Medicare Supplement Plan Documents | Blue Shield Medicare
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MEDICARE

Medicare Supplement plan documents

All your Blue Shield of California Medicare Supplement plan documents, including the multi-language notice are listed on this page.

Plan documents can be used to help you understand your plan.

Evidence of Coverage (EOC) describes in detail the health care benefits covered by your plan.

Summary of Benefits (SOB) is a simplified document that summarizes your health benefits and coverage.

New or Innovative Benefits Form details specific plan benefits, copayments, and coinsurance amounts for plans with extra benefits.

You can also log into your online account and go to the “Benefits" section on your member dashboard.

If you want help understanding your documents, please call Blue Shield of California Medicare Supplement plan Customer Care at (800) 248-2341 (TTY: 711), 8 a.m. to 8 p.m., seven days a week. 

 

Medicare Supplement plans

Medicare Supplement Dental plans

Please use Google Chrome when downloading or viewing PDF documents. 

1. Plan F Extra is only available to applicants who attained age 65 before January 1, 2020, 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.

Page last updated: 06/15/2022

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