Benefit modifications 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.

January 2025

2025 Legal Plan Name Size
Access+ HMO® Facility Coinsurance 15-20% 125 KB
Access+ HMO® Facility Coinsurance 20-20% 125 KB
Access+ HMO® Facility Coinsurance 25-25% 125 KB
Access+ HMO® Facility Coinsurance 30-30% 135 KB
Access+ HMO® Facility Coinsurance 40-40% 135 KB
Access+ HMO® Facility Deductible 15-10%/1500 140 KB
Access+ HMO® Facility Deductible 15-10%/250 140 KB
Access+ HMO® Facility Deductible 15-10%/500 140 KB
Access+ HMO® Facility Deductible 15-10%/750 140 KB
Access+ HMO® Facility Deductible 20-25%/1500 140 KB
Access+ HMO® Facility Deductible 30-10%/1500 140 KB
Access+ HMO® Facility Deductible 30-30%/2000 140 KB
Access+ HMO® Facility Deductible 40-40%/2000 145 KB
Access+ HMO® Per Admit 10-250 145 KB
Access+ HMO® Per Admit 20-250 145 KB
Access+ HMO® Per Admit 20-500 145 KB
Access+ HMO® Per Admit 25-750 145 KB
Access+ HMO® Per Admit 40-1000 145 KB
Access+ HMO® Per Day 15-500 145 KB
Access+ HMO® Per Day 20-250 145 KB
Access+ HMO® Per Day 20-500 145 KB
Access+ HMO® Per Day 25-750 145 KB
Access+ HMO® Per Day 30-500 145 KB
Access+ HMO® Zero Admit 10 145 KB
Access+ HMO® Zero Admit 15 145 KB
Access+ HMO® Zero Admit 20 145 KB
Access+ HMO® Zero Admit 30 145 KB
Access+ HMO® Zero Facility Deductible 30-20% 145 KB
Local Access+ HMO® Facility Coinsurance 15-20% 145 KB
Local Access+ HMO® Facility Coinsurance 20-20% 145 KB
Local Access+ HMO® Facility Coinsurance 25-25% 145 KB
Local Access+ HMO® Facility Coinsurance 40-40% 145 KB
Local Access+ HMO® Facility Deductible 15-10%/1500 145 KB
Local Access+ HMO® Facility Deductible 20-25%/1500 145 KB
Local Access+ HMO® Facility Deductible 30-30%/2000 145 KB
Local Access+ HMO® Facility Deductible 40-40%/2000 138 KB
Local Access+ HMO® Per Admit 10-250 145 KB
Local Access+ HMO® Per Admit 20-250 145 KB
Local Access+ HMO® Per Admit 20-500 145 KB
Local Access+ HMO® Per Admit 25-750 145 KB
Local Access+ HMO® Per Admit 40-1000 145 KB
Local Access+ HMO® Per Day 20-250 145 KB
Local Access+ HMO® Per Day 20-500 145 KB
Local Access+ HMO® Per Day 30-500 145 KB
Local Access+ HMO® Zero Admit 10 145 KB
Local Access+ HMO® Zero Admit 20 145 KB
Local Access+ HMO® Zero Admit 30 145 KB
Trio HMO Facility Coinsurance 15-20% 145 KB
Trio HMO Facility Coinsurance 20-20% 145 KB
Trio HMO Facility Coinsurance 25-25% 145 KB
Trio HMO Facility Coinsurance 30-30% 145 KB
Trio HMO Facility Coinsurance 40-40% 145 KB
Trio HMO Facility Deductible 15-10%/1500 145 KB
Trio HMO Facility Deductible 15-10%/250 145 KB
Trio HMO Facility Deductible 15-10%/500 145 KB
Trio HMO Facility Deductible 15-10%/750 145 KB
Trio HMO Facility Deductible 20-25%/1500 145 KB
Trio HMO Facility Deductible 30-10%/1500 145 KB
Trio HMO Facility Deductible 30-30%/2000 145 KB
Trio HMO Facility Deductible 40-40%/2000 145 KB
Trio HMO Per Admit 10-250 145 KB
Trio HMO Per Admit 20-250 145 KB
Trio HMO Per Admit 20-500 145 KB
Trio HMO Per Admit 25-750 145 KB
Trio HMO Per Admit 40-1000 145 KB
Trio HMO Per Day 15-500 142 KB
Trio HMO Per Day 20-250 142 KB
Trio HMO Per Day 20-500 142 KB
Trio HMO Per Day 25-750 142 KB
Trio HMO Per Day 30-500 142 KB
Trio HMO Zero Admit 10 142 KB
Trio HMO Zero Admit 15 142 KB
Trio HMO Zero Admit 20 142 KB
Trio HMO Zero Admit 30 142 KB
Trio HMO Zero Facility Deductible 30-20% 142 KB
Full EPO 10-250 90% 142 KB
Full EPO 20-500 80% 142 KB
Full EPO 25-1500 80% 142 KB
Full EPO 25-2500 80% 142 KB
Full EPO Facility Coinsurance 20-20% 142 KB
Full EPO Per Admit 10-250 142 KB
Full EPO Zero Admit 20 142 KB
Full EPO Zero Admit 30 142 KB
Tandem EPO 10-250 90% 142 KB
Tandem EPO 20-500 80% 142 KB
Tandem EPO 25-1500 80% 142 KB
Tandem EPO 25-2500 80% 142 KB
Tandem EPO Facility Coinsurance 20-20% 142 KB
Tandem EPO Per Admit 10-250 142 KB
Tandem EPO Zero Admit 20 142 KB
Tandem EPO Zero Admit 30 142 KB
Virtual BlueSM EPO 20-1000 80% 142 KB
Virtual BlueSM EPO 20-1500 80% 142 KB
Virtual BlueSM EPO 20-2000 70% 142 KB
Virtual BlueSM EPO 20-250 80% 142 KB
Virtual BlueSM EPO 20-250 90% 142 KB
Virtual BlueSM EPO 20-500 80% 142 KB
Virtual BlueSM EPO 20-750 80% 142 KB
Virtual BlueSM EPO 50-1000 70% 142 KB
Virtual BlueSM EPO 50-3000 60% 142 KB
Active Choice® Classic 600 70/50 2000 Deductible 142 KB
Active Choice® Classic 600 80/50 142 KB
Active Choice® Classic 850 70/50 1000 Deductible 142 KB
Active Choice® Classic 850 80/60 142 KB
Active Choice® Plus 1000 20 80/60 142 KB
Active Choice® Plus 1000 80/60 142 KB
Active Choice® Plus 1000 80/60 1000 Deductible 142 KB
Active Choice® Plus 300 20 80/60 142 KB
Active Choice® Plus 300 80/60 142 KB
Active Choice® Plus 300 80/60 2000 Deductible 142 KB
Added Advantage POS℠ 500-100/80/60 142 KB
Full PPO Combined Deductible 0-250 80/60 142 KB
Full PPO Combined Deductible 0-250 90/70 142 KB
Full PPO Combined Deductible 0-400 90/70 142 KB
Full PPO Combined Deductible 10-250 90/70 142 KB
Full PPO Combined Deductible 10-500 90/70 142 KB
Full PPO Combined Deductible 15-250 90/70 142 KB
Full PPO Combined Deductible 20-200 90/70 142 KB
Full PPO Combined Deductible 20-250 80/60 142 KB
Full PPO Combined Deductible 25-250 80/60 142 KB
Full PPO Combined Deductible 25-250 90/60 142 KB
Full PPO Combined Deductible 30-500 90/60 142 KB
Full PPO Combined Deductible 30-750 80/60 142 KB
Full PPO Combined Deductible 35-500 80/60 142 KB
Full PPO Combined Deductible 40-6350 80/50 142 KB
Full PPO Combined Deductible Value 10-1000 90/70 142 KB
Full PPO Combined Deductible Value 15-1500 80/50 142 KB
Full PPO Combined Deductible Value 20-2000 80/50 142 KB
Full PPO Combined Deductible Value 25-2500 80/50 142 KB
Full PPO Combined Deductible Value 30-3000 80/50 142 KB
Full PPO Combined Deductible Value 40-4000 80/50 142 KB
Full PPO No Network Deductible 10 100/50 142 KB
Full PPO No Network Deductible 20 100/50 142 KB
Full PPO Savings Embedded Deductible 3300 100% 142 KB
Full PPO Savings Embedded Deductible 3300/5200 142 KB
Full PPO Savings Embedded Deductible 3300/6000 142 KB
Full PPO Savings Embedded Deductible 3500 142 KB
Full PPO Savings Embedded Deductible 4000 142 KB
Full PPO Savings Embedded Deductible 4400 100% 142 KB
Full PPO Savings Embedded Deductible 5500 142 KB
Full PPO Savings Embedded Deductible 5500 with Value Formulary 142 KB
Full PPO Savings Embedded Deductible 6350 100% 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1650/3300/3300 100% 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1650/3300/3300 90/60 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1650/3300/3300 90/70 142 KB
Full PPO Savings Two-Tier Deductible 1650/3300/3300 with $0 HDHP Preventive Drug Benefit 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1650/3300/3300 with Value Formulary 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1800/3300/3600 142 KB
Full PPO Savings Two-Tier Embedded Deductible 2250/3300/4500 142 KB
Full PPO Savings Two-Tier Embedded Deductible 2250/3300/4500 with $0 HDHP Preventive Drug Benefit 142 KB
Full PPO Split Deductible 0-1750 80/60 143 KB
Full PPO Split Deductible 0-500 80/60 143 KB
Full PPO Split Deductible 10-250 90/70 145KB
Full PPO Split Deductible 15-500 90/60 145KB
Full PPO Split Deductible 20-500 80/60 145KB
Full PPO Split Deductible 25-750 80/60 145KB
Full PPO Split Deductible 30-2000 70/50 145KB
Full PPO Split Deductible 35-1000 80/60 979 KB
Full PPO Split Deductible 40-4000 70/50 144 KB
Full PPO Split Deductible 50-5000 70/50 144 KB
Full PPO Split Deductible 50-6350 70/50 144 KB
Tandem PPO Combined Deductible 0-250 80/60 143 KB
Tandem PPO Combined Deductible 0-250 90/70 143 KB
Tandem PPO Combined Deductible 0-400 90/70 143 KB
Tandem PPO Combined Deductible 10-250 90/70 143 KB
Tandem PPO Combined Deductible 15-250 90/70 143 KB
Tandem PPO Combined Deductible 20-250 80/60 143 KB
Tandem PPO No Network Deductible 10 100/50 143 KB
Tandem PPO Savings Embedded Deductible 3300 143 KB
Tandem PPO Savings Embedded Deductible 3300 100% 143 KB
Tandem PPO Savings Embedded Deductible 4425 143 KB
Tandem PPO Savings Embedded Deductible 5500 143 KB
Tandem PPO Savings Embedded Deductible 6350 100% 145KB
Tandem PPO Savings Two-Tier Embedded Deductible 1650/3300/3300 145KB
Tandem PPO Split Deductible 0-1750 80/60 145KB
Tandem PPO Split Deductible 0-500 80/60 143 KB
Tandem PPO Split Deductible 10-250 90/70 143 KB
Tandem PPO Split Deductible 20-500 80/60 143 KB
Tandem PPO Split Deductible 25-750 80/60 143 KB
Tandem PPO Split Deductible 35-1000 80/60 143 KB
Virtual Blue PPO Combined Deductible 20-250 80/60 143 KB
Virtual Blue PPO Combined Deductible 20-250 90/70 143 KB
Virtual Blue PPO Combined Deductible 20-500 80/60 143 KB
Virtual Blue PPO Savings Embedded Deductible 5500 143 KB
Virtual Blue PPO Savings Two-Tier Embedded Deductible 2500/3300/5000 143 KB
Virtual Blue PPO Split Deductible 20-1000 80/60 143 KB
Virtual Blue PPO Split Deductible 20-1500 80/60 143 KB
Virtual Blue PPO Split Deductible 20-2000 70/50 143 KB
Virtual Blue PPO Split Deductible 20-250 90/70 143 KB
Virtual Blue PPO Split Deductible 20-500 80/60 143 KB
Virtual Blue PPO Split Deductible 20-750 80/60 143 KB
Virtual Blue PPO Split Deductible 50-1000 70/50 143 KB
Virtual Blue PPO Split Deductible 50-3000 60/50 143 KB

 

Non-Marketed HMO Ben Mods Size
Access+ HMO® SaveNet Facility Deductible 15-10%/1500 143 KB
Access+ HMO® SaveNet Facility Deductible 20-25%/1500 143 KB
Access+ HMO® SaveNet Facility Deductible 30-30%/2000 143 KB
Access+ HMO® SaveNet Facility Deductible 40-40%/2000 143 KB
Access+ HMO® SaveNet Per Admit 20-500 143 KB
Access+ HMO® SaveNet Per Admit 25-750 143 KB
Access+ HMO® SaveNet Per Admit 40-1000 143 KB
Access+ HMO® SaveNet Zero Admit 10 143 KB
Access+ HMO® SaveNet Zero Admit 20 143 KB
Access+ HMO® SaveNet Zero Admit 30 143 KB
Access+ HMO® SaveNet Facility Coinsurance 40-40% 143 KB
Access+ HMO® Facility Deductible 40-40%/5800 143 KB
Access+ HMO® SaveNet Per Admit 10-250 143 KB
Access+ HMO® SaveNet Facility Coinsurance 15-20% 143 KB
Local Access+ HMO® Facility Deductible 40-40%/5800 143 KB
Access+ HMO® SaveNet Facility Deductible 40-40%/5800 143 KB
Trio HMO Facility Deductible 40-40%/5800 143 KB
Access+ HMO® SaveNet Facility Coinsurance 25-25% 143 KB
Access+ HMO® SaveNet Facility Coinsurance 20-20% 143 KB

 

Non-Marketed PPO Ben Mods Size
Shield Spectrum PPO℠ 250-90/70 Standard 143 KB
Tandem PPO Combined Deductible 20-200 90/70 143 KB
Tandem PPO Combined Deductible 25-250 80/60 143 KB
Tandem PPO Combined Deductible 25-250 90/60 143 KB
Tandem PPO Combined Deductible Value 10-1000 90/70 143 KB
Full PPO Combined Deductible Value 50-4500 80/50 143 KB
Tandem PPO Split Deductible 30-1500 80/50 143 KB
Tandem PPO Split Deductible 40-3000 70/50 143 KB

 

Non-Marketed POS Ben Mods Size
Added Advantage POS℠ 300-100/90/70 143 KB

January 2024

2024 Legal Plan Name Size
Access+ HMO® Facility Coinsurance 15-20% 125 KB
Access+ HMO® Facility Coinsurance 20-20% 125 KB
Access+ HMO® Facility Coinsurance 25-25% 125 KB
Access+ HMO® Facility Coinsurance 30-30% 135 KB
Access+ HMO® Facility Coinsurance 40-40% 135 KB
Access+ HMO® Facility Deductible 15-10%/1500 140 KB
Access+ HMO® Facility Deductible 15-10%/250 140 KB
Access+ HMO® Facility Deductible 15-10%/500 140 KB
Access+ HMO® Facility Deductible 15-10%/750 140 KB
Access+ HMO® Facility Deductible 20-25%/1500 140 KB
Access+ HMO® Facility Deductible 30-10%/1500 140 KB
Access+ HMO® Facility Deductible 30-30%/2000 140 KB
Access+ HMO® Facility Deductible 40-40%/2000 145 KB
Access+ HMO® Per Admit 10-250 145 KB
Access+ HMO® Per Admit 20-250 145 KB
Access+ HMO® Per Admit 20-500 145 KB
Access+ HMO® Per Admit 25-750 145 KB
Access+ HMO® Per Admit 40-1000 145 KB
Access+ HMO® Per Day 15-500 145 KB
Access+ HMO® Per Day 20-250 145 KB
Access+ HMO® Per Day 20-500 145 KB
Access+ HMO® Per Day 25-750 145 KB
Access+ HMO® Per Day 30-500 145 KB
Access+ HMO® Zero Admit 10 145 KB
Access+ HMO® Zero Admit 15 145 KB
Access+ HMO® Zero Admit 20 145 KB
Access+ HMO® Zero Admit 30 145 KB
Access+ HMO® Zero Facility Deductible 30-20% 145 KB
Local Access+ HMO® Facility Coinsurance 15-20% 145 KB
Local Access+ HMO® Facility Coinsurance 40-40% 138 KB
Local Access+ HMO® Per Admit 25-750 145 KB
Local Access+ HMO® Zero Admit 10 145 KB
Local Access+ HMO® Zero Admit 20 145 KB
Local Access+ HMO® Zero Admit 30 145 KB
Local Access+ HMO® Per Admit 10-250 140 KB
Local Access+ HMO® Per Admit 20-250 140 KB
Local Access+ HMO® Per Admit 20-500 140 KB
Local Access+ HMO® Per Admit 40-1000 140 KB
Local Access+ HMO® Per Day 20-250 140 KB
Local Access+ HMO® Per Day 20-500 140 KB
Local Access+ HMO® Per Day 30-500 140 KB
Local Access+ HMO® Facility Coinsurance 20-20% 145 KB
Local Access+ HMO® Facility Coinsurance 25-25% 140 KB
Trio HMO Facility Coinsurance 15-20% 145 KB
Trio HMO Facility Coinsurance 20-20% 145 KB
Trio HMO Facility Coinsurance 25-25% 145 KB
Trio HMO Facility Coinsurance 30-30% 145 KB
Trio HMO Facility Coinsurance 40-40% 145 KB
Trio HMO Facility Deductible 15-10%/1500 145 KB
Trio HMO Facility Deductible 15-10%/250 145 KB
Trio HMO Facility Deductible 15-10%/500 145 KB
Trio HMO Facility Deductible 15-10%/750 145 KB
Trio HMO Facility Deductible 20-25%/1500 145 KB
Trio HMO Facility Deductible 30-10%/1500 145 KB
Trio HMO Facility Deductible 30-30%/2000 145 KB
Trio HMO Facility Deductible 40-40%/2000 145 KB
Trio HMO Per Admit 10-250 145 KB
Trio HMO Per Admit 20-250 145 KB
Trio HMO Per Admit 20-500 145 KB
Trio HMO Per Admit 25-750 145 KB
Trio HMO Per Admit 40-1000 145 KB
Trio HMO Per Day 15-500 142 KB
Trio HMO Per Day 20-250 142 KB
Trio HMO Per Day 20-500 142 KB
Trio HMO Per Day 25-750 142 KB
Trio HMO Per Day 30-500 142 KB
Trio HMO Zero Admit 10 142 KB
Trio HMO Zero Admit 15 142 KB
Trio HMO Zero Admit 20 142 KB
Trio HMO Zero Admit 30 142 KB
Trio HMO Zero Facility Deductible 30-20% 142 KB
Full EPO 25-1500 80% 142 KB
Full EPO 25-2500 80% 142 KB
Full EPO Facility Coinsurance 20-20% 142 KB
Full EPO Per Admit 10-250 142 KB
Full EPO Zero Admit 20 142 KB
Full EPO Zero Admit 30 142 KB
Tandem EPO 25-1500 80% 142 KB
Tandem EPO 25-2500 80% 142 KB
Tandem EPO Facility Coinsurance 20-20% 142 KB
Tandem EPO Per Admit 10-250 142 KB
Tandem EPO Zero Admit 20 142 KB
Tandem EPO Zero Admit 30 142 KB
Tandem EPO 20-500 80% 142 KB
Tandem EPO 10-250 90% 142 KB
Full EPO 20-500 80% 142 KB
Full EPO 10-250 90% 142 KB
Added Advantage POS℠ 500-100/80/60 142 KB
Active Choice® Classic 600 80/50 142 KB
Active Choice® Classic 850 70/50 1000 Deductible 142 KB
Active Choice® Classic 850 80/60 142 KB
Active Choice® Plus 1000 20 80/60 142 KB
Active Choice® Plus 1000 80/60 142 KB
Active Choice® Plus 300 20 80/60 142 KB
Active Choice® Plus 300 80/60 142 KB
Full PPO Combined Deductible 0-250 80/60 142 KB
Full PPO Combined Deductible 0-250 90/70 142 KB
Full PPO Combined Deductible 0-400 90/70 142 KB
Full PPO Combined Deductible 10-250 90/70 142 KB
Full PPO Combined Deductible 10-500 90/70 142 KB
Full PPO Combined Deductible 15-250 90/70 142 KB
Full PPO Combined Deductible 20-200 90/70 142 KB
Full PPO Combined Deductible 20-250 80/60 142 KB
Full PPO Combined Deductible 25-250 80/60 142 KB
Full PPO Combined Deductible 25-250 90/60 142 KB
Full PPO Combined Deductible 30-500 90/60 142 KB
Full PPO Combined Deductible 30-750 80/60 142 KB
Full PPO Combined Deductible 35-500 80/60 142 KB
Full PPO Combined Deductible Value 10-1000 90/70 142 KB
Full PPO Combined Deductible Value 15-1500 80/50 142 KB
Full PPO Combined Deductible Value 20-2000 80/50 142 KB
Full PPO Combined Deductible Value 25-2500 80/50 142 KB
Full PPO Combined Deductible Value 30-3000 80/50 142 KB
Full PPO Combined Deductible Value 40-4000 80/50 142 KB
Full PPO No Network Deductible 10 100/50 142 KB
Full PPO No Network Deductible 20 100/50 142 KB
Full PPO Savings Embedded Deductible 3200/5200 142 KB
Full PPO Savings Embedded Deductible 3200/6000 142 KB
Full PPO Savings Embedded Deductible 3200 100% 142 KB
Full PPO Savings Embedded Deductible 3500 142 KB
Full PPO Savings Embedded Deductible 4000 142 KB
Full PPO Savings Embedded Deductible 4400 100% 142 KB
Full PPO Savings Embedded Deductible 5500 142 KB
Full PPO Savings Embedded Deductible 6350 100% 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1600/3200/3200 90/70 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1600/3200/3200 90/60 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1600/3200/3200 100% 142 KB
Full PPO Savings Two-Tier Deductible 1600/3200/3200 with $0 HDHP Preventive Drug Benefit 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1800/3200/3600 142 KB
Full PPO Savings Two-Tier Embedded Deductible 2250/3200/4500 142 KB
Full PPO Savings Two-Tier Embedded Deductible 2250/3200/4500 with $0 HDHP Preventive Drug Benefit 142 KB
Full PPO Savings Embedded Deductible 5500 with Value Formulary 142 KB
Full PPO Savings Two-Tier Embedded Deductible 1600/3200/3200 with Value Formulary 143 KB
Tandem PPO Savings Two-Tier Embedded Deductible 1600/3200/3200 90/60 143 KB
Full PPO Split Deductible 0-1750 80/60 143 KB
Full PPO Split Deductible 0-500 80/60 143 KB
Full PPO Split Deductible 10-250 90/70 145KB
Full PPO Split Deductible 15-500 90/60 145KB
Full PPO Split Deductible 20-500 80/60 145KB
Full PPO Split Deductible 25-750 80/60 145KB
Full PPO Split Deductible 30-2000 70/50 145KB
Full PPO Split Deductible 35-1000 80/60 979 KB
Full PPO Split Deductible 40-4000 70/50 144 KB
Tandem PPO Combined Deductible 0-250 80/60 143 KB
Tandem PPO Combined Deductible 0-250 90/70 143 KB
Tandem PPO Combined Deductible 0-400 90/70 143 KB
Tandem PPO Combined Deductible 10-250 90/70 143 KB
Tandem PPO Combined Deductible 15-250 90/70 143 KB
Tandem PPO Combined Deductible 20-250 80/60 143 KB
Tandem PPO No Network Deductible 10 100/50 143 KB
Tandem PPO Savings Embedded Deductible 3200 143 KB
Tandem PPO Savings Embedded Deductible 5500 143 KB
Tandem PPO Savings Embedded Deductible 3200 100% 143 KB
Tandem PPO Savings Embedded Deductible 4425 143 KB
Tandem PPO Savings Embedded Deductible 6350 100% 145KB
Tandem PPO Split Deductible 0-1750 80/60 145KB
Tandem PPO Split Deductible 0-500 80/60 143 KB
Tandem PPO Split Deductible 10-250 90/70 143 KB
Tandem PPO Split Deductible 20-500 80/60 143 KB
Tandem PPO Split Deductible 25-750 80/60 143 KB
Tandem PPO Split Deductible 35-1000 80/60 143 KB
Virtual Blue PPO Split Deductible 50-3000 60/50 143 KB
Virtual Blue PPO Split Deductible 50-1000 70/50 143 KB
Virtual Blue PPO Combined Deductible 20-250 80/60 143 KB

 

Non-Marketed HMO Ben Mods Size
Access+ HMO® SaveNet Per Admit 10-250 143 KB
Access+ HMO® SaveNet Facility Coinsurance 15-20% 143 KB
Local Access+ HMO® Facility Deductible 15-10%/1500 143 KB
Local Access+ HMO® Facility Deductible 20-25%/1500 143 KB
Access+ HMO® SaveNet Zero Admit 10 143 KB
Access+ HMO® SaveNet Zero Admit 20 143 KB
Access+ HMO® SaveNet Zero Admit 30 143 KB
Access+ HMO® SaveNet Per Admit 20-500 143 KB
Access+ HMO® SaveNet Per Admit 25-750 143 KB
Access+ HMO® SaveNet Per Admit 40-1000 143 KB
Access+ HMO® SaveNet Facility Coinsurance 20-20% 143 KB
Access+ HMO® SaveNet Facility Coinsurance 25-25% 143 KB
Access+ HMO® SaveNet Facility Coinsurance 40-40% 143 KB
Access+ HMO® SaveNet Facility Deductible 15-10%/1500 143 KB
Access+ HMO® SaveNet Facility Deductible 20-25%/1500 143 KB
Access+ HMO® SaveNet Facility Deductible 30-30%/2000 143 KB
Access+ HMO® SaveNet Facility Deductible 40-40%/2000 143 KB
Local Access+ HMO® Facility Deductible 30-30%/2000 143 KB
Local Access+ HMO® Facility Deductible 40-40%/2000 143 KB
Trio HMO Facility Deductible 40-40%/5800 143 KB
Access+ HMO® Facility Deductible 40-40%/5800 143 KB
Local Access+ HMO® Facility Deductible 40-40%/5800 143 KB
Access+ HMO® SaveNet Facility Deductible 40-40%/5800 143 KB

 

Non-Marketed PPO Ben Mods Size
Shield Spectrum PPO℠ 250-90/70 Standard 143 KB
Tandem PPO Combined Deductible 20-200 90/70 143 KB
Tandem PPO Combined Deductible 25-250 80/60 143 KB
Tandem PPO Combined Deductible 25-250 90/60 143 KB
Tandem PPO Combined Deductible Value 10-1000 90/70 143 KB
Full PPO Combined Deductible Value 50-4500 80/50 143 KB
Tandem PPO Split Deductible 30-1500 80/50 143 KB
Tandem PPO Split Deductible 40-3000 70/50 143 KB

 

Non-Marketed POS Ben Mods Size
Added Advantage POS℠ 300-100/90/70 143 KB

© California Physicians' Service DBA Blue Shield of California 1999-2025. All rights reserved. California Physicians’ Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.

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