Blue Shield Summary of Benefits - 8 pages - see links below
Blue Shield Summary of Benefits – 8 pages – see links below

This is an Historical Page
Please use menu above to find current information

Blue Shield Summary of Benefits  ♦  Evidence of Coverage

If any of the links require a password, just email us what you are looking for and we will send it to you.

See our Main Blue Shield Page for Introduction

MAIN Summary of Benefits Page – All Companies – Individual & Group

Legal Information Booklet 28 pages – gets attached to all summaries below

In addition to the benefit summaries, the Summary of Benefits and Coverage (SBC) forms provide you with an easy-to-understand overview of what the Blue Shield plans cover. Visit the Blue Shield  SBC page to download the forms.

PPO Plans Benefit Summaries
Platinum 90 PPO English (PDF, 498KB)
Gold 80 PPO English (PDF, 498KB)
Silver 70 PPO English (PDF, 498KB)
New Silver 1850 PPO English (PDF, 498KB)
New Silver Seven 3750 PPO English (PDF, 498KB)
New Bronze 5550 PPO English (PDF, 498KB)
Bronze 60 PPO English (PDF, 498KB)
Bronze 60 HSA English (PDF, 498KB)
Minimum Coverage PPO English (PDF, 498KB)
Cost savings reduction plans
We offer three PPO Silver cost-sharing reduction plans through Covered California for consumers whose income is between 138% to 250% of the federal poverty level (FPL). These plans are available only through Covered California.
Plan Benefit Summaries
Silver 73 PPO English (PDF, 498KB)
Silver 87 PPO English (PDF, 498KB)
Silver 94 PPO English (PDF, 498KB)

8.4.2014 Bulletin

  • Important question: “What is the overall deductible?”
  • Answer: “$5,000 per individual / $10,000 per family. Does not apply to preventive care.”
  • Why this matters: “You must pay all the costs up to the deductible amount before this plan begins to pay for covered services you use. Check your policy or plan document to see when the deductible starts over (usually, but not always, January 1). See the chart starting on page 3 for how much you pay for covered services after you meet the deductible.”

Related Blue Shield Pages

2014 Information

Choose from the following Individual and Family Plans
Covered California Ultimate PPO
Covered California Ultimate EPO
Covered California Preferred PPO
Covered California Preferred EPO
Covered California Enhanced PPO
Covered California Enhanced PPO 150 Subsidy
Covered California Enhanced PPO 200 Subsidy
Covered California Enhanced PPO 250 Subsidy
Covered California Enhanced EPO
Covered California Enhanced EPO 150 Subsidy
Covered California Enhanced EPO 200 Subsidy
Covered California Enhanced EPO 250 Subsidy
Covered California Basic PPO
Covered California Basic PPO for HSA
Covered California Basic EPO
Covered California Basic EPO for HSA
Covered California Get Covered PPO
Covered California Get Covered EPO
Covered California Ultimate PPO Native American
Covered California Ultimate EPO Native American
Covered California Preferred PPO Native American
Covered California Preferred EPO Native American
Covered California Enhanced PPO Native American
Covered California Enhanced EPO Native American
Covered California Basic PPO Native American
Covered California Basic PPO for HSA Native American
Covered California Basic EPO Native American
Covered California Basic EPO for HSA Native American
Covered California Native American PPO 300 Subsidy
Covered California Native American EPO 300 Subsidy
Ultimate PPO
Ultimate EPO
Preferred PPO
Preferred EPO
Enhanced PPO
Enhanced EPO
Basic PPO
Basic PPO for HSA
Basic EPO
Basic EPO for HSA
Get Covered PPO
Get Covered EPO

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