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, 295 KB) Spanish (PDF, 311 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Platinum Local Access+ HMO® 0/20 OffEx | English (PDF, 295 KB) Spanish (PDF, 311 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Platinum Trio HMO 0/20 OffEx | English (PDF, 294 KB) Spanish (PDF, 311 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Platinum Access+ HMO® 0/25 OffEx | English (PDF, 295 KB) Spanish (PDF, 311 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Platinum Local Access+ HMO® 0/25 OffEx | English (PDF, 295 KB) Spanish (PDF, 311 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Platinum Trio HMO 0/25 OffEx | English (PDF, 295 KB) Spanish (PDF, 311 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Platinum Access+ HMO® 0/30 OffEx | English (PDF, 295 KB) Spanish (PDF, 311 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203KB) Spanish (PDF, 211 KB) |
| Platinum Local Access+ HMO® 0/30 OffEx | English (PDF, 295 KB) Spanish (PDF, 311 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211KB) |
| Platinum Trio HMO 0/30 OffEx | English (PDF, 294 KB) Spanish (PDF, 311 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Gold Access+ HMO® 0/35 OffEx | English (PDF, 295 KB) Spanish (PDF, 311 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Gold Local Access+ HMO® 0/35 OffEx | English (PDF, 295 KB) Spanish (PDF, 311 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Gold Trio HMO 0/35 OffEx | English (PDF, 295 KB) Spanish (PDF, 311 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Gold Access+ HMO® 500/35 OffEx | English (PDF, 297 KB) Spanish (PDF, 315 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Gold Local Access+ HMO® 500/35 OffEx | English (PDF, 297 KB) Spanish (PDF, 315 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Gold Trio HMO 500/35 OffEx | English (PDF, 297 KB) Spanish (PDF, 315 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Gold Access+ HMO® 1000/35 OffEx | English (PDF, 297 KB) Spanish (PDF, 315 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Gold Local Access+ HMO® 1000/35 OffEx | English (PDF, 297 KB) Spanish (PDF, 315 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Gold Trio HMO 1000/35 OffEx | English (PDF, 296 KB) Spanish (PDF, 315 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203KB) Spanish (PDF, 211 KB) |
| Gold Access+ HMO® 1500/35 OffEx | English (PDF, 297 KB) Spanish (PDF, 315 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Gold Local Access+ HMO® 1500/35 OffEx | English (PDF, 297 KB) Spanish (PDF, 315 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Gold Trio HMO 1500/35 OffEx | English (PDF, 296 KB) Spanish (PDF, 315 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Silver Access+ HMO® 2100/70 OffEx | English (PDF, 297 KB) Spanish (PDF, 316 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Silver Access+ HMO® 2850/70 OffEx | English (PDF, 297 KB) Spanish (PDF, 315 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Silver Local Access+ HMO® 2100/70 OffEx | English (PDF, 297 KB) Spanish (PDF, 316 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Silver Local Access+ HMO® 2850/70 OffEx | English (PDF, 297 KB) Spanish (PDF, 316 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Silver Trio HMO 2100/70 OffEx | English (PDF, 297 KB) Spanish (PDF, 316 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Silver Trio HMO 2850/70 OffEx | English (PDF, 296 KB) Spanish (PDF, 315 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Bronze Access+ HMO® 7000/65 OffEx | English (PDF, 297 KB) Spanish (PDF, 315 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Bronze Local Access+ HMO® 7000/65 OffEx | English (PDF, 297 KB) Spanish (PDF, 315 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Bronze Trio HMO 7000/65 OffEx | English (PDF, 296 KB) Spanish (PDF, 315 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 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, 294 KB) Spanish (PDF, 310 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Blue Shield Trio Gold 80 HMO 325/40 PCP + Child Dental | English (PDF, 295 KB) Spanish (PDF, 313 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 212 KB) |
| Blue Shield Trio Silver 70 HMO 2500/60 PCP + Child Dental | English (PDF, 295 KB) Spanish (PDF, 314 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Blue Shield Access+ Gold 80 HMO® 325/40 PCP + Child Dental | English (PDF, 227 KB) Spanish (PDF, 314 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 212 KB) |
| Blue Shield Access+ Platinum 90 HMO® 0/25 PCP + Child Dental | English (PDF, 295 KB) Spanish (PDF, 311 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 KB) |
| Blue Shield Access+ Silver 70 HMO® 2500/60 PCP + Child Dental | English (PDF, 296 KB) Spanish (PDF, 315 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF,211 KB) |
| Blue Shield Trio Bronze 60 HMO 7000/65 PCP + Child Dental Alt | English (PDF, 296 KB) Spanish (PDF, 315 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 203 KB) Spanish (PDF, 211 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, 332 KB) Spanish (PDF, 368 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Platinum Tandem PPO 0/0 OffEx | English (PDF, 332 KB) Spanish (PDF, 368 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Platinum Full PPO 0/10 OffEx | English (PDF, 332 KB) Spanish (PDF, 368 KB) |
English (PDF, 497 KBB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Platinum Tandem PPO 0/10 OffEx | English (PDF, 332 KB) Spanish (PDF, 368 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Platinum Full PPO 250/10 OffEx | English (PDF, 333 KB) Spanish (PDF, 369 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Platinum Tandem PPO 250/10 OffEx | English (PDF, 333 KB) Spanish (PDF, 369 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Platinum Full PPO 250/15 OffEx | English (PDF, 334 KB) Spanish (PDF, 371 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Platinum Tandem PPO 250/15 OffEx | English (PDF, 334 KB) Spanish (PDF, 371 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Gold Full PPO 0/35 OffEx | English (PDF, 334 KB) Spanish (PDF, 371 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Gold Tandem PPO 0/35 OffEx | English (PDF, 334 KB) Spanish (PDF, 371 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Gold Full PPO 500/30 OffEx | English (PDF, 335 KB) Spanish (PDF, 372 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Gold Tandem PPO 500/30 OffEx | English (PDF, 335 KB) Spanish (PDF, 372 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Gold Full PPO 750/35 OffEx | English (PDF, 335 KB) Spanish (PDF, 372 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Gold Tandem PPO 750/35 OffEx | English (PDF, 335 KB) Spanish (PDF, 372 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Gold Full PPO 1000/30 OffEx | English (PDF, 335 KB) Spanish (PDF, 372 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Gold Tandem PPO 1000/30 OffEx | English (PDF, 335 KB) Spanish (PDF, 372 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Silver Full PPO 1800/65 OffEx | English (PDF, 335 KB) Spanish (PDF, 372 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Silver Tandem PPO 1800/65 OffEx | English (PDF, 335 KB) Spanish (PDF, 372 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Silver Full PPO 2100/75 OffEx | English (PDF, 335 KB) Spanish (PDF, 373 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Silver Tandem PPO 2100/75 OffEx | English (PDF, 335 KB) Spanish (PDF, 373 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Silver Full PPO 2550/75 OffEx | English (PDF, 335 KB) Spanish (PDF, 372 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Silver Tandem PPO 2550/75 OffEx | English (PDF, 335 KB) Spanish (PDF, 372 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Bronze Full PPO 4500/65 OffEx | English (PDF, 347 KB) Spanish (PDF, 380 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Bronze Tandem PPO 4500/65 OffEx | English (PDF, 335 KB) Spanish (PDF, 380 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Bronze Full PPO 6250/65 OffEx | English (PDF, 347 KB) Spanish (PDF, 379 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Bronze Tandem PPO 6250/65 OffEx | English (PDF, 347 KB) Spanish (PDF, 379 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Bronze Full PPO 6500/70 OffEx | English (PDF, 347 KB) Spanish (PDF, 380 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Bronze Tandem PPO 6500/70 OffEx | English (PDF, 347 KB) Spanish (PDF, 380 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Bronze Full PPO 7500/65 OffEx | English (PDF, 346 KB) Spanish (PDF, 379 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Bronze Tandem PPO 7500/65 OffEx | English (PDF, 347 KB) Spanish (PDF, 379 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Bronze Full PPO 6850/55 OffEx | English (PDF, 347 KB) Spanish (PDF, 380 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Bronze Tandem PPO 6850/55 OffEx | English (PDF, 347 KB) Spanish (PDF, 380 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 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, 330 KB) Spanish (PDF, 367 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Blue Shield Gold 80 PPO 500/30 PCP + Child Dental | English (PDF, 332 KB) Spanish (PDF, 369 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Blue Shield Silver 70 PPO 2500/60 PCP + Child Dental | English (PDF, 333 KB) Spanish (PDF, 370 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Blue Shield Bronze 60 PPO 5800/60 PCP + Child Dental | English (PDF, 345 KB) Spanish (PDF, 377 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Blue Shield Bronze 60 HDHP PPO 7850/0% PCP + Child Dental Alt | English (PDF, 333 KB) Spanish (PDF, 369 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Blue Shield Silver 70 HDHP PPO 2450/30% PCP + Child Dental Alt | English (PDF, 333 KB) Spanish (PDF, 372 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 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, 334 KB) Spanish (PDF, 371 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Gold Tandem PPO Savings 1900/15% HDHP PrevRx OffEx | English (PDF, 334 KB) Spanish (PDF, 371 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Silver Full PPO Savings 2450/30% OffEx | English (PDF, 333 KB) Spanish (PDF, 371 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 217 KB) |
| Silver Tandem PPO Savings 2450/30% OffEx | English (PDF, 333 KB) Spanish (PDF, 371 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 217 KB) |
| Silver Full PPO Savings 2950/35% HDHP PrevRx OffEx | English (PDF, 334 KB) Spanish (PDF, 372 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Silver Tandem PPO Savings 2950/35% HDHP PrevRx OffEx | English (PDF, 334 KB) Spanish (PDF, 372 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Bronze Full PPO Savings 6000/40% OffEx | English (PDF, 332 KB) Spanish (PDF, 371 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Bronze Tandem PPO Savings 6000/40% OffEx | English (PDF, 333 KB) Spanish (PDF, 371 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Bronze Full PPO Savings 7850 OffEx | English (PDF, 332 KB) Spanish (PDF, 367 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |
| Bronze Tandem PPO Savings 7850 OffEx | English (PDF, 332 KB) Spanish (PDF, 367 KB) |
English (PDF, 497 KB) |
Infertility English (PDF, 212 KB) Spanish (PDF, 218 KB) |