Benefit Modifications Home

Benefit Modification Brochures

The Benefit Modifications offer a summary of specific benefit changes to your clients' plans in a convenient chart. Keep them up-to-date by downloading and sharing the fliers with your clients upon renewal. Copies will be included along with a complete list of legislative mandates and Blue Shield required changes in each renewal package delivered by your Blue Shield sales representative.

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Summary of benefits | Forms and applications | Contact us 

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Active Choice® 500 80/50 717KB
Active Choice® 500 80/50 1500 Deductible 716KB
Active Choice® 750 70/50 716KB
Active Choice® 750 70/50 1000 Deductible 716KB
Active Choice® 750 80/60 717KB
Active Choice® Classic 600 80/50 981KB
Active Choice® Classic 850 70/50 1000 Deductible 981KB
Active Choice® Classic 850 80/60 981KB
Active Choice® Plus 1000 20 80/60 979KB
Active Choice® Plus 1000 80/60 980KB
Active Choice® Plus 300 20 80/60 980KB
Active Choice® Plus 300 80/60 980KB
Access+ HMO® Facility Coinsurance 15-20% 1MB
Access+ HMO® Facility Coinsurance 20-20% 1MB
Access+ HMO® Facility Coinsurance 25-25% 1MB
Access+ HMO® Facility Coinsurance 30-30% 1MB
Access+ HMO® Facility Coinsurance 40-40% 1MB
Access+ HMO® Facility Deductible 15-10%/1500 1MB
Access+ HMO® Facility Deductible 15-10%/250 1MB
Access+ HMO® Facility Deductible 15-10%/500 1MB
Access+ HMO® Facility Deductible 15-10%/750 1MB
Access+ HMO® Facility Deductible 20-25%/1500 1MB
Access+ HMO® Facility Deductible 30-10%/1500 1MB
Access+ HMO® Facility Deductible 30-30%/2000 1MB
Access+ HMO® Facility Deductible 40-40%/2000 1MB
Access+ HMO® Facility Deductible 40-40%/5800 1MB
Access+ HMO® Per Admit 10-250 974KB
Access+ HMO® Per Admit 20-250 974KB
Access+ HMO® Per Admit 20-500 974KB
Access+ HMO® Per Admit 25-750 974KB
Access+ HMO® Per Admit 40-1000 974KB
Access+ HMO® Per Day 15-500 974KB
Access+ HMO® Per Day 25-750 974KB
Access+ HMO® SaveNet Facility Coinsurance 15-20% 1MB
Access+ HMO® SaveNet Facility Coinsurance 20-20% 1MB
Access+ HMO® SaveNet Facility Coinsurance 25-25% 1MB
Access+ HMO® SaveNet Facility Coinsurance 40-40% 1MB
Access+ HMO® SaveNet Facility Deductible 15-10%/1500 1MB
Access+ HMO® SaveNet Facility Deductible 20-25%/1500 1MB
Access+ HMO® SaveNet Facility Deductible 30-30%/2000 1MB
Access+ HMO® SaveNet Facility Deductible 40-40%/2000 1MB
Access+ HMO® SaveNet Facility Deductible 40-40%/5800 1MB
Access+ HMO® SaveNet Per Admit 10-250 1MB
Access+ HMO® SaveNet Per Admit 20-500 1MB
Access+ HMO® SaveNet Per Admit 25-750 1MB
Access+ HMO® SaveNet Per Admit 40-1000 1MB
Access+ HMO® SaveNet Zero Admit 10 1MB
Access+ HMO® SaveNet Zero Admit 20 1MB
Access+ HMO® SaveNet Zero Admit 30 1MB
Access+ HMO® Zero Admit 10 1MB
Access+ HMO® Zero Admit 15 1MB
Access+ HMO® Zero Admit 20 1MB
Access+ HMO® Zero Admit 30 1MB
Access+ HMO® Zero Facility Deductible 30-20% 1MB
Added Advantage POSSM 300-100/90/70 997KB
Added Advantage POSSM 500-100/80/60 998KB
Full EPO Facility Coinsurance 20-20% 979KB
Full EPO Per Admit 10-250 979KB
Full EPO Zero Admit 20 976KB
Full EPO Zero Admit 30 976KB
Full PPO Combined Deductible 0-250 80/60 975KB
Full PPO Combined Deductible 0-250 90/70 975KB
Full PPO Combined Deductible 0-400 90/70 975KB
Full PPO Combined Deductible 10-250 90/70 975KB
Full PPO Combined Deductible 10-500 90/70 975KB
Full PPO Combined Deductible 15-250 90/70 975KB
Full PPO Combined Deductible 20-200 90/70 975KB
Full PPO Combined Deductible 20-250 80/60 975KB
Full PPO Combined Deductible 25-250 80/60 975KB
Full PPO Combined Deductible 25-250 90/60 975KB
Full PPO Combined Deductible 30-500 90/60 975KB
Full PPO Combined Deductible 30-750 80/60 975KB
Full PPO Combined Deductible 35-500 80/60 975KB
Full PPO Combined Deductible Value 10-1000 90/70 975KB
Full PPO Combined Deductible Value 15-1500 80/50 975KB
Full PPO Combined Deductible Value 20-2000 80/50 975KB
Full PPO Combined Deductible Value 25-2500 80/50 975KB
Full PPO Combined Deductible Value 30-3000 80/50 975KB
Full PPO Combined Deductible Value 40-4000 80/50 975KB
Full PPO Combined Deductible Value 50-4500 80/50 975KB
Full PPO No Network Deductible 10 100/50 975KB
Full PPO No Network Deductible 20 100/50 975KB
Full PPO Savings Embedded Deductible 2800 1MB
Full PPO Savings Embedded Deductible 3000 1MB
Full PPO Savings Embedded Deductible 3000 100% 1MB
Full PPO Savings Embedded Deductible 3500 1MB
Full PPO Savings Embedded Deductible 4000 1MB
Full PPO Savings Embedded Deductible 4400 100% 1MB
Full PPO Savings Embedded Deductible 5500 1MB
Full PPO Savings Two-Tier Embedded Deductible 1400/2800/2800 1MB
Full PPO Savings Two-Tier Embedded Deductible 1500/2800/3000 1MB
Full PPO Savings Two-Tier Embedded Deductible 1500/2800/3000 100% 1MB
Full PPO Savings Two-Tier Embedded Deductible 1500/2800/3000 with $0 HDHP Preventive Drug Benefit 1MB
Full PPO Savings Two-Tier Embedded Deductible 1800/2800/3600 1MB
Full PPO Savings Two-Tier Embedded Deductible 2250/2800/4500 1MB
Full PPO Savings Two-Tier Embedded Deductible 2250/2800/4500 with $0 HDHP Preventive Drug Benefit 1MB
Full PPO Split Deductible 0-500 80/60 975KB
Full PPO Split Deductible 0-1750 80/60 975KB
Full PPO Split Deductible 10-250 90/70 975KB
Full PPO Split Deductible 15-500 90/60 975KB
Full PPO Split Deductible 20-500 80/60 975KB
Full PPO Split Deductible 25-750 80/60 975KB
Full PPO Split Deductible 30-2000 70/50 975KB
Full PPO Split Deductible 35-1000 80/60 975KB
Full PPO Split Deductible 40-4000 70/50 975KB
Local Access+ HMO® Facility Coinsurance 15-20% 1MB
Local Access+ HMO® Facility Coinsurance 20-20% 1MB
Local Access+ HMO® Facility Coinsurance 25-25% 1MB
Local Access+ HMO® Facility Coinsurance 40-40% 1MB
Local Access+ HMO® Facility Deductible 15-10%/1500 1MB
Local Access+ HMO® Facility Deductible 20-25%/1500 1MB
Local Access+ HMO® Facility Deductible 30-30%/2000 1MB
Local Access+ HMO® Facility Deductible 40-40%/2000 1MB
Local Access+ HMO® Facility Deductible 40-40%/5800 1MB
Local Access+ HMO® Per Admit 10-250 975KB
Local Access+ HMO® Per Admit 20-500 975KB
Local Access+ HMO® Per Admit 25-750 975KB
Local Access+ HMO® Per Admit 40-1000 975KB
Local Access+ HMO® Zero Admit 10 1MB
Local Access+ HMO® Zero Admit 20 1MB
Local Access+ HMO® Zero Admit 30 1MB
Shield Spectrum PPO℠ 250-90/70 Standard 1MB
Tandem EPO Facility Coinsurance 20-20% 1MB
Tandem EPO Per Admit 10-250 979KB
Tandem EPO Zero Admit 20 976KB
Tandem EPO Zero Admit 30 977KB
Tandem PPO Combined Deductible 0-250 80/60 975KB
Tandem PPO Combined Deductible 0-250 90/70 975KB
Tandem PPO Combined Deductible 0-400 90/70 975KB
Tandem PPO Combined Deductible 10-250 90/70 975KB
Tandem PPO Combined Deductible 15-250 90/70 975KB
Tandem PPO Combined Deductible 20-200 90/70 975KB
Tandem PPO Combined Deductible 20-250 80/60 975KB
Tandem PPO Combined Deductible 25-250 80/60 975KB
Tandem PPO Combined Deductible 25-250 90/60 975KB
Tandem PPO Combined Deductible Value 10-1000 90/70 975KB
Tandem PPO No Network Deductible 10 100/50 975KB
Tandem PPO Savings Embedded Deductible 3000 1MB
Tandem PPO Savings Embedded Deductible 4425 1MB
Tandem PPO Split Deductible 0-1750 80/60 975KB
Tandem PPO Split Deductible 0-500 80/60 975KB
Tandem PPO Split Deductible 10-250 90/70 975KB
Tandem PPO Split Deductible 20-500 80/60 975KB
Tandem PPO Split Deductible 25-750 80/60 975KB
Tandem PPO Split Deductible 30-1500 80/50 975KB
Tandem PPO Split Deductible 35-1000 80/60 975KB
Tandem PPO Split Deductible 40-3000 70/50 975KB
Trio HMO Facility Coinsurance 15-20% 975KB
Trio HMO Facility Coinsurance 20-20% 975KB
Trio HMO Facility Coinsurance 25-25% 975KB
Trio HMO Facility Coinsurance 30-30% 975KB
Trio HMO Facility Coinsurance 40-40% 975KB
Trio HMO Facility Deductible 15-10%/1500 975KB
Trio HMO Facility Deductible 15-10%/250 975KB
Trio HMO Facility Deductible 15-10%/500 975KB
Trio HMO Facility Deductible 15-10%/750 975KB
Trio HMO Facility Deductible 20-25%/1500 975KB
Trio HMO Facility Deductible 30-10%/1500 975KB
Trio HMO Facility Deductible 30-30%/2000 975KB
Trio HMO Facility Deductible 40-40%/2000 975KB
Trio HMO Facility Deductible 40-40%/5800 975KB
Trio HMO Per Admit 10-250 975KB
Trio HMO Per Admit 20-250 975KB
Trio HMO Per Admit 20-500 975KB
Trio HMO Per Admit 25-750 975KB
Trio HMO Per Admit 40-1000 975KB
Trio HMO Per Day 15-500 975KB
Trio HMO Per Day 25-750 975KB
Trio HMO Zero Admit 10 975KB
Trio HMO Zero Admit 15 975KB
Trio HMO Zero Admit 20 975KB
Trio HMO Zero Admit 30 975KB
Trio HMO Zero Facility Deductible 30-20% 975KB
Show full contents

Access+ HMO® Facility Coinsurance 15-20% 672KB
Access+ HMO® Facility Coinsurance 20-20% 672KB
Access+ HMO® Facility Coinsurance 25-25% 672KB
Access+ HMO® Facility Coinsurance 30-30% 672KB
Access+ HMO® Facility Coinsurance 40-40% 672KB
Access+ HMO® Facility Deductible 15-10%/1500 672KB
Access+ HMO® Facility Deductible 15-10%/250 672KB
Access+ HMO® Facility Deductible 15-10%/500 672KB
Access+ HMO® Facility Deductible 15-10%/750 672KB
Access+ HMO® Facility Deductible 20-25%/1500 672KB
Access+ HMO® Facility Deductible 30-10%/1500 672KB
Access+ HMO® Facility Deductible 30-30%/2000 672KB
Access+ HMO® Facility Deductible 40-40%/2000 672KB
Access+ HMO® Facility Deductible 40-40%/5800 672KB
Access+ HMO® Per Admit 10-250 672KB
Access+ HMO® Per Admit 20-250 672KB
Access+ HMO® Per Admit 20-500 672KB
Access+ HMO® Per Admit 25-750 672KB
Access+ HMO® Per Admit 40-1000 672KB
Access+ HMO® Per Day 15-500 672KB
Access+ HMO® Per Day 25-750 672KB
Access+ HMO® SaveNet Facility Coinsurance 15-20% 672KB
Access+ HMO® SaveNet Facility Coinsurance 20-20% 672KB
Access+ HMO® SaveNet Facility Coinsurance 25-25% 672KB
Access+ HMO® SaveNet Facility Coinsurance 40-40% 672KB
Access+ HMO® SaveNet Facility Deductible 15-10%/1500 672KB
Access+ HMO® SaveNet Facility Deductible 20-25%/1500 672KB
Access+ HMO® SaveNet Facility Deductible 30-30%/2000 672KB
Access+ HMO® SaveNet Facility Deductible 40-40%/2000 672KB
Access+ HMO® SaveNet Facility Deductible 40-40%/5800 672KB
Access+ HMO® SaveNet Per Admit 10-250 672KB
Access+ HMO® SaveNet Per Admit 20-500 672KB
Access+ HMO® SaveNet Per Admit 25-750 672KB
Access+ HMO® SaveNet Per Admit 40-1000 672KB
Access+ HMO® SaveNet Zero Admit 10 672KB
Access+ HMO® SaveNet Zero Admit 20 672KB
Access+ HMO® SaveNet Zero Admit 30 672KB
Access+ HMO® Zero Admit 10 672KB
Access+ HMO® Zero Admit 15 672KB
Access+ HMO® Zero Admit 20 672KB
Access+ HMO® Zero Admit 30 672KB
Access+ HMO® Zero Facility Deductible 30-20% 672KB
Active Choice® 500 80/50 672KB
Active Choice® 750 80/60 672KB
Active Choice® 750 70/50 672KB
Active Choice® 750 70/50 1000 Deductible 672KB
Active Choice® 500 80/50 1500 Deductible 672KB
Added Advantage POSSM 300-100/90/70 672KB
Added Advantage POSSM 500-100/80/60 672KB
Full EPO Per Admit 10-250 672KB
Full PPO Combined Deductible 0-400 90/70 672KB
Full PPO Combined Deductible 10-250 90/70 672KB
Full PPO Combined Deductible 10-500 90/70 672KB
Full PPO Combined Deductible 15-250 90/70 672KB
Full PPO Combined Deductible 20-200 90/70 672KB
Full PPO Combined Deductible 20-250 80/60 672KB
Full PPO Combined Deductible 25-250 80/60 672KB
Full PPO Combined Deductible 25-250 90/60 672KB
Full PPO Combined Deductible 30-500 90/60 672KB
Full PPO Combined Deductible 30-750 80/60 672KB
Full PPO Combined Deductible 35-500 80/60 672KB
Full PPO Combined Deductible Value 10-1000 90/70 672KB
Full PPO Combined Deductible Value 15-1500 80/50 672KB
Full PPO Combined Deductible Value 20-2000 80/50 672KB
Full PPO Combined Deductible Value 25-2500 80/50 672KB
Full PPO Combined Deductible Value 30-3000 80/50 672KB
Full PPO Combined Deductible Value 40-4000 80/50 672KB
Full PPO Combined Deductible Value 50-4500 80/50 672KB
Full PPO No Network Deductible 10 100/50 672KB
Full PPO No Network Deductible 20 100/50 672KB
Full PPO Savings Embedded Deductible 2800 672KB
Full PPO Savings Embedded Deductible 3000 672KB
Full PPO Savings Embedded Deductible 3000 100% 672KB
Full PPO Savings Embedded Deductible 3500 672KB
Full PPO Savings Embedded Deductible 4000 672KB
Full PPO Savings Embedded Deductible 4400 100% 672KB
Full PPO Savings Embedded Deductible 5500 672KB
Full PPO Savings Two-Tier Embedded Deductible 1400/2800/2800 672KB
Full PPO Savings Two-Tier Embedded Deductible 1500/2800/3000 672KB
Full PPO Savings Two-Tier Embedded Deductible 1500/2800/3000 100% 672KB
Full PPO Savings Two-Tier Embedded Deductible 1500/2800/3000 with Value-Based Tier Drug Benefit 672KB
Full PPO Savings Two-Tier Embedded Deductible 1800/2800/3600 672KB
Full PPO Savings Two-Tier Embedded Deductible 2250/2800/4500 672KB
Full PPO Savings Two-Tier Embedded Deductible 2250/2800/4500 with Value-Based Tier Drug Benefits 672KB
Full PPO Split Deductible 0-1750 80/60 672KB
Full PPO Split Deductible 10-250 90/70 672KB
Full PPO Split Deductible 15-500 90/60 672KB
Full PPO Split Deductible 20-500 80/60 672KB
Full PPO Split Deductible 25-750 80/60 672KB
Full PPO Split Deductible 30-2000 70/50 672KB
Full PPO Split Deductible 35-1000 80/60 672KB
Full PPO Split Deductible 40-4000 70/50 672KB
Local Access+ HMO® Facility Coinsurance 15-20% 672KB
Local Access+ HMO® Facility Coinsurance 20-20% 672KB
Local Access+ HMO® Facility Coinsurance 25-25% 672KB
Local Access+ HMO® Facility Coinsurance 40-40% 672KB
Local Access+ HMO® Facility Deductible 15-10%/1500 672KB
Local Access+ HMO® Facility Deductible 20-25%/1500 672KB
Local Access+ HMO® Facility Deductible 30-30%/2000 672KB
Local Access+ HMO® Facility Deductible 40-40%/2000 672KB
Local Access+ HMO® Facility Deductible 40-40%/5800 672KB
Local Access+ HMO® Per Admit 10-250 672KB
Local Access+ HMO® Per Admit 20-500 672KB
Local Access+ HMO® Per Admit 25-750 672KB
Local Access+ HMO® Per Admit 40-1000 672KB
Local Access+ HMO® Zero Admit 10 672KB
Local Access+ HMO® Zero Admit 20 672KB
Local Access+ HMO® Zero Admit 30 672KB
Shield Spectrum PPO℠ 250-90/70 Standard 672KB
Tandem EPO Per Admit 10-250 672KB
Tandem PPO Combined Deductible 0-400 90/70 672KB
Tandem PPO Combined Deductible 10-250 90/70 672KB
Tandem PPO Combined Deductible 15-250 90/70 672KB
Tandem PPO Combined Deductible 20-200 90/70 672KB
Tandem PPO Combined Deductible 20-250 80/60 672KB
Tandem PPO Combined Deductible 25-250 80/60 672KB
Tandem PPO Combined Deductible 25-250 90/60 672KB
Tandem PPO Combined Deductible Value 10-1000 90/70 672KB
Tandem PPO No Network Deductible 10 100/50 672KB
Tandem PPO Savings Embedded Deductible 3000 672KB
Tandem PPO Savings Embedded Deductible 4425 672KB
Tandem PPO Split Deductible 0-1750 80/60 672KB
Tandem PPO Split Deductible 10-250 90/70 672KB
Tandem PPO Split Deductible 20-500 80/60 672KB
Tandem PPO Split Deductible 25-750 80/60 672KB
Tandem PPO Split Deductible 30-1500 80/50 672KB
Tandem PPO Split Deductible 35-1000 80/60 672KB
Tandem PPO Split Deductible 40-3000 70/50 672KB
Trio HMO Facility Coinsurance 15-20% 672KB
Trio HMO Facility Coinsurance 20-20% 672KB
Trio HMO Facility Coinsurance 25-25% 672KB
Trio HMO Facility Coinsurance 30-30% 672KB
Trio HMO Facility Coinsurance 40-40% 672KB
Trio HMO Facility Deductible 15-10%/1500 672KB
Trio HMO Facility Deductible 15-10%/250 672KB
Trio HMO Facility Deductible 15-10%/500 672KB
Trio HMO Facility Deductible 15-10%/750 672KB
Trio HMO Facility Deductible 20-25%/1500 672KB
Trio HMO Facility Deductible 30-10%/1500 672KB
Trio HMO Facility Deductible 30-30%/2000 672KB
Trio HMO Facility Deductible 40-40%/2000 672KB
Trio HMO Facility Deductible 40-40%/5800 672KB
Trio HMO Per Admit 10-250 672KB
Trio HMO Per Admit 20-250 672KB
Trio HMO Per Admit 20-500 672KB
Trio HMO Per Admit 25-750 672KB
Trio HMO Per Admit 40-1000 672KB
Trio HMO Per Day 15-500 672KB
Trio HMO Per Day 25-750 672KB
Trio HMO Zero Admit 10 672KB
Trio HMO Zero Admit 15 672KB
Trio HMO Zero Admit 20 672KB
Trio HMO Zero Admit 30 672KB
Trio HMO Zero Facility Deductible 30-20% 672KB
Show full contents

HMO PLANS

Size
Trio HMO Facility Coinsurance 15-20% 672KB
Trio HMO Facility Coinsurance 20-20% 672KB
Trio HMO Facility Coinsurance 25-25% 672KB
Trio HMO Facility Coinsurance 40-40% 672KB
Trio HMO Facility Deductible 15-10%/1500 672KB
Trio HMO Facility Deductible 20-25%/1500 672KB
Trio HMO Facility Deductible 30-10%/1500 672KB
Trio HMO Facility Deductible 30-30%/2000 672KB
Trio HMO Facility Deductible 40-40%/2000 672KB
Trio HMO Facility Deductible 40-40%/5800 672KB
Trio HMO Per Admit 10-250 672KB
Trio HMO Per Admit 20-250 672KB
Trio HMO Per Admit 20-500 672KB
Trio HMO Per Admit 25-750 672KB
Trio HMO Per Admit 40-1000 672KB
Trio HMO Per Day 15-500 672KB
Trio HMO Per Day 25-750 672KB
Trio HMO Zero Admit 10 672KB
Trio HMO Zero Admit 20 672KB
Trio HMO Zero Admit 30 672KB
Trio HMO Zero Facility Deductible 30-20% 672KB
Access+ HMO® Facility Coinsurance 15-20% 672KB
Access+ HMO® Facility Coinsurance 20-20% 672KB
Access+ HMO® Facility Coinsurance 25-25% 672KB
Access+ HMO® Facility Coinsurance 40-40% 672KB
Access+ HMO® SaveNet Facility Coinsurance 15-20% 672KB
Access+ HMO® SaveNet Facility Coinsurance 20-20% 672KB
Access+ HMO® SaveNet Facility Coinsurance 25-25% 672KB
Access+ HMO® SaveNet Facility Coinsurance 40-40% 672KB
Access+ HMO® SaveNet Zero Admit 10 672KB
Access+ HMO® SaveNet Zero Admit 20 672KB
Access+ HMO® SaveNet Zero Admit 30 672KB
Access+ HMO® Zero Admit 10 672KB
Access+ HMO® Zero Admit 20 672KB
Access+ HMO® Zero Admit 30 672KB
Local Access+ HMO® Facility Coinsurance 15-20% 672KB
Local Access+ HMO® Facility Coinsurance 20-20% 672KB
Local Access+ HMO® Facility Coinsurance 25-25% 672KB
Local Access+ HMO® Facility Coinsurance 40-40% 672KB
Local Access+ HMO® Zero Admit 10 672KB
Local Access+ HMO® Zero Admit 20 672KB
Local Access+ HMO® Zero Admit 30 672KB

PPO PLANS

  
Tandem PPO Combined Deductible 10-250 90/70 672KB
Tandem PPO Combined Deductible 15-250 90/70 672KB
Tandem PPO Combined Deductible 20-200 90/70 672KB
Tandem PPO Combined Deductible 20-250 80/60 672KB
Tandem PPO Combined Deductible 25-250 80/60 672KB
Tandem PPO Combined Deductible 25-250 90/60 672KB
Tandem PPO Combined Deductible Value 10-1000 90/70 672KB
Tandem PPO No Network Deductible 10 100/50 672KB
Tandem PPO Split Deductible 10-250 90/70 672KB
Tandem PPO Split Deductible 20-500 80/60 672KB
Tandem PPO Split Deductible 25-750 80/60 672KB
Tandem PPO Split Deductible 35-1000 80/60 672KB

FULL PPO PLANS

 
Full PPO Combined Deductible 10-250 90/70 672KB  
Full PPO Combined Deductible 15-250 90/70 672KB
Full PPO Combined Deductible 20-200 90/70 672KB
Full PPO Combined Deductible 20-250 80/60 672KB
Full PPO Combined Deductible 25-250 80/60 672KB
Full PPO Combined Deductible 25-250 90/60 672KB
Full PPO Combined Deductible 30-500 90/60 672KB
Full PPO Combined Deductible 30-750 80/60 672KB
Full PPO Combined Deductible 35-500 80/60 672KB
Full PPO Combined Deductible Value 10-1000 90/70 672KB
Full PPO Combined Deductible Value 15-1500 80/50 672KB
Full PPO Combined Deductible Value 20-2000 80/50 672KB
Full PPO Combined Deductible Value 25-2500 80/50 672KB
Full PPO Combined Deductible Value 30-3000 80/50 672KB
Full PPO Combined Deductible Value 40-4000 80/50 672KB
Full PPO No Network Deductible 10 100/50 672KB
Full PPO Split Deductible 10-250 90/70 672KB
Full PPO Split Deductible 15-500 90/60 672KB
Full PPO Split Deductible 20-500 80/60 672KB
Full PPO Split Deductible 25-750 80/60 672KB
Full PPO Split Deductible 30-2000 70/50 672KB
Full PPO Split Deductible 35-1000 80/60 672KB
Full PPO Split Deductible 40-4000 70/50 672KB
Shield Spectrum PPO℠ 250-90/70 Standard 672KB

PPO SAVINGS PLANS

  
Full PPO Savings Embedded Deductible 2800 672KB
Full PPO Savings Embedded Deductible 3000 672KB
Full PPO Savings Embedded Deductible 3500 672KB
Full PPO Savings Embedded Deductible 4000 672KB
Full PPO Savings Embedded Deductible 5500 672KB
Full PPO Savings Two-Tier Embedded Deductible 1400/2800/2800 672KB
Full PPO Savings Two-Tier Embedded Deductible 1500/2800/3000 672KB
Full PPO Savings Two-Tier Embedded Deductible 1800/2800/3600 672KB
Full PPO Savings Two-Tier Embedded Deductible 2250/2800/4500 672KB
Full PPO Savings Two-Tier Embedded Deductible 1500/2800/3000 with Value-Based Tier Drug Benefits 672KB
Full PPO Savings Two-Tier Embedded Deductible 2250/2800/4500 with Value-Based Tier Drug Benefits 672KB
Tandem PPO Savings Embedded Deductible 3000 672KB
Show full contents

HMO PLANS

Size
Trio HMO Facility Coinsurance 15-20% 672KB
Trio HMO Facility Coinsurance 20-20% 672KB
Trio HMO Facility Coinsurance 25-25% 672KB
Trio HMO Facility Coinsurance 40-40% 672KB
Trio HMO Facility Deductible 15-10%/1500 672KB
Trio HMO Facility Deductible 20-25%/1500 672KB
Trio HMO Facility Deductible 30-10%/1500 672KB
Trio HMO Facility Deductible 30-30%/2000 672KB
Trio HMO Facility Deductible 40-40%/2000 672KB
Trio HMO Facility Deductible 40-40%/5800 672KB
Trio HMO Per Admit 10-250 672KB
Trio HMO Per Admit 20-250 672KB
Trio HMO Per Admit 20-500 672KB
Trio HMO Per Admit 25-750 672KB
Trio HMO Per Admit 40-1000 672KB
Trio HMO Per Day 15-500 672KB
Trio HMO Per Day 25-750 672KB
Trio HMO Zero Admit 10 672KB
Trio HMO Zero Admit 20 672KB
Trio HMO Zero Admit 30 672KB
Trio HMO Zero Facility Deductible 30-20% 672KB
Access+ HMO® Facility Coinsurance 15-20% 672KB
Access+ HMO® Facility Coinsurance 20-20% 672KB
Access+ HMO® Facility Coinsurance 25-25% 672KB
Access+ HMO® Facility Coinsurance 40-40% 672KB
Access+ HMO® Facility Deductible 15-10%/1500 672KB
Access+ HMO® Facility Deductible 20-25%/1500 672KB
Access+ HMO® Facility Deductible 30-10%/1500 672KB
Access+ HMO® Facility Deductible 30-30%/2000 672KB
Access+ HMO® Facility Deductible 40-40%/2000 672KB
Access+ HMO® Facility Deductible 40-40%/5800 672KB
Access+ HMO® Per Admit 10-250 672KB
Access+ HMO® Per Admit 20-250 672KB
Access+ HMO® Per Admit 20-500 672KB
Access+ HMO® Per Admit 25-750 672KB
Access+ HMO® Per Admit 40-1000 672KB
Access+ HMO® Per Day 15-500 672KB
Access+ HMO® Per Day 25-750 672KB
Access+ HMO® SaveNet Facility Coinsurance 15-20% 672KB
Access+ HMO® SaveNet Facility Coinsurance 20-20% 672KB
Access+ HMO® SaveNet Facility Coinsurance 25-25% 672KB
Access+ HMO® SaveNet Facility Coinsurance 40-40% 672KB
Access+ HMO® SaveNet Facility Deductible 15-10%/1500 672KB
Access+ HMO® SaveNet Facility Deductible 20-25%/1500 672KB
Access+ HMO® SaveNet Facility Deductible 30-30%/2000 672KB
Access+ HMO® SaveNet Facility Deductible 40-40%/2000 672KB
Access+ HMO® SaveNet Facility Deductible 40-40%/5800 672KB
Access+ HMO® SaveNet Per Admit 10-250 672KB
Access+ HMO® SaveNet Per Admit 20-500 672KB
Access+ HMO® SaveNet Per Admit 25-750 672KB
Access+ HMO® SaveNet Per Admit 40-1000 672KB
Access+ HMO® SaveNet Zero Admit 10 672KB
Access+ HMO® SaveNet Zero Admit 20 672KB
Access+ HMO® SaveNet Zero Admit 30 672KB
Access+ HMO® Zero Admit 10 672KB
Access+ HMO® Zero Admit 20 672KB
Access+ HMO® Zero Admit 30 672KB
Access+ HMO® Zero Facility Deductible 30-20% 672KB
Local Access+ HMO® Facility Coinsurance 15-20% 672KB
Local Access+ HMO® Facility Coinsurance 20-20% 672KB
Local Access+ HMO® Facility Coinsurance 25-25% 672KB
Local Access+ HMO® Facility Coinsurance 40-40% 672KB
Local Access+ HMO® Facility Deductible 15-10%/1500 672KB
Local Access+ HMO® Facility Deductible 20-25%/1500 672KB
Local Access+ HMO® Facility Deductible 30-30%/2000 672KB
Local Access+ HMO® Facility Deductible 40-40%/2000 672KB
Local Access+ HMO® Facility Deductible 40-40%/5800 672KB
Local Access+ HMO® Per Admit 10-250 672KB
Local Access+ HMO® Per Admit 20-500 672KB
Local Access+ HMO® Per Admit 25-750 672KB
Local Access+ HMO® Per Admit 40-1000 672KB
Local Access+ HMO® Zero Admit 10 672KB
Local Access+ HMO® Zero Admit 20 672KB
Local Access+ HMO® Zero Admit 30 672KB

PPO PLANS

Size
Tandem PPO Combined Deductible 10-250 90/70 672KB
Tandem PPO Combined Deductible 15-250 90/70 672KB
Tandem PPO Combined Deductible 20-200 90/70 672KB
Tandem PPO Combined Deductible 20-250 80/60 672KB
Tandem PPO Combined Deductible 25-250 80/60 672KB
Tandem PPO Combined Deductible 25-250 90/60 672KB
Tandem PPO Combined Deductible Value 10-1000 90/70 672KB
Tandem PPO No Network Deductible 10 100/50 672KB
Tandem PPO Savings Embedded Deductible 3000 672KB
Tandem PPO Split Deductible 10-250 90/70 672KB
Tandem PPO Split Deductible 20-500 80/60 672KB
Tandem PPO Split Deductible 25-750 80/60 672KB
Tandem PPO Split Deductible 35-1000 80/60 672KB

FULL PPO PLANS

Size
Full PPO Combined Deductible 10-250 90/70 672KB
Full PPO Combined Deductible 15-250 90/70 672KB
Full PPO Combined Deductible 20-200 90/70 672KB
Full PPO Combined Deductible 20-250 80/60 672KB
Full PPO Combined Deductible 25-250 80/60 672KB
Full PPO Combined Deductible 25-250 90/60 672KB
Full PPO Combined Deductible 30-500 90/60 672KB
Full PPO Combined Deductible 30-750 80/60 672KB
Full PPO Combined Deductible 35-500 80/60 672KB
Full PPO Combined Deductible Value 10-1000 90/70 672KB
Full PPO Combined Deductible Value 15-1500 80/50 672KB
Full PPO Combined Deductible Value 20-2000 80/50 672KB
Full PPO Combined Deductible Value 25-2500 80/50 672KB
Full PPO Combined Deductible Value 30-3000 80/50 672KB
Full PPO Combined Deductible Value 40-4000 80/50 672KB
Full PPO No Network Deductible 10 100/50 672KB
Full PPO No Network Deductible 20 100/50 672KB
Full PPO Split Deductible 10-250 90/70 672KB
Full PPO Split Deductible 15-500 90/60 672KB
Full PPO Split Deductible 20-500 80/60 672KB
Full PPO Split Deductible 25-750 80/60 672KB
Full PPO Split Deductible 30-2000 70/50 672KB
Full PPO Split Deductible 35-1000 80/60 672KB
Full PPO Split Deductible 40-4000 70/50 672KB
Shield Spectrum PPO℠ 250-90/70 Standard 672KB

PPO SAVINGS PLANS

Size
Full PPO Savings Embedded Deductible 2700 672KB
Full PPO Savings Embedded Deductible 3000 672KB
Full PPO Savings Embedded Deductible 3500 672KB
Full PPO Savings Embedded Deductible 4000 672KB
Full PPO Savings Embedded Deductible 5500 672KB
Full PPO Savings Two-Tier Embedded Deductible 1350/2700/2700 672KB
Full PPO Savings Two-Tier Embedded Deductible 1500/2700/3000 672KB
Full PPO Savings Two-Tier Embedded Deductible 1800/2700/3600 672KB
Full PPO Savings Two-Tier Embedded Deductible 2250/2700/4500 672KB
Full PPO Savings Two-Tier Embedded Deductible 1500/2700/3000 with Value-Based Tier Drug Benefits 672KB
Full PPO Savings Two-Tier Embedded Deductible 2250/2700/4500 with Value-Based Tier Drug Benefits 672KB
Show full contents

PPO Savings Plans

Size

Full PPO℠ Savings Embedded Deductible 2600

672KB

Full PPO℠ Savings Two-Tier Embedded Deductible 1300/2600/2600

672KB

Full PPO℠ Savings Two-Tier Embedded Deductible 1500/2600/3000

672KB

Full PPO℠ Savings Two-Tier Embedded Deductible 1800/2600/3600

672KB

Full PPO℠ Savings Two-Tier Embedded Deductible 2250/2600/4500

672KB

Full PPO℠ Savings Two-Tier Embedded Deductible 1300/2600/3000 with Value-Based Tier Drug Benefits

672KB

Full PPO℠ Savings Two-Tier Embedded Deductible 2250/2600/4500 with Value-Based Tier Drug Benefits

672KB

Full PPO℠ ASO Savings Embedded Deductible 2600

672KB

Full PPO℠ ASO Savings Aggregate Deductible 1300/2600

672KB

Contact Us

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  • Blue Shield of California

    PO Box 272540

    Chico, CA 95927-2540

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