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 plan
- 2024
- Summary of Benefits - MedicalPDF, 1015 KB
- Summary of Benefits - PharmacyPDF, 110 KB
- Summary of Benefits - Acupuncture and chiropractic servicesPDF, 109 KB
- Summary of Benefits and CoveragePDF, 539 KB
- Evidence of CoveragePDF, 2.3 MB
- 2023
- Summary of Benefits - Medical, pharmacy, acupuncture, and chiropractic servicesPDF, 324 KB
- Summary of Benefits and CoveragePDF, 681 KB
Trio HMO plan
- 2024
- Summary of Benefits - MedicalPDF, 1024 KB
- Summary of Benefits - PharmacyPDF, 110 KB
- Summary of Benefits - Acupuncture and chiropractic servicesPDF, 109 KB
- Summary of Benefits and CoveragePDF, 537 KB
- Evidence of CoveragePDF, 2.35 MB
- 2023
- Summary of Benefits - Medical, pharmacy, acupuncture and chiropractic servicesPDF, 324 KB
- Summary of Benefits and CoveragePDF, 681 KB
EPO plan
- 2024
- Summary of Benefits – Medical, acupuncture, and chiropractic servicesPDF, 1039 KB
- Summary of Benefits - PharmacyPDF, 113 KB
- Summary of Benefits and CoveragePDF, 542 KB
- Evidence of CoveragePDF, 2.3 MB
- 2023
- Summary of Benefits - Medical, pharmacy, acupuncture, and chiropractic servicesPDF, 254 KB
- Summary of Benefits and CoveragePDF, 684 KB