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Get complete descriptions of our closed Medicare Supplement plans effective 10/1/2019.

Plan C (PDF, 207 KB)
Plan D (PDF, 206 KB)
Plan F (PDF, 209 KB)
High Deductible Plan F (PDF, 207 KB)
Plan K (PDF, 199 KB)

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Get complete descriptions of our closed Medicare Supplement plans.

Plan A (pre June 2010) (PDF, 176 KB)
Plan B (pre June 2010) (PDF, 172 KB)
Plan C (pre June 2010) (PDF, 177 KB)
Plan D (pre June 2010) (PDF, 186 KB)
Plan F (pre June 2010) (PDF, 182 KB)
Plan G (pre June 2010) (PDF, 185KB)
Plan J (pre June 2010) (PDF, 180 KB)
Plan K (pre June 2010) (PDF, 191 KB)
Plan H Standard  (PDF, 166 KB)
Plan H Plus Rx  (PDF, 167 KB)
Plan I Standard (PDF, 170 KB)
Plan I Plus Rx (PDF, 172KB)
Coronet Major Medicare (PDF, 161 KB)
Coronet Senior Standard (PDF, 159 KB)
Coronet Senior Plus Rx (PDF, 159 KB)
Golden Coronet Senior Standard (PDF, 189KB)
Golden Coronet Senior Plus Rx (PDF, 160 KB)
Preferred Senior (PDF, 164 KB)
Specialty Duo Dental Policy(PDF)
Specialty Duo Vision Policy(PDF, 794 KB)

* Underwritten by Blue Shield Life and Health

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Dental PPO 1000 (PDF, 223 KB)
Dental PPO 1500 (PDF, 223 KB)

 

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Open plan rate sheet (PDF, 237 KB)
Dental PPO 1000 rate sheet (PDF, 59.4 KB)
Dental PPO 1500 rate sheet (PDF, 54.2 KB)

 

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2010 Standardized Closed Plans (closed 9/30/2019) (PDF, 387 KB)
1990 Standardized Closed Plans (closed 5/31/2010) (PDF, 190 KB)
1990 Standardized Closed Plans (closed 12/31/2005) (PDF, 50 KB)

Specialty Duo rate sheet (PDF, 39.6 KB)

 

Enrollment
Tools and resources to help you sell Blue Shield of California Medicare Supplement plans. You and your clients can now get a quote, compare plans, and apply through our online tool. After applications are submitted, their status can be tracked online as well.

Renewals
Get information on how to handle renewals.

 

* Underwritten by Blue Shield Life and Health

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2022 Blue Shield Inspire (HMO) – Los Angeles and Orange counties, English and Spanish
2022 Blue Shield Inspire (HMO) – Alameda and San Mateo counties, English and Spanish
2022 Blue Shield Inspire (PPO) – Alameda County, English and Spanish
2022 Blue Shield Inspire (HMO) – Fresno and Madera counties, English and Spanish
2022 Blue Shield Inspire (HMO) – Sacramento County, English and Spanish
2022 Blue Shield Inspire (HMO) – Santa Clara County, English and Spanish
2022 Blue Shield Inspire (HMO) – San Joaquin, Stanislaus and Merced counties, English and Spanish
 

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2022 Blue Shield Vital (HMO) – Los Angeles, Orange, Riverside and San Bernardino counties, English and Spanish
 

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2022 Blue Shield 65 Plus (HMO) – Los Angeles and Orange counties, English and Spanish
2022 Blue Shield 65 Plus (HMO) – San Bernardino County, English and Spanish
2022 Blue Shield 65 Plus (HMO) – Riverside County, English and Spanish
2022 Blue Shield 65 Plus Plan 2 (HMO) – Los Angeles and Orange counties, English and Spanish
2022 Blue Shield 65 Plus Choice Plan (HMO) – Riverside and San Bernardino counties, English and Spanish
2022 Blue Shield 65 Plus (HMO) – San Diego County, English and Spanish
2022 Blue Shield 65 Plus (HMO) – Ventura County, English and Spanish
2022 Blue Shield 65 Plus (HMO) – Kern County, English and Spanish
2022 Blue Shield 65 Plus (HMO) – San Luis Obispo and Santa Barbara counties, English and Spanish
 

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2022 Blue Shield Balance (HMO) – Los Angeles County, English and Spanish
 

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2022 Blue Shield AdvantageOptimum Plan (HMO) – Los Angeles and Orange counties, English and Spanish
2022 Blue Shield AdvantageOptimum Plan 1 (HMO) – San Diego County, English and Spanish
2022 Blue Shield AdvantageOptimum Plan (HMO) – Fresno County, English and Spanish
2022 Blue Shield AdvantageOptimum Plan (HMO) – Merced and Santa Clara Counties, English and Spanish
2022 Blue Shield AdvantageOptimum Plan (HMO) – Stanislaus County, English and Spanish
2022 Blue Shield AdvantageOptimum Plan (HMO) – San Joaquin County, English and Spanish
2022 Blue Shield AdvantageOptimum Plan 2 (HMO) – San Diego County, English and Spanish
 

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2022 Blue Shield TotalDual Plan (HMO D-SNP) – Los Angeles, Orange, San Bernardino & San Diego counties, English and Spanish
2022 Blue Shield Inspire (HMO D-SNP) – Fresno, Merced, San Joaquin & Stanislaus counties, English and Spanish
2022 Blue Shield Coordinated Choice Plan (HMO) – Los Angeles, Orange, San Bernardino, Riverside, San Diego, Fresno, Santa Clara, Merced, San Joaquin & Stanislaus counties, English and Spanish

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Blue Shield 65 Plus (HMO), Blue Shield 65 Plus Plan 2 (HMO), Blue Shield 65 Plus Choice Plan (HMO), Blue Shield AdvantageOptimum Plan (HMO), Blue Shield AdvantageOptimum Plan 1 (HMO), Blue Shield AdvantageOptimum Plan 2 (HMO), Blue Shield Inspire (HMO), Blue Shield Inspire (PPO), and Blue Shield Vital (HMO)

Blue Shield Balance (HMO)

Blue Shield Coordinated Choice Plan (HMO), Blue Shield Inspire (HMO D-SNP), and Blue Shield TotalDual Plan (HMO D-SNP)

 

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English
2022 Optional supplemental dental HMO & PPO plan flyer and enrollment form

Spanish
2022 Optional supplemental dental HMO & PPO plan flyer and enrollment form

 

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Authorization for the Use or Disclosure of Health Information

English (PDF, 141 KB)
Spanish (PDF, 200 KB)
Vietnamese (PDF, 357 KB)
Chinese (PDF, 209 KB)
Korean (PDF, 263 KB)
Hindi (PDF, 210 KB)

 

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2022 Plans with the OTC Items Benefit:

OTC Catalog, English (PDF, 7 MB)

 

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Blue Shield OTC Catalog (English) (PDF, 3.7 MB)

Blue Shield OTC Catalog (Spanish) (PDF, 3.74 MB)

 

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2022 Blue Shield Rx Plus (PDP), English and Spanish (PDF, 1.2 MB)
2022 Blue Shield Rx Enhanced (PDP), English and Spanish (PDF, 1.3 MB)

 

Blue Shield of California is an HMO, HMO D-SNP, PPO and a PDP plan with a Medicare contract and a contract with the California State Medicaid Program. Enrollment in Blue Shield of California depends on contract renewal.

The company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability. La compañía cumple con las leyes de derechos civiles federales y estatales aplicables, y no discrimina, ni excluye ni trata de manera diferente a las personas por su raza, color, país de origen, identificación con determinado grupo étnico, condición médica, información genética, ascendencia, religión, sexo, estado civil, género, identidad de género, orientación sexual, edad, ni discapacidad física ni mental. 本公司遵守適用的州法律和聯邦民權法律,並且不會以種族、膚色、原國籍、族群認同、醫療狀況、遺傳資訊、血統、宗教、性別、婚姻狀況、性別認同、性取向、年齡、精神殘疾或身體殘疾而進行歧視、排斥或區別對待他人。

Y0118_22_147A_C 03282022
Page last updated: 6/17/2022