January 2019 Summary of Benefits

Download summary of benefits and disclosures for Blue Shield Off-Exchange Package for Small Business.

PPO plans | HSA-compatible HDHP | HMO plans


Blue Shield Off-Exchange PPO Plans

Plans Summary of Benefits Disclosures Optional
Benefits
Platinum Full PPO 0/10 OffEx English
Spanish
English
Spanish
Infertility
English
Spanish
Platinum Tandem PPO 0/10 OffEx English
Spanish
English
Spanish
Infertility
English
Spanish
Platinum Full PPO 250/15 OffEx English
Spanish
English
Spanish
Infertility
English
Spanish
Platinum Tandem PPO 250/15 OffEx English
Spanish
English
Spanish
Infertility 
English
Spanish

Gold Full PPO 0/20 OffEx

English
Spanish
English
Spanish
Infertility
English
Spanish
Gold Full PPO 500/30 OffEx English
Spanish
English
Spanish
Infertility
English
Spanish

Gold Full PPO 750/30 OffEx

English
Spanish
English
Spanish
Infertility
English
Spanish
Gold Tandem PPO 750/30 OffEx English
Spanish
English
Spanish
Infertility 
English
Spanish
Gold Full PPO 1200/35 OffEx English
Spanish
English
Spanish
Infertility 
English
Spanish

Silver Full PPO 1700/55 OffEx

English
Spanish
English
Spanish
Infertility 
English
Spanish
Silver Tandem PPO 1700/55 OffEx

English
Spanish

English
Spanish
Infertility 
English
Spanish
Silver Full PPO 2000/45 OffEx English
Spanish
English
Spanish
Infertility 
English
Spanish
Silver Tandem PPO 2000/45 OffEx English
Spanish
English
Spanish
Infertility 
English
Spanish
Bronze Full PPO 6500/50% OffEx

English
Spanish

English
Spanish
Infertility 
English
Spanish
Bronze Tandem PPO 6500/50% OffEx English
Spanish
English
Spanish
Infertility 
English
Spanish


Blue Shield Off-Exchange HSA-HDHP Plans

Plans

Summary of Benefits Disclosures Optional
Benefits
Silver Full PPO Savings 2000/20% OffEx English
Spanish
English
Spanish
Infertility
English
Spanish
Bronze Full PPO Savings 5300/40% OffEx English
Spanish
English
Spanish
Infertility
English
Spanish
Bronze Full PPO Savings 6650 OffEx English
Spanish
English
Spanish
Infertility 
English
Spanish
Silver Tandem PPO Savings 2000/20% OffEx English
Spanish
English
Spanish
Infertility 
English
Spanish


Blue Shield Off-Exchange HMO Plans

Plans Summary of Benefits Disclosures Optional
Benefits

Platinum Access+ HMO® 0/25 OffEx

English
Spanish
English
Spanish
Infertility
English
Spanish

Platinum Local Access+ HMO® 0/25 OffEx

English
Spanish
English
Spanish
Infertility
English
Spanish

Platinum Trio HMO 0/25 OffEx

English
Spanish
English
Spanish
Infertility
English
Spanish

Platinum Access+ HMO® 0/20 OffEx

English
Spanish
English
Spanish
Infertility
English
Spanish

Platinum Local Access+ HMO® 0/20

English
Spanish
English
Spanish
Infertility
English
Spanish

Platinum Trio HMO 0/20 OffEx

English
Spanish
English
Spanish
Infertility
English
Spanish

Platinum Access+ HMO® 0/30 OffEx

English
Spanish
English
Spanish
Infertility
English
Spanish

Platinum Local Access+ HMO® 0/30

English
Spanish
English
Spanish
Infertility
English
Spanish

Platinum Trio HMO 0/30 OffEx

English
Spanish
English
Spanish
Infertility
English
Spanish

Gold Access+ HMO® 500/35 OffEx

English
Spanish
English
Spanish
Infertility
English
Spanish

Gold Local Access+ HMO® 500/35 OffEx

English
Spanish

English
Spanish
Infertility
English
Spanish

Gold Trio HMO 500/35 OffEx

English
Spanish
English
Spanish
Infertility
English
Spanish

Gold Access+ HMO® 1500/35 OffEx

English
Spanish
English
Spanish
Infertility
English
Spanish

Gold Local Access+ HMO® 1500/35 OffEx

English
Spanish
English
Spanish
Infertility
English
Spanish

Gold Trio HMO 1700/35 OffEx

English
Spanish
English
Spanish
Infertility
English
Spanish

Silver Access+ HMO® 1975/55 OffEx

English
Spanish
English
Spanish
Infertility
English
Spanish
Silver Local Access+ HMO® 1975/55 OffEx English
Spanish
English
Spanish
Infertility
English
Spanish

Silver Trio HMO 1975/55 OffEx

English
Spanish

English
Spanish

Infertility
English
Spanish

Download summary of benefits and disclosures for Blue Shield Mirror Package for Small Business.

PPO plans | HMO plans


Blue Shield Mirror PPO Plans

Plans Summary of Benefits Disclosures Optional
Benefits

Blue Shield Platinum 90 PPO 0/15 + Child Dental

English
Spanish
English
Spanish
Infertility
English
Spanish

Blue Shield Gold 80 PPO 0/30 + Child Dental

English
Spanish

English
Spanish

Infertility
English
Spanish

Blue Shield Silver 70 PPO 2000/45 + Child Dental

English
Spanish
English
Spanish
Infertility
English
Spanish

Blue Shield Bronze 60 PPO 6300/75 + Child Dental

English
Spanish

English
Spanish

Infertility
English
Spanish


Blue Shield Mirror HMO Plans

Plans Summary of Benefits Disclosures Optional
Benefits

Blue Shield Platinum 90 HMO 0/15 Trio + Child Dental

English
Spanish
English
Spanish
Infertility
English
Spanish

Blue Shield Gold 80 HMO 0/30 Trio + Child Dental

English
Spanish
English
Spanish
Infertility
English
Spanish

Blue Shield Silver 70 HMO 2000/45 Trio + Child Dental

English
Spanish
English
Spanish
Infertility
English
Spanish