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The SBC shows you how you and the plan would share the cost for covered health care services. /*-->stream We believe in the power of partnerships. % L.A. Care Covered Gold 80 HMO Evidence of . (800) 440-4347 Share via Facebook. All insurance plans are required to produce a Summary of Benefits and Coverage based on a uniform template and customized to reflect the plan's unique terms. Contact a plan for a Summary of Benefits. All rights reserved | About | Contact | Legal and Privacy. Medi-Cal is a no-cost or low-cost health coverage program. [CDATA[/* >