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SFHSS Part B PPO

Health plan documents

Blue Shield Part B PPO + Rx plan: January 1, 2025 - December 31, 2025

  • Summary of Benefits and Coverage- Medical (coming soon)
  • Summary of Benefits - Medical (coming soon)
  • Summary of Benefits and Coverage - RX (coming soon)
  • Summary of Benefits - RX (coming soon)
  • Evidence of Coverage - RX (coming soon)
  • Evidence of Coverage - (coming soon)
  • 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.

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Pharmacy resources

Blue Shield Medicare (PPO) plan: January 1, 2025 - December 31, 2025


Blue Shield of California is a PDP plan with a Medicare contract. Enrollment in Blue Shield of California depends on contract renewal. Blue Shield of California offers individual and employer group retiree plans to Medicare beneficiaries who have Part A and/or Part B. Individual plans are open to all Medicare beneficiaries who reside within a plan’s specific service area. Employer group retiree plans are open only to Medicare beneficiaries who are eligible group retirees and who reside within a plan’s specific service area. Individual and employer group retiree plans have different service areas and benefits.

Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our Customer Service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

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