Summary of Benefits 2027
For 2027 medical plans, the Summary of Benefits (SOBs) include coverage information in a simplified format, making it easier for members to read and understand their plan benefits. SOBs are included in renewals, open enrollment materials and member welcome kits as part of the Evidence of Coverage (EOC).
When providing a SOB to an applicant or Blue Shield member, you must also include a disclosure and a Notice of Language Assistance (PDF, 1.1 MB).
In addition to the SOBs, the Summary of Benefits and Coverage (SBC) Forms provide your clients with an easy-to-understand overview of what our plans for groups of 1 to 100 cover. Click here to download SBC forms and other resources.
These SOBs are effective January 1, 2027, for small businesses of 1 to 100.
Off-exchange package for Small Business – HMO plans
| Blue Shield Off-Exchange HMO Plans | Summary of Benefits | Disclosures | Optional Benefit |
|---|---|---|---|
| Platinum Access+ HMO® 0/20 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Platinum Local Access+ HMO® 0/20 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Platinum Trio HMO 0/20 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Platinum Access+ HMO® 0/25 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Platinum Local Access+ HMO® 0/25 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Platinum Trio HMO 0/25 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Platinum Access+ HMO® 0/30 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Platinum Local Access+ HMO® 0/30 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Platinum Trio HMO 0/30 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Gold Access+ HMO® 0/35 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Gold Local Access+ HMO® 0/35 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Gold Trio HMO 0/35 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Gold Access+ HMO® 500/35 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Gold Local Access+ HMO® 500/35 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Gold Trio HMO 500/35 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Gold Access+ HMO® 1000/35 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Gold Local Access+ HMO® 1000/35 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Gold Trio HMO 1000/35 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Gold Access+ HMO® 1500/35 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 97 KB) Spanish (PDF, 863 KB) |
| Gold Local Access+ HMO® 1500/35 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Gold Trio HMO 1500/35 OffEx | English (PDF, 49 KB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Silver Access+ HMO® 2100/70 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Silver Access+ HMO® 2850/70 OffEx | English (PDF, 1 MB) Spanish (Coming soon)) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Silver Local Access+ HMO® 2100/70 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Silver Local Access+ HMO® 2850/70 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Silver Trio HMO 2100/70 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Silver Trio HMO 2850/70 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Bronze Access+ HMO® 7000/65 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Bronze Local Access+ HMO® 7000/65 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Bronze Trio HMO 7000/65 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
Mirror package for Small Business – HMO plans
| Blue Shield Mirror HMO Plans | Summary of Benefits | Disclosures | Optional Benefit |
|---|---|---|---|
| Blue Shield Trio Platinum 90 HMO 0/25 PCP + Child Dental | English (PDF, 1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 1.0MB) Spanish (PDF, 863 KB) |
| Blue Shield Trio Gold 80 HMO 325/40 PCP + Child Dental | English (PDF, 1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 1.0MB) Spanish (PDF, 863 KB) |
| Blue Shield Trio Silver 70 HMO 2500/60 PCP + Child Dental | English (PDF, 1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 1.0MB) Spanish (PDF, 863 KB) |
| Blue Shield Access+ Gold 80 HMO® 325/40 PCP + Child Dental | English (PDF, 227KB) Spanish (Coming soon) |
English (PDF, 311KB) |
Infertility English (PDF, 1.0MB) Spanish (PDF, 863 KB) |
| Blue Shield Access+ Platinum 90 HMO® 0/25 PCP + Child Dental | English (PDF, 218KB) Spanish (Coming soon) |
English (PDF, 311KB) |
Infertility English (PDF, 1.0MB) Spanish (PDF, 863 KB) |
| Blue Shield Access+ Silver 70 HMO® 2500/60 PCP + Child Dental | English (PDF, 220KB) Spanish (Coming soon) |
English (PDF, 311KB) |
Infertility English (PDF, 1.0MB) Spanish (PDF, 863 KB) |
| Blue Shield Trio Bronze 60 HMO 7000/65 PCP + Child Dental Alt | English (PDF, 231KB) Spanish (Coming soon) |
English (PDF, 311KB) |
Infertility English (PDF, 1.0MB) Spanish (PDF, 863 KB) |
Off-exchange package for Small Business – PPO plans
| Blue Shield Off-Exchange PPO Plans | Summary of Benefits | Disclosures | Optional Benefit |
|---|---|---|---|
| Platinum Full PPO 0/0 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Platinum Tandem PPO 0/0 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Platinum Full PPO 0/10 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Platinum Tandem PPO 0/10 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Platinum Full PPO 250/10 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Platinum Tandem PPO 250/10 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Platinum Full PPO 250/15 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Platinum Tandem PPO 250/15 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Gold Full PPO 0/35 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Gold Tandem PPO 0/35 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Gold Full PPO 500/30 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Gold Tandem PPO 500/30 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Gold Full PPO 750/35 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Gold Tandem PPO 750/35 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Gold Full PPO 1000/30 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Gold Tandem PPO 1000/30 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Silver Full PPO 1800/65 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Silver Tandem PPO 1800/65 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Silver Full PPO 2100/75 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Silver Tandem PPO 2100/75 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Silver Full PPO 2550/75 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Silver Tandem PPO 2550/75 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Bronze Full PPO 4500/65 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Bronze Tandem PPO 4500/65 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Bronze Full PPO 6250/65 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Bronze Tandem PPO 6250/65 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Bronze Full PPO 6500/70 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Bronze Tandem PPO 6500/70 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Bronze Full PPO 7500/65 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Bronze Tandem PPO 7500/65 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Bronze Full PPO 6850/55 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
| Bronze Tandem PPO 6850/55 OffEx | English (PDF, 1.1MB) Spanish (Coming soon) |
English (PDF, 1.1MB) |
Infertility English (PDF, 997KB) Spanish (PDF, 863 KB) |
Mirror package for Small Business – PPO plans
| Blue Shield Mirror PPO Plans | Summary of Benefits | Disclosures | Optional Benefit |
|---|---|---|---|
| Blue Shield Platinum 90 PPO 0/25 PCP + Child Dental | English (PDF, 1.1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 1 MB) Spanish (PDF, 863 KB) |
| Blue Shield Gold 80 PPO 500/30 PCP + Child Dental | English (PDF, 1.1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 1 MB) Spanish (PDF, 863 KB) |
| Blue Shield Silver 70 PPO 2500/60 PCP + Child Dental | English (PDF, 1.1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 1 MB) Spanish (PDF, 863 KB) |
| Blue Shield Bronze 60 PPO 5800/60 PCP + Child Dental | English (PDF, 1.1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 1 MB) Spanish (PDF, 863 KB) |
| Blue Shield Bronze 60 HDHP PPO 7850/0% PCP + Child Dental Alt | English (PDF, 257 KB) Spanish (Coming soon) |
English (PDF, 340 KB) |
Infertility English (PDF, 1 MB) Spanish (PDF, 863 KB) |
| Blue Shield Silver 70 HDHP PPO 2450/30% PCP + Child Dental Alt | English (PDF, 277 KB) Spanish (Coming soon) |
English (PDF, 340 KB) |
Infertility English (PDF, 1 MB) Spanish (PDF, 863 KB) |
Off-exchange package for Small Business – HSA/HDHP plans
| Blue Shield Off-Exchange HSA HDHP Plans | Summary of Benefits | Disclosures | Optional Benefit |
|---|---|---|---|
| Gold Full PPO Savings 1900/15% HDHP PrevRx OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Gold Tandem PPO Savings 1900/15% HDHP PrevRx OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Silver Full PPO Savings 2450/30% OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Silver Tandem PPO Savings 2450/30% OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Silver Full PPO Savings 2950/35% HDHP PrevRx OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Silver Tandem PPO Savings 2950/35% HDHP PrevRx OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Bronze Full PPO Savings 6000/40% OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Bronze Tandem PPO Savings 6000/40% OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Bronze Full PPO Savings 7850 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |
| Bronze Tandem PPO Savings 7850 OffEx | English (PDF, 1 MB) Spanish (Coming soon) |
English (PDF, 1.1 MB) |
Infertility English (PDF, 997 KB) Spanish (PDF, 863 KB) |