles Los Angeles 1 Citrus Valley Med Ctrs – Queen Of The Valley Los Angeles 1 Citrus Valley Med Ctrs – Inter-Community Campus Los Angeles 1 Henry Mayo Newhall Memorial Hospital Los Angeles 1 Los Angeles 1 Foothill Presbyterian Hospital Los Angeles 1 AHMC Garfield Medical Center Los Angeles 2 Hospital County Tier Torrance Memorial Medical Center Los Angeles 1 Marina Del Rey Hospital Los Angeles 1 Lakewood Regional Medical Center Los Angeles 1 Glendale Memorial Hospital & Health Center Los Angeles 2 St John’s Hospital And Health Center Los Angeles 1 Huntington Memorial Hospital Los Angeles 2 Miller Children’s Hospital Los Angeles 2 West Hills Hospital & Medical Center Los Angeles 1 Long Beach Memorial Medical Center Los Angeles 1 Providence Holy Cross Medical Center Los Angeles 1 Glendale Adventist Medical Center Los Angeles 1 Motion Picture & Television Hospital Los Angeles 2 St Mary Medical Center Los Angeles 2 Providence Saint Joseph Medical Center Los Angeles 2 Ronald Reagan UCLA Medical Center Los Angeles 2 St Francis Medical Center Los Angeles 2 San Gabriel Valley Medical Center Los Angeles 2 Providence Tarzana Medical Center Los Angeles 2 Santa Monica UCLA Medical Center Los Angeles 2 Kenneth Norris Jr Cancer Hospital Los Angeles 2 Presbyterian Intercommunity Hospital Los Angeles 2 Northridge Hospital Medical Center Los Angeles 2 Community And Mission Hospital Of Huntington Los Angeles 2 LAC Olive View Med Ctr Mid Valley Los Angeles 2 LAC Rancho Los Amigos Natl Rehabilitation Ctr Los Angeles 2 St Vincent Medical Center Los Angeles 2 USC University Hospital Los Angeles 2 City Of Hope National Medical Center Los Angeles 2 LAC USC Medical Center Los Angeles 2 Hospital Medical Center Los Angeles 2 Cedars-Sinai Medical Center Los Angeles 2 Temple Community Hospital Los Angeles 2 LAC Harbor UCLA Med Ctr Los Angeles 2 East Los Angeles Doctors Hospital Los Angeles 2 Promise Hosp Of East Los Angeles – Suburban Los Angeles 2 Pacific Hospital Of Long Beach Los Angeles 2 Catalina Island Medical Center Los Angeles 2 Brotman Medical Center Los Angeles 1 Madera Community Hospital Madera 1 Children’s Hospital Central California Madera 1 Kentfield Rehabilitation And Specialty Hospital Marin 2 Marin General Hospital Marin 2 Novato Community Hospital Marin 1 John C Fremont Healthcare District Mariposa 1 Ukiah Valley Medical Center Mendocino 1 Frank R Howard Memorial Hospital Mendocino 1 Hospital County Tier Mendocino Coast District Hospital Mendocino 2 Mercy Medical Center Merced Merced 2 Surprise Valley Community Hospital Modoc 1 Modoc Medical Center Modoc 1 Mammoth Hospital Mono 1 Community Hospital Of Monterey Peninsula Monterey 1 George L Mee Memorial Hospital Monterey 2 Salinas Valley Memorial Healthcare District Monterey 2 St Helena Hospital & Health Center Napa 1 Queen Of The Valley Medical Center Napa 2 Novato Community Hospital Novato 1 Sierra Nevada Memorial Hospital Nevada 1 Tahoe Forest Hospital District Nevada 2 Healthsouth Tustin Rehabilitation Hospital Orange 1 Anaheim General Hospital Orange 1 Placentia Linda Hospital Orange 1 Coastal Communities Hospital Orange 1 South Coast Medical Center Orange 1 Anaheim Memorial Medical Center Orange 1 Los Alamitos Medical Center Orange 1 Western Medical Center – Anaheim Orange 1 Chapman Medical Center Orange 1 UC Irvine Medical Center Orange 1 Orange Coast Memorial Medical Center Orange 1 Children’s Hospital At Mission Orange 1 Saddleback Memorial Medical Center Orange 1 Fountain Valley Regional Hospital And Med Ctr Orange 2 Healthbridge Childrens Hospital – Orange Orange 1 Western Medical Center – Santa Ana Orange 1 Children’s Hospital Of Orange County Orange 2 Mission Hospital Regional Medical Center Orange 2 St Joseph Hospital – Orange Orange 2 Memorial Hospital Presbyterian Orange 2 St Jude Medical Center Orange 2 Plumas District Hospital Plumas 1 Seneca District Hospital Plumas 2 Eastern Plumas Health Care Plumas 2 San Gorgonio Memorial Hospital Riverside 1 Menifee Valley Medical Center Riverside 1 Corona Regional Medical Center Riverside 1 Hemet Valley Medical Center Riverside 1 John F Kennedy Memorial Hospital Riverside 1 Parkview Community Hospital Medical Center Riverside 1 Southwest Healthcare System – Murrieta Riverside 1 Eisenhower Medical Center Riverside 1 Riverside Community Hospital Riverside 1 Hospital County Tier Desert Regional Medical Center Riverside 2 Palo Verde Hospital Riverside 2 Kindred Hospital Sacramento Sacramento 1 UC Davis Medical Center Sacramento 1 Mercy Hospital Of Folsom Sacramento 2 Methodist Hospital Of Sacramento Sacramento 2 Mercy San Juan Hospital Sacramento 1 Mercy General Hospital Sacramento 2 Hazel Hawkins Memorial Hospital San Benito 1 Vibra Specialty Hospital Of San Bernardino San Bernardino 1 Victor Valley Community Hospital San Bernardino 1 Hi-Desert Medical Center San Bernardino 1 Redlands Community Hospital San Bernardino 1 San Antonio Community Hospital San Bernardino 1 Mountains Community Hospital San Bernardino 1 St Mary Medical Center San Bernardino 2 St Bernardine Medical Center San Bernardino 1 Colorado River Medical Center San Bernardino 2 Community Hospital Of San Bernardino San Bernardino 1 Loma Linda University Medical Center San Bernardino 2 Bear Valley Community Hospital San Bernardino 2 Barstow Community Hospital San Bernardino 2 Sutter Maternity & Center Santa Cruz 1 Promise Hospital Of San Diego 2 Continental Rehabilitation Hospital Of San Diego San Diego 1 Fallbrook Hospital District San Diego 1 Tri-City Medical Center San Diego 1 Pomerado Hospital San Diego 1 Alvarado Hospital Llc San Diego 1 San Diego 1 UCSD Medical Center San Diego 2 Rady Childrens Hospital San Diego San Diego 1 Sharp Coronado Hospital & Healthcare Center San Diego 2 Scripps Memorial Hospital – Encinitas San Diego 2 Grossmont District Hospital San Diego 2 Scripps Memorial Hospital – La Jolla San Diego 2 Sharp Chula Vista Medical Center San Diego 2 San Diego 2 Scripps Green Hospital San Diego 2 San Diego 2 California Pacific Med Ctr - Pacific Campus San Francisco 1 California Pacific Medical Center - California Campus San Francisco 1 California Pacific Medical Center - California Campus SNF San Francisco 1 California Pacific Medical Center - Davies Campus San Francisco 1 California Pacific Medical Center - Davies Campus Rehab Hospital San Francisco 1 California Pacific Medical Center - Davies Campus SNF San Francisco 1 Hospital County Tier California Pacific Medical Center - Pacific Campus Psychiatric Hospital San Francisco 1 California Pacific Medical Center - Pacific Campus Rehab Hospital San Francisco 1 California Pacific Medical Center - St Luke’s Hospital San Francisco 1 California Pacific Medical Center- Pacific Medical Center San Francisco 1 California Pacific Medical Center- Pacific Medical Center SNF San Francisco 1 Chinese Hospital San Francisco 1 UCSF Medical Center San Francisco 1 St Francis Memorial Hospital San Francisco 1 St Mary’s Medical Center San Francisco 2 Dameron Hospital San Joaquin 1 Doctors Hospital Of Manteca Inc San Joaquin 1 Lodi Memorial Hospital San Joaquin 2 San Joaquin General Hospital San Joaquin 1 St Joseph’s Medical Center Of Stockton San Joaquin 2 Arroyo Grande Community Hospital San Luis Obispo 2 Twin Cities Community Hospital Inc San Luis Obispo 1 Sierra Vista Regional Medical Center San Luis Obispo 1 French Hospital Medical Center San Luis Obispo 2 Burlingame Dialysis Center San Mateo 1 Menlo Park Surgical Hospital San Mateo 1 Mills Hospital San Mateo 1 Mills Peninsula Health Services SNF San Mateo 1 Mills Peninsula Med Ctr Rehab Unit San Mateo 1 Mills Peninsula SNF San Mateo 1 Peninsula Hospital & Medical Center San Mateo 1 Peninsula Hospital Med Ctr Chem Treatment Rehab Facility San Mateo 1 Peninsula Hospital Medical Ctr Psychiatric Facility San Mateo 1 San Mateo County General Hospital San Mateo 1 Sequoia Health Services San Mateo 1 Seton Medical Center San Mateo 2 Lompoc Healthcare District Santa Barbara 1 Santa Ynez Valley Cottage Hospital Santa Barbara 1 Central Coast – Marian Medical Center Santa Barbara 1 Goleta Valley Cottage Hospital Santa Barbara 2 Santa Barbara Cottage Hospital Santa Barbara 2 Community Hospital Of Los Gatos Santa Clara 1 Santa Clara Valley Health & Hospital System Santa Clara 2 Regional Medical Center Of San Jose Santa Clara 1 Good Samaritan Hospital Santa Clara 1 El Camino Hospital Santa Clara 1 O’Connor Hospital Santa Clara 2 Saint Louise Regional Hospital Santa Clara 2 Lucile Salter Packard Childrens Hospital Santa Clara 2 Stanford University Hospital Santa Clara 2 Watsonville Community Hospital Santa Cruz 1 Dominican Santa Cruz Hospital Santa Cruz 2 Hospital County Tier Patients Hospital Of Redding Shasta 1 Northern California Rehabilitation Hospital Shasta 1 Mercy Medical Center – Redding Shasta 1 Mayers Memorial Hospital Shasta 2 Fairchild Medical Center Siskiyou 1 Mercy Medical Center – Mt Shasta Siskiyou 2 Northbay Medical Center Solano 2 Vaca Valley Hospital Solano 2 Healdsburg District Hospital Sonoma 1 Palm Drive Hospital Sonoma 1 Sonoma Valley Hospital Sonoma 1 Petaluma Valley Hospital Sonoma 2 Santa Rosa Memorial Hospital Sonoma 1 Stanislaus Surgery Center Stanislaus 1 Emanuel Medical Center Stanislaus 1 Doctors Medical Center Of Modesto Stanislaus 1 Oak Valley District Hospital Stanislaus 2 St Elizabeth Community Hospital Tehama 1 Trinity Hospital Trinity 1 Tulare Local Health Care District Tulare 1 Kaweah Delta Medical Center Tulare 1 Sierra View District Hospital Tulare 2 Sonora Regional Medical Center Tuolumne 1 Ventura County Medical Center Ventura 1 Thousand Oaks Surgical Hospital Ventura 1 Simi Valley Hospital Ventura 1 Community Memorial Hospital San Buenaventura Ventura 1 St John’s Pleasant Valley Hospital Ventura 2 Los Robles Regional Medical Center Ventura 2 St John’s Regional Medical Center Ventura 2 Woodland Memorial Hospital Yolo 1 Rideout Memorial Hospital Yuba 2 Renown Regional Medical Center Outside Ca 1 St Mary’s Medical Center Outside Ca 1 Renown South Meadows Medical Center Outside Ca 1

This listing is accurate at the time of printing and subject to change.

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.