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Vision Benefit Summaries - Closed Plans
The plans below are closed effective April 1, 2009 to groups with 2 to 50 employees and are closed effective July 1, 2009 to groups with 51 or more employees. For further details, please contact your Blue Shield sales representative.

When providing a benefit summary to an applicant or Blue Shield member, you must also include a Notice of Language Assistance(PDF, 1MB)
Vision Basic Plans (Riders) - Closed to new groups with 51 or more
 Plan Name Download  Size 
 Blue Shield Vision Basic 10/130  
English
Spanish
Chinese
Vietnamese
PDF,61KB
PDF, 32KB
PDF, 195KB
PDF, 125KB
 Blue Shield Vision Basic 0/100   
   
  
English
Spanish
Chinese
Vietnamese
PDF, 63KB
PDF, 30KB
PDF, 180KB
PDF, 145KB
 Blue Shield Vision Basic 10/75 
English
Spanish
Chinese
Vietnamese
PDF, 61KB
PDF, 30KB
PDF, 187KB
PDF, 145KB
 Blue Shield Life Vision Basic 10/130
English
Spanish
Chinese
Vietnamese
PDF, 63KB
PDF, 31KB
PDF, 189KB
PDF, 143KB
 Blue Shield Life Vision Basic 0/100
English
Spanish
Chinese
Vietnamese
PDF, 70KB
PDF, 139KB
PDF, 374KB
PDF, 234KB
 Blue Shield Life Vision Basic 10/75
English
Spanish
Chinese
Vietnamese
PDF, 59KB
PDF, 138KB
PDF, 380KB
PDF, 234KB
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Blue Shield Life Vision Benefit Summaries - Closed to all new business
 Plan Name Download  Size 
 Vision Standard 0/75
English
Spanish
Chinese
Vietnamese
PDF, 61KB
PDF, 32KB
PDF, 195KB
PDF, 125KB
 Vision Standard 10/75
   
  
English
Spanish
Chinese
Vietnamese
PDF, 63KB
PDF, 30KB
PDF, 180KB
PDF, 145KB
 Vision Standard 25/75
English
Spanish
Chinese
Vietnamese
PDF, 61KB
PDF, 30KB
PDF, 187KB
PDF, 145KB
 Vision Standard Voluntary 0/25/75 English
Spanish
PDF, 66KB
PDF, 96KB
 Vision Standard Voluntary 25/25/75 English
Spanish
PDF, 66KB
PDF, 96KB
 Vision Standard 10/130
English
Spanish
Chinese
Vietnamese
PDF, 62KB
PDF, 30KB
PDF, 186KB
PDF, 145KB
 Vision Plus 0/75
English
Spanish
Chinese
Vietnamese
PDF, 61KB
PDF, 30KB
PDF, 187KB
PDF, 145KB
 Vision Plus 10/100
English
Spanish
Chinese
Vietnamese
PDF, 61KB
PDF, 30KB
PDF, 187KB
PDF, 145KB
 Vision Plus 10/75
English
Spanish
Chinese
Vietnamese
PDF, 61KB
PDF, 30KB
PDF, 187KB
PDF, 145KB
 Vision Plus 10/130
English
Spanish
Chinese
Vietnamese
PDF, 61KB
PDF, 30KB
PDF, 187KB
PDF, 145KB
 Vision Deluxe 10/100
English
PDF, 62KB
 Vision Deluxe 10/130
English
Spanish
Chinese
Vietnamese
PDF, 70KB
PDF, 139KB
PDF, 374KB
PDF, 234KB
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Vision Benefit Summaries - Open Plans
View and download Small Group Vision Benefit Summaries.
View and download Midsize and Large Group Vision Benefit Summaries.
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