The SOB documents will include the coverage information you are used to seeing but in a much simplified format. The format makes it easier for members to read and understand their plan benefits. SOBs will be included in new business proposals and renewals, open-enrollment materials, as well as member welcome kits as part of the Evidence of Coverage (EOC).
See FAQs about the new Summary of Benefits.
When providing the Summary of Benefits to an applicant or Blue Shield member, you must also include a Notice of Language Assistance (PDF, 1.04MB).
In addition the Summary of Benefits and Coverage (SBC) Forms, provide your clients with an easy-to-understand overview of what our plans for groups of 101 and above cover. You can download SBC Forms and other resources for these plans:
Forms and Applications | Benefit Modification Brochures | Group administrator guide | Employer Connection provides resources for your clients | Network
Full PPO Savings Two-Tier Plans | Summary of Benefits | Optional Benefits | Disclosures |
Full PPO Savings Two-Tier Embedded Deductible 1400/2800/2800 |
English (PDF, 1MB) Spanish (PDF, 196KB) |
Hearing aid (PDF, 987KB) |
English (PDF, 1.1MB) |
Full PPO Savings Two-Tier Embedded Deductible 1500/2800/3000 |
English (PDF, 1MB) Spanish (PDF, 196KB) |
Hearing aid (PDF, 987KB) |
English (PDF, 1.1MB) |
Full PPO Savings Two-Tier Embedded Deductible 1500/2800/3000 100% |
English (PDF, 1MB) Spanish (PDF, 196KB) |
Hearing aid (PDF, 987KB) |
English (PDF, 1.1MB) |
Full PPO Savings Two-Tier Embedded Deductible 1500/2800/3000 with $0 HDHP Preventive Drug Benefit |
English (PDF, 1MB) Spanish (PDF, 196KB) |
Hearing aid (PDF, 987KB) |
English (PDF, 1.1MB) |
Full PPO Savings Two-Tier Embedded Deductible 1800/2800/3600 |
English (PDF, 1MB) Spanish (PDF, 196KB) |
Hearing aid (PDF, 987KB) |
English (PDF, 1.1MB) |
Full PPO Savings Two-Tier Embedded Deductible 2250/2800/4500 |
English (PDF, 1MB) Spanish (PDF, 196KB) |
Hearing aid (PDF, 987KB) |
English (PDF, 1.1MB) |
Full PPO Savings Two-Tier Embedded Deductible 2250/2800/4500 with $0 HDHP Preventive Drug Benefit |
English (PDF, 1MB) Spanish (PDF, 196KB) |
Hearing aid (PDF, 987KB) |
English (PDF, 1.1MB) |
Active Choice PPO Classic/Plus Plans | Summary of Benefits | Optional Benefits | Disclosures |
Active Choice® Plus 300 20 80/60 | English (PDF, 882KB) Spanish (PDF, 916KB) |
Hearing aid (PDF, 9724KB) |