Full PPO Plans | Summary of Benefits | Optional Benefits | Disclosures |
Full PPO No Network Deductible 10 100/50 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO No Network Deductible 20 100/50 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Combined Deductible 0-250 80/60 |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) | |
Full PPO Combined Deductible 0-250 90/70 |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) | |
Full PPO Combined Deductible 0-400 90/70 |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) | |
Full PPO Combined Deductible 10-250 90/70 |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) | |
Full PPO Combined Deductible 10-500 90/70 |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) | |
Full PPO Combined Deductible 15-250 90/70 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Combined Deductible 20-200 90/70 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Combined Deductible 20-250 80/60 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Combined Deductible 25-250 80/60 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Combined Deductible 25-250 90/60 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Combined Deductible 30-500 90/60 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Combined Deductible 30-750 80/60 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Combined Deductible 35-500 80/60 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Combined Deductible 40-6350 80/50 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Combined Deductible Value 10-1000 90/70 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Combined Deductible Value 15-1500 80/50 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Combined Deductible Value 20-2000 80/50 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Combined Deductible Value 25-2500 80/50 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Combined Deductible Value 30-3000 80/50 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Combined Deductible Value 40-4000 80/50 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Split Deductible 0-1750 80/60 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Split Deductible 0-500 80/60 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Split Deductible 10-250 90/70 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Split Deductible 15-500 90/60 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Split Deductible 20-500 80/60 | English ((PDF, 47 KB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Split Deductible 25-750 80/60 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Split Deductible 30-2000 70/50 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Split Deductible 35-1000 80/60 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Split Deductible 40-4000 70/50 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Split Deductible 50-5000 70/50 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Split Deductible 50-6350 70/50 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Savings Two-Tier Plans | Summary of Benefits | Optional Benefits | Disclosures |
Full PPO Savings Two-Tier Embedded Deductible 1600/3200/3200 90/70 |
English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Savings Two-Tier Embedded Deductible 1600/3200/3200 90/60 |
English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Savings Two-Tier Embedded Deductible 1600/3200/3200 100% |
English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Savings Two-Tier Embedded Deductible 1600/3200/3200 with $0 HDHP Preventive Drug Benefit |
English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Savings Two-Tier Embedded Deductible 1800/3200/3600 |
English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Savings Two-Tier Embedded Deductible 2250/3200/4500 |
English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Savings Two-Tier Embedded Deductible 2250/3200/4500 with $0 HDHP Preventive Drug Benefit |
English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Savings Two-Tier Embedded Deductible 1600/3200/3200 with Value Formulary |
English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Savings Two-Tier Embedded Deductible 1600/3200/3200 |
English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Savings Plans | Summary of Benefits | Optional Benefits | Disclosures |
Full PPO Savings Embedded Deductible 3200/5200 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Savings Embedded Deductible 3200/6000 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1MB) |
Full PPO Savings Embedded Deductible 3200 100% | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Savings Embedded Deductible 3500 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Savings Embedded Deductible 4000 |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) | |
Full PPO Savings Embedded Deductible 4400 100% |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) | |
Full PPO Savings Embedded Deductible 5500 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Savings Embedded Deductible 5500 with Value Formulary | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Full PPO Savings Embedded Deductible 6350 100% | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Plans | Summary of Benefits | Optional Benefits | Disclosures |
Tandem PPO No Network Deductible 10 100/50 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Combined Deductible 0-250 80/60 |
English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Combined Deductible 0-250 90/70 |
English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Combined Deductible 0-400 90/70 |
English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Combined Deductible 10-250 90/70 |
English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Combined Deductible 15-250 90/70 |
English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Combined Deductible 20-250 80/60 |
English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Split Deductible 0-1750 80/60 |
English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Split Deductible 0-500 80/60 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Split Deductible 10-250 90/70 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Split Deductible 20-500 80/60 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Split Deductible 25-750 80/60 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Split Deductible 35-1000 80/60 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Savings Plans | Summary of Benefits | Optional Benefits | Disclosures |
Tandem PPO Savings Embedded Deductible 3200 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Savings Embedded Deductible 4425 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Savings Embedded Deductible 3200 100% | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Savings Embedded Deductible 5500 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Savings Embedded Deductible 6350 100% | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987KB) |
English (PDF, 1.1 MB) |
Virtual Blue PPO Plans | Summary of Benefits | Optional Benefits | Disclosures |
Virtual BlueSM PPO Combined Deductible 20-250 80/60 | English (PDF, 223 KB) Spanish (PDF, 262 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 218 KB) |
Virtual BlueSM PPO Split Deductible 50-1000 70/50 | English (PDF, 223 KB) Spanish (PDF, 262 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 218 KB) |
Virtual BlueSM PPO Split Deductible 50-3000 60/50 | English (PDF, 223 KB) Spanish (PDF, 262 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 218 KB) |
Virtual BlueSM PPO Combined Deductible 20-250 90/70 | English (PDF, 223 KB) Spanish (PDF, 265 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 218 KB) |
Virtual BlueSM PPO Combined Deductible 20-500 80/60 | English (PDF, 223 KB) Spanish (PDF, 263 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 218 KB) |
Virtual BlueSM PPO Split Deductible 20-250 90/70 | English (PDF, 224 KB) Spanish (PDF, 264 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 218 KB) |
Virtual BlueSM PPO Split Deductible 20-500 80/60 | English (PDF, 224 KB) Spanish (PDF, 264 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 218 KB) |
Virtual BlueSM PPO Split Deductible 20-750 80/60 | English (PDF, 224 KB) Spanish (PDF, 264 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 218 KB) |
Virtual BlueSM PPO Split Deductible 20-1000 80/60 | English (PDF, 224 KB) Spanish (PDF, 264 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 218 KB) |
Virtual BlueSM PPO Split Deductible 20-1500 80/60 | English (PDF, 224 KB) Spanish (PDF, 264 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 218 KB) |
Virtual BlueSM PPO Split Deductible 20-2000 70/50 | English (PDF, 224 KB) Spanish (PDF, 261 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 218 KB) |
Active Choice PPO Plans | Summary of Benefits | Optional Benefits | Disclosures |
Active Choice® Plus 300 20 80/60 | English (PDF, 882 KB) Spanish (PDF, 916 KB) |
Hearing aid (PDF, 1 MB) |
English (PDF, 1.1 MB) |
Active Choice® Plus 300 80/60 | English (PDF, 882 KB) Spanish (PDF, 994 KB) |
Hearing aid (PDF, 1 MB) |
English (PDF, 1.1 MB) |
Active Choice® Plus 1000 20 80/60 | English (PDF, 882 KB) Spanish (PDF, 994 KB) |
Hearing aid (PDF, 1 MB) |
English (PDF, 1.1 MB) |
Active Choice® Plus 1000 80/60 | English (PDF, 882 KB) Spanish (PDF, 919 KB) |
Hearing aid (PDF, 1 MB) |
English (PDF, 1.1 MB) |
Active Choice® Plus 1000 80/60 1000 Deductible | English (PDF, 882 KB) Spanish (PDF, 919 KB) |
Hearing aid (PDF, 1 MB) |
English (PDF, 1.1 MB) |
Active Choice® Plus 300 80/60 2000 Deductible | English (PDF, 882 KB) Spanish (PDF, 919 KB) |
Hearing aid (PDF, 1 MB) |
English (PDF, 1.1 MB) |
Active Choice® Classic 600 80/50 | English (PDF, 882 KB) Spanish (PDF, 984 KB) |
Hearing aid (PDF, 1 MB) |
English (PDF, 1.1 MB) |
Active Choice® Classic 850 70/50 1000 Deductible | English (PDF, 882 KB) Spanish (PDF, 984 KB) |
Hearing aid (PDF, 1 MB) |
English (PDF, 1.1 MB) |
Active Choice® Classic 850 80/60 | English (PDF, 882 KB) Spanish (PDF, 984 KB) |
Hearing aid (PDF, 1 MB) |
English (PDF, 1.1 MB) |
Active Choice® Classic 600 70/50 2000 Deductible | English (PDF, 882 KB) Spanish (PDF, 984 KB) |
Hearing aid (PDF, 1 MB) |
English (PDF, 1.1 MB) |
Not Marketed PPO Plans | Summary of Benefits | Optional Benefits | Disclosures |
Full PPO Combined Deductible Value 50-4500 80/50 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Shield Spectrum PPOSM 250-90/70 Standard | English (PDF, 1.1 MB) Spanish (PDF, 273 KB) |
Hearing aid (PDF, 1 MB) |
English (PDF, 1.1 MB) |
Tandem PPO Combined Deductible 20-200 90/70 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Combined Deductible 25-250 80/60 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Combined Deductible 25-250 90/60 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Combined Deductible Value 10-1000 90/70 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Split Deductible 30-1500 80/50 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
Tandem PPO Split Deductible 40-3000 70/50 | English (PDF, 1 MB) Spanish (PDF, 196 KB) |
Hearing aid (PDF, 987 KB) |
English (PDF, 1.1 MB) |
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Blue Shield of California
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Chico, CA 95927-2540
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© California Physicians’ Service DBA Blue Shield of California 1999-. 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.