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, 952 KB
- Summary of Benefits - PharmacyPDF, 44 KB
- Summary of Benefits - Acupuncture and chiropractic servicesPDF, 44 KB
- Summary of Benefits and CoveragePDF, 255 KB
- Evidence of CoveragePDF, 2.6 MB
- 2023
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic servicesPDF, 324 KB
- Summary of Benefits and CoveragePDF, 292 KB
- Evidence of CoveragePDF, 2.6 MB
Trio HMO plan
- 2024
- Summary of Benefits - MedicalPDF, 952 KB
- Summary of Benefits - PharmacyPDF, 44 KB
- Summary of Benefits - Acupuncture and chiropractic servicesPDF, 44 KB
- Summary of Benefits and CoveragePDF, 225 KB
- Evidence of CoveragePDF, 2.6 MB
- 2023
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic servicesPDF, 324 KB
- Evidence of CoveragePDF, 2.7MB
PPO plan with HSA
- 2024
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic servicesPDF, 949 KB
- Summary of Benefits and CoveragePDF, 261 KB
- Evidence of CoveragePDF, 2.6 MB
- 2023
- Summary of Benefits – Medical, pharmacy, acupuncture, and chiropractic servicesPDF, 249 KB
- Summary of Benefits and CoveragePDF, 298 KB
- Evidence of CoveragePDF, 2.6 MB