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MEDICARE
All your Blue Shield of California Medicare Supplement plan documents are listed on this page. These include your Evidence of Coverage (EOC) and Summary of Benefits (SOB). You can also log into your account and go to the Benefits section on your member dashboard.
If you want help understanding your documents, call Blue Shield of California Customer Care:
Medicare Supplement plan Customer Care at (800) 248-2341 [TTY: 711], 8 a.m. to 5:30 p.m., Monday through Friday, excluding holidays.
Summary of Benefits (SOB) English (PDF, 461 KB)
Summary of Benefits (SOB) Spanish (PDF, 475 KB)
Summary of Benefits (SOB) Chinese (PDF, 1 MB)
Summary of Benefits (SOB) Vietnamese (PDF, 480 KB)
Evidence of Coverage (EOC) English (PDF, 230KB)
Evidence of Coverage (EOC) English (PDF, 239KB)
Evidence of Coverage (EOC) English (PDF, 236KB)
Medicare Supplement Multi-Language insert, English (PDF, 567 KB)
Medicare Supplement Multi-Language insert, Español (PDF, 601 KB)
1. Plan F Extra is only available to applicants who attained age 65 or first became eligible for Medicare benefits due to disability before January 1, 2020.
2. Please note, the Extra benefits are embedded in your medical benefits under your Medicare Supplement Plan. This separate rate is part of your Total Amount Due.
3. Plan G Inspire is only available in the following counties: Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Fresno, Glenn, Humboldt, Kings, Lake, Lassen, Madera, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Shasta, Sierra, Siskiyou, Solano, Sonoma, Stanislaus, Sutter, Tehama, Trinity, Tuolumne, Yolo and Yuba.
Y0118_20_663A_M Accepted 09292020
Page last updated: 4/26/2021
