Health plan documents

CCPOA Medical Plan Medicare (PPO) plan: January 1, 2026 - December 31, 2026

Summary of Benefits
Evidence of Coverage
Provider Directory
Formulary Drug List
Pharmacy Directory

CCPOA Medical Plan Medicare (PPO) plan: January 1, 2025 - December 31, 2025

Summary of Benefits
Evidence of Coverage
Provider Directory
Formulary Search Tool
Formulary
Pharmacy Directory
https://main--bsca-secondsale--aemsites.aem.page/group/fragments/glossary-sob-eoc
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Blue Shield of California is a PPO plan with a Medicare contract. Enrollment in Blue Shield of California depends on contract renewal. Blue Shield of California offers individual and employer group retiree plans to Medicare beneficiaries who have Part A and Part B. Individual plans are open to all Medicare beneficiaries who reside within a plan’s specific service area. Employer group retiree plans are open only to Medicare beneficiaries who are eligible group retirees and who reside within a plan’s specific service area. Individual and employer group retiree plans have different service areas, benefits and provider networks.

Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our Customer Service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Y0118_25_337A1_M 09122025

Page Last Updated 10/09/2025