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Access 2016 Plan Documents

Get immediate access to your plan documents here.

Blue Shield Dental and Vision Plan Documents

Thank you for being a Blue Shield member. We value your membership, and are committed to helping you make the most of your health coverage. Part of that commitment includes giving you the resources to help you understand what your plan covers and how it works.

The following documents provide detailed information about your 2016 plan benefits. Be sure to download and keep these documents in your files for future reference. If you need hard copies mailed to you, please call us at the phone number on the back of your Blue Shield ID card.

Evidence of Coverage or Policy

The Evidence of Coverage or Policy explains the terms of your plan coverage, benefits, copayments, exclusions, limitations, and how to access coverage.

Search for your plan’s Evidence of Coverage or Policy in the box below.

Choose from the following Individual and Family Dental and Vision Plans
Dental HMOEnhanced Dental PPO 50/1250
Dental PPOSpecialty Duo Dental + Vision Plan*
Enhanced Dental HMO $0Ultimate Vision 15/25/150*
Enhanced Dental Plus PPO 25/500Ultimate Vision 15/25/120*
Enhanced Dental PPO 25/500Smile PPO*
Enhanced Dental Plus PPO 50/1250Value Smile PPO*

*Underwritten by Blue Shield of California Life & Health Insurance Company (Blue Shield Life)


It’s best to stay in your plan's network

Different Blue Shield plans use different networks, so to get the most value from your coverage, be sure to check that your provider is in your plan’s network.

If you see a dentist or vision care provider that’s not in your plan’s network, you may have to pay more for services, or, depending on your plan, you may be responsible for all of the costs. Use our Find a Provider tool to search for dentists or vision care providers in your plan’s network. Be sure to register or log in first to ensure the results are tailored to your plan’s network.