Health plan documents - current year
Bassett
View previous year plan documents
Bronze Plan Options
- Bronze Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Gold Plan Options
Platinum Plan Options
Silver Plan Options
- Silver Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Bear Valley
View previous year plan documents
Bronze Plan Options
- Bronze Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Gold Plan Options
Platinum Plan Options
Silver Plan Options
- Silver Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Central
View previous year plan documents
Bronze Plan Options
- Bronze Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Gold Plan Options
Platinum Plan Options
Silver Plan Options
- Silver Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Centralia
Bronze Plan Options
Gold Plan Options
Platinum Plan Options
Silver Plan Options
CharterSafe (including River Springs)
View previous year plan documents
Bronze Plan Options
- Bronze Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Gold Plan Options
Platinum Plan Options
Silver Plan Options
- Silver Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Cucamonga
View previous year plan documents
Bronze Plan Options
- Bronze Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Gold Plan Options
Platinum Plan Options
Silver Plan Options
- Silver Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Etiwanda
View previous year plan documents
Bronze Plan Options
- Bronze Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Gold Plan Options
Platinum Plan Options
Silver Plan Options
- Silver Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Hesperia
View previous year plan documents
Bronze Plan Options
- Bronze Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Gold Plan Options
Platinum Plan Options
Silver Plan Options
- Silver Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Mountain View
View previous year plan documents
Bronze Plan Options
- Bronze Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Gold Plan Options
Platinum Plan Options
Silver Plan Options
- Silver Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Ramona
View previous year plan documents
Bronze Plan Options
- Bronze Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Gold Plan Options
Platinum Plan Options
Silver Plan Options
- Silver Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Rim of the World
View previous year plan documents
Bronze Plan Options
- Bronze Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Gold Plan Options
Platinum Plan Options
Silver Plan Options
- Silver Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
San Gabriel Valley ROP
Bronze Plan Options
Gold Plan Options
Platinum Plan Options
Silver Plan Options
Santee
Bronze Plan Options
Gold Plan Options
Platinum Plan Options
Silver Plan Options
Savanna
View previous year plan documents
Bronze Plan Options
- Bronze Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Gold Plan Options
Platinum Plan Options
Silver Plan Options
- Silver Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Summit Leadership Academy
View previous year plan documents
Bronze Plan Options
- Bronze Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
Gold Plan Options
Platinum Plan Options
Silver Plan Options
- Silver Tandem PPO plan with HSA
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic services
- Summary of Benefits and Coverage
- Glossary
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.