Blue Shield offers

2025 Prescription Drug Plan Documents

All of your Blue Shield of California Medicare Prescription Drug Plan documents, including the enrollment form, enrollment checklist, multi-language notice, and Medicare Star Ratings documents are listed on this page.

Plan documents can help you understand your plan.

  • Evidence of Coverage (EOC) describes in detail the healthcare benefits your plan covers.
  • Summary of Benefits (SOB) is a simplified document that outlines your health benefits and coverage.
  • Annual Notice of Changes (ANOC) is a summary of any changes in the costs and coverage of your plan, effective every January 1.

For information on members and Blue Shield of California’s rights and responsibilities upon disenrollment, please refer to Chapter 8 in your EOC linked below.

Medicare Prescription Drug Plans (PDP)

Evidence of Coverage (EOC): English (PDF,  808 KB) / Español (PDF,  796 KB)

Summary of Benefits (SOB): English (PDF, 97 KB) / Español (PDF, 543 KB)

Annual Notice of Changes: English (PDF,  488 KB) / Español (PDF, 518 KB)

Enrollment Forms English (PDF, 300 KB) / Español (PDF, 278 KB)

Pre-enrollment Checklist: English (PDF, 130 KB) / Español (PDF, 110 KB)


 

Evidence of Coverage (EOC): English (PDF,  744 KB) / Español (PDF,  788 KB)

Summary of Benefits (SOB): English (PDF, 97 KB) / Español (PDF, 543 KB)

Annual Notice of Changes: English (PDF,  469 KB) / Español (PDF, 498 KB)

Enrollment Forms English (PDF, 300 KB) / Español (PDF, 278 KB)

Pre-enrollment Checklist: English (PDF, 130 KB) / Español (PDF, 110 KB)


 

Multi-language Interpreter Services and Nondiscrimination notices, and Blue Shield PDP Star ratings

Multi-language Interpreter Services notice, English (PDF, 2 MB)
Nondiscrimination notice, English (PDF, 489 KB) / Español (PDF, 525 KB)


 

Blue Shield PDP Medicare Star Ratings* English (PDF, 108 KB) / Español (PDF, 105 KB)

*Every year, Medicare evaluates plans based on a 5­-star rating system.


 

Please refer to our list of compatible browsers when downloading or viewing PDF documents.

You can also log into your online account and visit the Benefits section on your member dashboard.

If you want help understanding your documents, please call Blue Shield of California Medicare Prescription Drug Plan Customer Service at (888) 239-6469 (TTY: 711), 8 a.m. to 8 p.m., seven days a week.

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Page last updated: 1/1/2025

*Free digital copy with no obligation to enroll.

† Blue Shield Medicare Advisers are available April 1 through September 30: 8 a.m. to 8 p.m., weekdays and October 1 through March 31: 8 a.m. to 8 p.m., seven days a week.

© California Physician’s Service DBA Blue Shield of California 1999-2025. All rights reserved.

California Physician’s Service DBA Blue Shield of California is an independent member of the Blue Shield Association.

Blue Shield of California 601 12th Street, Oakland, CA 94607.

For Blue Shield Medicare Advantage Plans: 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.

 
 
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