| Blue Shield Off-Exchange PPO Plans | Summary of Benefits | Disclosures | Optional Benefit |
|---|---|---|---|
| Platinum Full PPO 0/0 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.8MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Platinum Tandem PPO 0/0 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.8MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Platinum Full PPO 0/10 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.8MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Platinum Tandem PPO 0/10 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.8MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Platinum Full PPO 250/10 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.8MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Platinum Tandem PPO 250/10 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.8MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Platinum Full PPO 250/15 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.8MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Platinum Tandem PPO 250/15 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.9MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Gold Full PPO 0/25 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.8MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Gold Tandem PPO 0/25 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.8MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Gold Full PPO 500/30 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.8MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Gold Tandem PPO 500/30 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.9MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Gold Full PPO 750/30 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.8MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Gold Tandem PPO 750/30 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.9MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Gold Full PPO 1000/35 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.8MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Gold Tandem PPO 1000/35 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.9MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Silver Full PPO 2000/60 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.8MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Silver Tandem PPO 2000/60 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.9MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Silver Full PPO 2350/65 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.8MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Silver Tandem PPO 2350/65 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.9MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Silver Full PPO 2550/70 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.8MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Silver Tandem PPO 2550/70 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.9MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Bronze Full PPO 5500/65 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.9MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Bronze Tandem PPO 5500/65 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.9MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Bronze Full PPO 6250/65 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.9MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Bronze Tandem PPO 6250/65 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.9MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Bronze Full PPO 6500/70 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.9MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Bronze Tandem PPO 6500/70 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.9MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Bronze Full PPO 7500/65 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.9MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Bronze Tandem PPO 7500/65 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.9MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Bronze Full PPO 6850/55 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.9MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Bronze Tandem PPO 6850/55 OffEx | English (PDF, 1.1MB) Spanish (PDF, 1.9MB) |
English (PDF, 1.1MB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Virtual Blue Plans | Summary of Benefits | Disclosures | Optional Benefit |
|---|---|---|---|
| Virtual Blue℠ Gold Tandem PPO 1500/45 OffEx | English (PDF, 275KB) Spanish (PDF, 344KB) |
English (PDF, 310KB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
| Virtual Blue℠ Bronze Tandem PPO 7500/75 OffEx | English (PDF, 288KB) Spanish (PDF, 353KB) |
English (PDF, 310KB) |
Infertility English (PDF, 996.7KB) Spanish (PDF, 1.7MB) |
Contact Us
Producer Services (800) 559-5905
Employer Services (800) 325-5166
Blue Shield of California
PO Box 272540
Chico, CA 95927-2540
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© California Physicians’ Service DBA Blue Shield of California 1999-2022. 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.