Health Plan Documents
Glossary
These are the Blue Shield documents that describe your benefits, copayments, exclusions, and limitations.
- Summary of Benefits (SOB): This document outlines what the plan covers and how much it costs, helping you make an informed decision. This document has fewer details than the EOC but more details that the SBC.
- Evidence of coverage (EOC): This is your plan document that explains in full all the terms of your plan coverage, the benefits, copays or coinsurance, exclusions, limitations and how to access coverage.
- Summary of Benefits and Coverage (SBC): This is an easy-to-read summary of the plan’s benefits and coverage that is in a standardized format that allows you to easily compare the Blue Shield health plans to other carriers’ health plans.
Access+ HMO ($15 copay) plan
- 2024
- Summary of Benefits - MedicalPDF, 1012 KB
- Summary of Benefits - PharmacyPDF, 121 KB
- Summary of Benefits - Acupuncture and chiropractic servicesPDF, 121 KB
- Summary of Benefits - Hearing aid servicesPDF, 113 KB
- Summary of Benefits and CoveragePDF, 535 KB
- Evidence of CoveragePDF, 2.3 MB
- 2023
- Summary of Benefits – Medical, pharmacy, acupuncture, chiropractic, and hearing aid servicesPDF, 370 KB
- Summary of Benefits and CoveragePDF, 683 KB
Access+ HMO ($20 copay) plan
- 2024
- Summary of Benefits – MedicalPDF, 1035 KB
- Summary of Benefits – PharmacyPDF, 121 KB
- Summary of Benefits - Acupuncture and chiropractic servicesPDF, 121 KB
- Summary of Benefits - Hearing aid servicesPDF, 113 KB
- Summary of Benefits and CoveragePDF, 538 KB
- Evidence of CoveragePDF, 2.3 MB
- 2023
- Summary of Benefits – Medical, pharmacy, acupuncture, chiropractic, and hearing aid servicesPDF, 393 KB
- Summary of Benefits and CoveragePDF, 683 KB
Trio HMO plan
- 2024
- Summary of Benefits - MedicalPDF, 1035 KB
- Summary of Benefits - PharmacyPDF, 121 KB
- Summary of Benefits - Acupuncture and chiropractic servicesPDF, 121 KB
- Summary of Benefits - Hearing aid servicesPDF, 113 KB
- Summary of Benefits and CoveragePDF, 537 KB
- Evidence of CoveragePDF, 2.4 MB
- 2023
- Summary of Benefits – Medical, pharmacy, acupuncture, chiropractic, and hearing aid servicesPDF, 384 KB
- Summary of Benefits and CoveragePDF, 683 KB
PPO plan
- 2024
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic servicesPDF, 1149 KB
- Summary of Benefits - Hearing aid servicesPDF, 113 KB
- Summary of Benefits and CoveragePDF, 595 KB
- Evidence of CoveragePDF, 2.3 MB
- 2023
- Summary of Benefits – Medical, pharmacy, acupuncture, chiropractic, and hearing aid servicesPDF, 348 KB
- Summary of Benefits and CoveragePDF, 688 KB