The following documents are effective January 1, 2027.
For prior year documents, please see 2026 Medical Summary of Benefits.
To help your clients understand their plan benefits, we have provided documents in a simplified format that will be either the Summary of Benefits (SOB) or a Benefit Summary only for specific Specialty plans. Your clients will also be able to access their SOB as part of their Evidence of Coverage (EOC) or policy on blueshieldca.com/policies along with their Summary of Benefits and Coverage (SBC).
When sharing the SOB and/or Benefit Summary with your clients, you must also provide the Legal Disclosure document applicable to the medical, dental, or vision plan.
Translations for Trio HMO, PPO, and AI-AN medical plans will be available 10/1
Trio HMO plans
| Trio HMO Plans | Summary of Benefits |
|---|---|
| Blue Shield Platinum 90 Trio HMO | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Gold 80 Trio HMO | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Silver 70 Trio HMO | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Silver 70 Off Exchange Trio HMO | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Bronze 7500 Trio HMO | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Bronze 60 Trio HMO | English (PDF, 2 MB) Spanish (Pending 10/1) |
We offer three Silver Trio HMO cost-sharing reduction plans through Covered California for clients whose income is between 138% to 250% of the federal poverty level (FPL). These plans are available only through Covered California.
PPO plans
| PPO Plans | Summary of Benefits |
|---|---|
| Blue Shield Platinum 90 PPO | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Gold 80 PPO | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Silver 70 PPO | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Silver 70 Off Exchange PPO | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Silver 1850 PPO | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Silver 2800 HDHP PPO | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Bronze 60 PPO | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Bronze 60 HDHP PPO | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Minimum Coverage PPO | English (PDF, 2 MB) Spanish (Pending 10/1) |
We offer three Silver PPO cost-sharing reduction plans through Covered California for clients whose income is between 138% to 250% of the federal poverty level (FPL). These plans are available only through Covered California.
Alaska Native and American Indian Plans
We offer American Indian and Alaska Native plans for each metal level that are available only to eligible American Indians and Alaska Natives through Covered California. These plans differ from the standard metal level plans in that they allow American Indian and Alaska Native members to access covered services from American Indian and Alaskan Native providers for no out-of-pocket costs. In addition to the Alaska Native and American Indian versions of the standard metal level plans, we offer a $0 cost share PPO plan to American Indian and Alaska Native members who qualify based on household income. Members can choose to access covered services through a Blue Shield participating provider or non-network provider for an out-of-pocket cost.
| Alaska Native and American Indian Trio HMO Plans | Summary of Benefits |
|---|---|
| Blue Shield Platinum 90 Trio HMO AI-AN | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Gold 80 Trio HMO AI-AN | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Silver 70 Trio HMO AI-AN | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Bronze 60 Trio HMO AI-AN | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield $0 Cost Share Trio HMO AI-AN | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Alaska Native and American Indian PPO Plans | Summary of Benefits |
|---|---|
| Blue Shield Platinum 90 PPO AI-AN | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Gold 80 PPO AI-AN | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Silver 70 PPO AI-AN | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Bronze 60 PPO AI-AN | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield Bronze 60 HDHP PPO AI-AN | English (PDF, 2 MB) Spanish (Pending 10/1) |
| Blue Shield $0 Cost Share PPO AI-AN | English (PDF, 2 MB) Spanish (Pending 10/1) |
Specialty Plans
Summary of Benefits are available for dental plans while Benefit Summaries are available for vision plans. Dental and vision plans sold through Blue Shield can be purchased with a Blue Shield medical plan or as stand-alone policies. Family Dental Plans are sold only through Covered California and can only be purchased when enrolling in a medical plan sold through Covered California.
Dental Plans Underwritten by DMHC
| Plan Name | Summary of Benefits |
|---|---|
| Dental PPO | English (PDF, 1.2 MB) Spanish (PDF, 1.2 MB) |
| Dental PPO 1500 | English (PDF, 2 MB) Spanish (PDF, 2 MB) |
| Enhanced Dental PPO 50/2000 | English (PDF, 2 MB) Spanish (PDF, 2 MB) |
| Enhanced Dental PPO 50/2000 Lifetime Ortho 1500 | English (PDF, 2 MB) Spanish (PDF, 2 MB) |
| Dental HMO | English (PDF, 2 MB) Spanish (PDF, 2 MB) |
| Dental Standard HMO | English (PDF, 2 MB) Spanish (PDF, 2 MB) |