2019 Summary of Benefits

2018 Benefit Summaries  |  Dental Benefit Summaries  |  Vision Benefit Summaries

The following Individual and Family Plan medical Summaries of Benefits (SOB) are effective January 1, 2019, and must be accompanied by the Important Legal Information booklet (PDF, 2.5MB), Spanish  (PDF, 2.1MB)

In addition to the Summary of Benefits, the Evidence of Coverage/Policy (EOC) and Summary of Benefits and Coverage (SBC) forms provide your clients with an easy-to-understand overview of what our IFP plans cover. Visit blueshieldca.com/policies to download the forms.

We offer six Silver cost-sharing reduction plans through Covered California for clients whose income is between 138% to 250% of the federal poverty level (FPL). These plans are available only through Covered California.

We offer American Indian and Alaska Native plans for each metal level that are available only to eligible American Indians and Alaska Natives through Covered California. These plans differ from the standard metal level plans in that they allow American Indian and Alaska Native members to access covered services from American Indian and Alaskan Native providers for no out-of-pocket costs. In addition to the Alaska Native and American Indian versions of the standard metal level plans, we offer a $0 cost share PPO plan to American Indian and Alaska Native members who qualify based on household income. Members can choose to access covered services through a Blue Shield participating provider or non-network provider for an out-of-pocket cost.