Blue Shield of California

As a not-for-profit health plan, Blue Shield is guided by our mission and values, which encourage innovation and enable us to be a catalyst for constructive change. Our mission and values are embodied in our proposal to guarantee health coverage for all Californians, the first time a major health plan has called for universal coverage.

Provider Finder

Form Name Effective Date Download Form
New Group Submission
New Group Submission Checklist
01/01/2019 Download
Express Enrollment Guidelines
01/01/2019 Download
Employer Application 1.19 to 3.19 Effective Dates
01/01/2019 Download
Employer Application 4.19 to 6.19 Effective Dates
04/01/2019 Download
Employer Application 7.19 to 9.19 Effective Dates
07/01/2019 Download
Eligibility/Participation Attestation (for groups with 5+ enrolling employees)
01/01/2019 Download
Sole Proprietor, Partner, or Corporate Officer Statement
01/01/2019 Download
Small Group Check by Fax Form
01/01/2019 Download
In Force Group Forms
Employer Request For Contract Change Form 1.19 to 3.19 Effective Dates
01/01/2019 Download
Employer Request For Contract Change Form 4.19 to 6.19 Effective Dates
04/01/2019 Download
Employer Request For Contract Change Form 7.19 to 9.19 Effective Dates
07/01/2019 Download
Blue Shield Multiple Subscriber Change Spreadsheet
01/01/2019 Download
Employee Cancellation Transmittal Request
01/01/2019 Download
Employer Notification of Qualifying Events under Cal-COBRA
01/01/2019 Download
CMS Reporting Form
01/01/2019 Download
Group Information Update Form
01/01/2019 Download
Administration
2019 Group Administrator's Guide
01/01/2019 Download
2018 Group Administrator's Guide
01/01/2018 Download
Employer Connection Plus FAQ & QuickStart Guide
01/01/2019 Download
Employer Connection Plus Online Bill Payment FAQ
01/01/2019 Download
Employer Connection Plus Open Enrollment Guide
01/01/2019 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Small Group Employee Enrollment Form 1.19 to 3.19 Effective Dates
01/01/2019 Download
Small Group Employee Enrollment Form 4.19 to 6.19 Effective Dates
04/01/2019 Download
Small Group Employee Enrollment Form 7.19 to 9.19 Effective Dates
07/01/2019 Download
Refusal of Coverage Form
01/01/2019 Download
Continuity of Care Program Brochure
01/01/2019 Download
Continuity of Care Services Request Form
01/01/2019 Download
Declaration of Disability for Over-Age Dependent Child
01/01/2019 Download
Prior Carrier Deductible Instructions and Form
01/01/2019 Download
Subscriber Change Request Form 1.19 to 3.19 Effective Dates
01/01/2019 Download
Subscriber Change Request Form 4.19 to 6.19 Effective Dates
04/01/2019 Download
Subscriber Change Request Form 7.19 to 9.19 Effective Dates
07/01/2019 Download
COBRA and Cal-COBRA Forms
COBRA Continuation of Coverage Application
01/01/2019 Download
Continuing Group Coverage After Federal COBRA Cal-COBRA Election Form
01/01/2019 Download
Cal-COBRA Take-Over Form
01/01/2019 Download
Cal-COBRA Election Form
01/01/2019 Download
Cal-COBRA Dental Election Form
01/01/2019 Download
Claim Forms
Authorization for the Use or Disclosure of Health Information
01/01/2019 Download
Medical Claim Form
01/01/2019 Download
Medical Claim Form - Blue Shield Life
01/01/2019 Download
Pharmacy Reimbursement Form
01/01/2019 Download
Global Care International Claim Form
01/01/2019 Download
Dental Claim Form
01/01/2019 Download
Vision Claim Form
01/01/2019 Download
Proof of Death Form - Group Life
01/01/2019 Download
Dismemberment Claim Form - Group Life
01/01/2019 Download
Accelerated Death Benefit Claim Form - Group Life
01/01/2019 Download
Waiver of Premium Claim Form - Group Life
01/01/2019 Download
Form Name Effective Date Download Form
2019 Medical HMO Off-Exchange Package
Access+ HMO Network
Platinum Access+ HMO 0/20 OffEx
01/01/2019 Summary SBC
Platinum Access+ HMO 0/20 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Platinum Access+ HMO 0/25 OffEx
01/01/2019 Summary SBC
Platinum Access+ HMO 0/25 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Platinum Access+ HMO 0/30 OffEx
01/01/2019 Summary SBC
Platinum Access+ HMO 0/30 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Gold Access+ HMO 0/30 OffEx
01/01/2019 Summary SBC
Gold Access+ HMO 0/30 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Gold Access+ HMO 500/35 OffEx
01/01/2019 Summary SBC
Gold Access+ HMO 500/35 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Gold Access+ HMO 1500/35 OffEx
01/01/2019 Summary SBC
Gold Access+ HMO 1500/35 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Silver Access+ HMO 1975/55 OffEx
01/01/2019 Summary SBC
Silver Access+ HMO 1975/55 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Local Access+ HMO Network
Platinum Local Access+ HMO 0/20 OffEx
01/01/2019 Summary SBC
Platinum Local Access+ HMO 0/20 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Platinum Local Access+ HMO 0/25 OffEx
01/01/2019 Summary SBC
Platinum Local Access+ HMO 0/25 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Platinum Local Access+ HMO 0/30 OffEx
01/01/2019 Summary SBC
Platinum Local Access+ HMO 0/30 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Gold Local Access+ HMO 0/30 OffEx
01/01/2019 Summary SBC
Gold Local Access+ HMO 0/30 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Gold Local Access+ HMO 500/35 OffEx
01/01/2019 Summary SBC
Gold Local Access+ HMO 500/35 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Gold Local Access+ HMO 1500/35 OffEx
01/01/2019 Summary SBC
Gold Local Access+ HMO 1500/35 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Silver Local Access+ HMO 1975/55 OffEx
01/01/2019 Summary SBC
Silver Local Access+ HMO 1975/55 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Trio HMO Network
Platinum Trio HMO 0/20 OffEx
01/01/2019 Summary SBC
Platinum Trio HMO 0/20 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Platinum Trio HMO 0/25 OffEx
01/01/2019 Summary SBC
Platinum Trio HMO 0/25 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Platinum Trio HMO 0/30 OffEx
01/01/2019 Summary SBC
Platinum Trio HMO 0/30 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Gold Trio HMO 0/30 OffEx
01/01/2019 Summary SBC
Gold Trio HMO 0/30 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Gold Trio HMO 500/35 OffEx
01/01/2019 Summary SBC
Gold Trio HMO 500/35 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Gold Trio HMO 1500/35 OffEx
01/01/2019 Summary SBC
Gold Trio HMO 1500/35 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Silver Trio HMO 1975/55 OffEx
01/01/2019 Summary SBC
Silver Trio HMO 1975/55 OffEx INF (with Infertility Rider)
01/01/2019 SBC
2019 Medical PPO Off-Exchange Package
Full PPO Network
Platinum Full PPO 0/10 OffEx
01/01/2019 Summary SBC
Platinum Full PPO 0/10 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Platinum Full PPO 250/15 OffEx
01/01/2019 Summary SBC
Platinum Full PPO 250/15 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Gold Full PPO 0/20 OffEx
01/01/2019 Summary SBC
Gold Full PPO 0/20 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Gold Full PPO 500/30 OffEx
01/01/2019 Summary SBC
Gold Full PPO 500/30 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Gold Full PPO 750/30 OffEx
01/01/2019 Summary SBC
Gold Full PPO 750/30 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Gold Full PPO 1200/35 OffEx
01/01/2019 Summary SBC
Gold Full PPO 1200/35 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Silver Full PPO 1700/55 OffEx
01/01/2019 Summary SBC
Silver Full PPO 1700/55 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Silver Full PPO 2000/45 OffEx
01/01/2019 Summary SBC
Silver Full PPO 2000/45 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Silver Full PPO Savings 2000/20% OffEx
01/01/2019 Summary SBC
Silver Full PPO Savings 2000/20% OffEx INF (with Infertility Rider)
01/01/2019 SBC
Bronze Full PPO 4500/70 OffEx
07/01/2019 Summary SBC
Bronze Full PPO 4500/70 OffEx INF (with Infertility Rider)
07/01/2019 SBC
Bronze Full PPO 6000/65 OffEx [SBC Pending]
07/01/2019 Summary
Bronze Full PPO 6000/65 OffEx INF (with Infertility Rider) [SBC Pending]
07/01/2019
Bronze Full PPO 6500/50% OffEx
01/01/2019 Summary SBC
Bronze Full PPO 6500/50% OffEx INF (with Infertility Rider)
01/01/2019 SBC
Bronze Full PPO Savings 5300/40% OffEx
01/01/2019 Summary SBC
Bronze Full PPO Savings 5300/40% OffEx INF (with Infertility Rider)
01/01/2019 SBC
Bronze Full PPO Savings 6650 OffEx
01/01/2019 Summary SBC
Bronze Full PPO Savings 6650 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Tandem PPO Network
Platinum Tandem PPO 0/10 OffEx
01/01/2019 Summary SBC
Platinum Tandem PPO 0/10 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Platinum Tandem PPO 250/15 OffEx
01/01/2019 Summary SBC
Platinum Tandem PPO 250/15 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Gold Tandem PPO 750/30 OffEx
01/01/2019 Summary SBC
Gold Tandem PPO 750/30 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Silver Tandem PPO 1700/55 OffEx
01/01/2019 Summary SBC
Silver Tandem PPO 1700/55 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Silver Tandem PPO 2000/45 OffEx
01/01/2019 Summary SBC
Silver Tandem PPO 2000/45 OffEx INF (with Infertility Rider)
01/01/2019 SBC
Silver Tandem PPO Savings 2000/20% OffEx
01/01/2019 Summary SBC
Silver Tandem PPO Savings 2000/20% OffEx INF (with Infertility Rider)
01/01/2019 SBC
Bronze Tandem PPO 4500/70 OffEx
07/01/2019 Summary SBC
Bronze Tandem PPO 4500/70 OffEx INF (with Infertility Rider)
07/01/2019 SBC
Bronze Tandem PPO 6500/50% OffEx
01/01/2019 Summary SBC
Bronze Tandem PPO 6500/50% OffEx INF (with Infertility Rider)
01/01/2019 SBC
2019 Medical HMO MIrror Package
Blue Shield Trio Platinum 90 HMO 0/15 + Child Dental
01/01/2019 Summary SBC
Blue Shield Trio Platinum 90 HMO 0/15 + Child Dental INF (with Infertility Rider)
01/01/2019 SBC
Blue Shield Trio Gold 80 HMO 0/30 + Child Dental
01/01/2019 Summary SBC
Blue Shield Trio Gold 80 HMO 0/30 + Child Dental INF (with Infertility Rider)
01/01/2019 SBC
Blue Shield Trio Silver 70 HMO 2000/45 + Child Dental
01/01/2019 Summary SBC
Blue Shield Trio Silver 70 HMO 2000/45 + Child Dental INF (with Infertility Rider)
01/01/2019 SBC
2019 Medical PPO Mirror Package
Blue Shield Platinum 90 PPO 0/15 + Child Dental
01/01/2019 Summary SBC
Blue Shield Platinum 90 PPO 0/15 + Child Dental INF (with Infertility Rider)
01/01/2019 SBC
Blue Shield Gold 80 PPO 0/30 + Child Dental
01/01/2019 Summary SBC
Blue Shield Gold 80 PPO 0/30 + Child Dental INF (with Infertility Rider)
01/01/2019 SBC
Blue Shield Silver 70 PPO 2000/45 + Child Dental
01/01/2019 Summary SBC
Blue Shield Silver 70 PPO 2000/45 + Child Dental INF (with Infertility Rider)
01/01/2019 SBC
Blue Shield Bronze 60 PPO 6300/75 + Child Dental
01/01/2019 Summary SBC
Blue Shield Bronze 60 PPO 6300/75 + Child Dental INF (with Infertility Rider)
01/01/2019 SBC
2019 Infertility Riders
Infertility Rider for HMO Plans
01/01/2019 Summary
Infertility Rider for PPO Plans
01/01/2019 Summary
2019 Disclosures (pending)
2019 Dental Plans
DHMO Plans
Dental HMO Basic
01/01/2019 Summary
Dental HMO Standard
01/01/2019 Summary
Dental HMO Plus
01/01/2019 Summary
Dental HMO Deluxe
01/01/2019 Summary
Dental HMO Voluntary
01/01/2019 Summary
Dental PPO - Plans Effective April 1, 2019
Ultimate Dental Plus PPO for Small Business 50/2000/MAC/NR
04/01/2019 Summary
Ultimate Dental PPO for Small Business 50/2000/MAC/NR
04/01/2019 Summary
Ultimate Dental PPO for Small Business 50/2000/No Ortho/U80
04/01/2019 Summary
Smile Deluxe Plus 2000 50/2000/Ortho/MAC/NR
04/01/2019 Summary
Smile Deluxe Gold 50/1500/Ortho/U85/NR
04/01/2019 Summary
Smile Deluxe 2000 50/2000/No Ortho/MAC/NR
04/01/2019 Summary
Smile Deluxe 50/1500/Ortho/MAC/NR
04/01/2019 Summary
Smile Plus Gold 50/1500/Ortho/U85/NR
04/01/2019 Summary
Smile Plus Gold 50/1500/Ortho/U80
04/01/2019 Summary
Smile Plus Gold 50/1500/Ortho/U80/ADV
04/01/2019 Summary
Smile Plus Gold 50/1500/No Ortho/U80
04/01/2019 Summary
Smile Plus 50/1500/Ortho/MAC/NR
04/01/2019 Summary
Smile Plus 50/1500/No Ortho/MAC
04/01/2019 Summary
Smile Plus 50/1500/No Ortho/MAC/WP
04/01/2019 Summary
Smile 50/1500/No Ortho/MAC/NR
04/01/2019 Summary
Smile Value 50/1500/No Ortho/MAC/NR
04/01/2019 Summary
Smile Basic 50/1000/Ortho/U85
04/01/2019 Summary
Smile Basic 50/1000/No Ortho/MAC
04/01/2019 Summary
Smile Basic 75/1000/No Ortho/MAC/NR
04/01/2019 Summary
Smile Basic Voluntary 50/1500/Ortho/U80
04/01/2019 Summary
Smile Basic Voluntary 50/1000/No Ortho/U80
04/01/2019 Summary
Smile Basic Voluntary 50/1000/No Ortho/MAC
04/01/2019 Summary
Smile Basic Voluntary 75/1000/No Ortho/MAC/NR
04/01/2019 Summary
Smile Basic Voluntary 75/1000/No Ortho/MAC/No Wait/NR
04/01/2019 Summary
Dental PPO Plans with Rollover Rewards - Available to Renewing Groups Only as of April 1, 2019
Ultimate Dental Plus PPO for Small Business 50/2000 MAC
01/01/2019 Summary
Ultimate Dental PPO for Small Business 50/2000 MAC
01/01/2019 Summary
Smile Deluxe Plus 2000 50/2000 Ortho/MAC
01/01/2019 Summary
Smile Deluxe Gold 50/1500 Ortho/U85
01/01/2019 Summary
Smile Deluxe 2000 50/2000/No Ortho/MAC
01/01/2019 Summary
Smile Deluxe 50/1500/Ortho/MAC
01/01/2019 Summary
Smile Plus Gold 50/1500 Ortho/U85
01/01/2019 Summary
Smile Plus 50/1500 Ortho/MAC
01/01/2019 Summary
Smile 50/1500/No Ortho/MAC
01/01/2019 Summary
Smile Value 50/1500/No Ortho/MAC
01/01/2019 Summary
Smile Basic 75/1000/No Ortho/MAC
01/01/2019 Summary
Smile Basic Voluntary 75/1000/No Ortho/MAC
01/01/2019 Summary
Smile Basic Voluntary 75/1000/No Ortho/MAC No Waiting Period
01/01/2019 Summary
2019 Vision Plans
Ultimate Vision Plans (12/12/12)
Ultimate Vision 0/0/120
01/01/2019 Summary
Ultimate Vision 0/0/150
01/01/2019 Summary
Ultimate Vision 10/25/120
01/01/2019 Summary
Ultimate Vision 10/25/150
01/01/2019 Summary
Ultimate Vision Plus 0/0/150/120
01/01/2019 Summary
Ultimate Vision Plus 10/25/150/120
01/01/2019 Summary
Ultimate Vision Voluntary 10/25/150
01/01/2019 Summary
Preferred Vision Plans (12/12/24)
Preferred Vision 0/0/120
01/01/2019 Summary
Preferred Vision 0/0/150
01/01/2019 Summary
Preferred Vision 10/25/120
01/01/2019 Summary
Preferred Vision 10/25/150
01/01/2019 Summary
Preferred Vision Plus 0/0/150/120
01/01/2019 Summary
Preferred Vision Plus 10/25/150/120
01/01/2019 Summary
Preferred Vision Voluntary 10/25/120
01/01/2019 Summary
Basic Vision Plans (12/24/24)
Basic Vision 0/0/120
01/01/2019 Summary
Basic Vision 0/0/150
01/01/2019 Summary
Basic Vision 10/25/120
01/01/2019 Summary
Basic Vision 10/25/150
01/01/2019 Summary
Basic Vision Plus 0/0/150/120
01/01/2019 Summary
Basic Vision Plus 10/25/150/120
01/01/2019 Summary
Basic Vision Voluntary 10/25/120
01/01/2019 Summary
2019 Basic Group Term Life and AD&D Flat Benefit Plans
Basic Group Term Life and AD&D - $15,000
01/01/2019 Summary
Basic Group Term Life and AD&D - $20,000
01/01/2019 Summary
Basic Group Term Life and AD&D - $25,000
01/01/2019 Summary
Basic Group Term Life and AD&D - $30,000
01/01/2019 Summary
Basic Group Term Life and AD&D - $50,000
01/01/2019 Summary
Basic Group Term Life and AD&D - $75,000
01/01/2019 Summary
Basic Group Term Life and AD&D - $100,000
01/01/2019 Summary
Basic Group Term Life and AD&D - $150,000
01/01/2019 Summary
2018 Medical HMO Off-Exchange Package
Access+ HMO Network
Platinum Access+ HMO 0/20 OffEx
01/01/2018 Summary SBC
Platinum Access+ HMO 0/20 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Platinum Access+ HMO 0/25 OffEx
01/01/2018 Summary SBC
Platinum Access+ HMO 0/25 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Platinum Access+ HMO 0/30 OffEx
01/01/2018 Summary SBC
Platinum Access+ HMO 0/30 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Gold Access+ HMO 500/35 OffEx
01/01/2018 Summary SBC
Gold Access+ HMO 500/35 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Gold Access+ HMO 1700/35 OffEx
01/01/2018 Summary SBC
Gold Access+ HMO 1700/35 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Silver Access+ HMO 1750/55 OffEx
01/01/2018 Summary SBC
Silver Access+ HMO 1750/55 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Local Access+ HMO Network
Platinum Local Access+ HMO 0/20 OffEx
01/01/2018 Summary SBC
Platinum Local Access+ HMO 0/20 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Platinum Local Access+ HMO 0/25 OffEx
01/01/2018 Summary SBC
Platinum Local Access+ HMO 0/25 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Platinum Local Access+ HMO 0/30 OffEx
01/01/2018 Summary SBC
Platinum Local Access+ HMO 0/30 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Gold Local Access+ HMO 500/35 OffEx
01/01/2018 Summary SBC
Gold Local Access+ HMO 500/35 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Gold Local Access+ HMO 1700/35 OffEx
01/01/2018 Summary SBC
Gold Local Access+ HMO 1700/35 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Silver Local Access+ HMO 1750/55 OffEx
01/01/2018 Summary SBC
Silver Local Access+ HMO 1750/55 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Trio HMO Network
Platinum Trio HMO 0/20 OffEx
01/01/2018 Summary SBC
Platinum Trio HMO 0/20 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Platinum Trio HMO 0/25 OffEx
01/01/2018 Summary SBC
Platinum Trio HMO 0/25 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Platinum Trio HMO 0/30 OffEx
01/01/2018 Summary SBC
Platinum Trio HMO 0/30 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Gold Trio HMO 500/35 OffEx
01/01/2018 Summary SBC
Gold Trio HMO 500/35 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Gold Trio HMO 1700/35 OffEx
01/01/2018 Summary SBC
Gold Trio HMO 1700/35 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Silver Trio HMO 1750/55 OffEx
01/01/2018 Summary SBC
Silver Trio HMO 1750/55 OffEx INF (with Infertility Rider)
01/01/2018 SBC
2018 Medical PPO Off-Exchange Package
Full PPO Network
Platinum Full PPO 0/10 OffEx
01/01/2018 Summary SBC
Platinum Full PPO 0/10 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Platinum Full PPO 250/15 OffEx
01/01/2018 Summary SBC
Platinum Full PPO 250/15 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Gold Full PPO 0/20 OffEx
01/01/2018 Summary SBC
Gold Full PPO 0/20 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Gold Full PPO 450/30 OffEx
01/01/2018 Summary SBC
Gold Full PPO 450/30 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Gold Full PPO 750/30 OffEx
01/01/2018 Summary SBC
Gold Full PPO 750/30 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Gold Full PPO 1200/35 OffEx
01/01/2018 Summary SBC
Gold Full PPO 1200/35 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Silver Full PPO 1700/55 OfEx
01/01/2018 Summary SBC
Silver Full PPO 1700/55 OfEx INF (with Infertility Rider)
01/01/2018 SBC
Silver Full PPO 2000/45 OffEx
01/01/2018 Summary SBC
Silver Full PPO 2000/45 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Silver Full PPO Savings 2000/20% OffEx
01/01/2018 Summary SBC
Silver Full PPO Savings 2000/20% OffEx INF (with Infertility Rider)
01/01/2018 SBC
Bronze Full PPO 3750/65 OffEx
01/01/2018 Summary SBC
Bronze Full PPO 3750/65 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Bronze Full PPO 5700/60 OffEx
01/01/2018 Summary SBC
Bronze Full PPO 5700/60 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Bronze Full PPO Savings 4300/40% OffEx
01/01/2018 Summary SBC
Bronze Full PPO Savings 4300/40% OffEx INF (with Infertility Rider)
01/01/2018 SBC
Bronze Full PPO Savings 6550 OffEx
01/01/2018 Summary SBC
Bronze Full PPO Savings 6550 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Tandem PPO Network
Platinum Tandem PPO 0/10 OffEx
01/01/2018 Summary SBC
Platinum Tandem PPO 0/10 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Platinum Tandem PPO 250/15 OffEx
01/01/2018 Summary SBC
Platinum Tandem PPO 250/15 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Gold Tandem PPO 750/30 OffEx
01/01/2018 Summary SBC
Gold Tandem PPO 750/30 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Silver Tandem PPO 1700/55 OffEx
01/01/2018 Summary SBC
Silver Tandem PPO 1700/55 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Silver Tandem PPO 2000/45 OffEx
01/01/2018 Summary SBC
Silver Tandem PPO 2000/45 OffEx INF (with Infertility Rider)
01/01/2018 SBC
Bronze Tandem PPO 3750/65 OffEx
01/01/2018 Summary SBC
Bronze Tandem PPO 3750/65 OffEx INF (with Infertility Rider)
01/01/2018 SBC
2018 Medical HMO Mirror Package
Platinum 90 HMO 0/15 Trio + Child Dental
01/01/2018 Summary SBC
Platinum 90 HMO 0/15 Trio + Child Dental INF (with Infertility Rider)
01/01/2018 SBC
Gold 80 HMO 0/25 Trio + Child Dental
01/01/2018 Summary SBC
Gold 80 HMO 0/25 Trio + Child Dental INF (with Infertility Rider)
01/01/2018 SBC
Silver 70 HMO 2000/45 Trio + Child Dental
01/01/2018 Summary SBC
Silver 70 HMO 2000/45 Trio + Child Dental INF (with Infertility Rider)
01/01/2018 SBC
2018 Medical PPO Mirror Package
Platinum 90 PPO 0/15 + Child Dental
01/01/2018 Summary SBC
Platinum 90 PPO 0/15 + Child Dental INF (with Infertility Rider)
01/01/2018 SBC
Gold 80 PPO 0/25 + Child Dental
01/01/2018 Summary SBC
Gold 80 PPO 0/25 + Child Dental INF (with Infertility Rider)
01/01/2018 SBC
Silver 70 PPO 2000/45 + Child Dental
01/01/2018 Summary SBC
Silver 70 PPO 2000/45 + Child Dental INF (with Infertility Rider)
01/01/2018 SBC
Bronze 60 PPO 6300/75 + Child Dental
01/01/2018 Summary SBC
Bronze 60 PPO 6300/75 + Child Dental INF (with Infertility Rider)
01/01/2018 SBC
2018 Infertility Riders
Infertility Rider for HMO Plans
01/01/2018 Summary
Infertility Rider for PPO and HSA Plans
01/01/2018 Summary
2018 Disclosures
HMO Plans for Small Business Disclosure
01/01/2018 Summary
PPO Plans for Small Business Disclosure
01/01/2018 Summary
PPO Savings (HSA) Plans for Small Business Disclosure
01/01/2018 Summary
2018 Dental Plans
DHMO Plans
Dental HMO Basic
01/01/2018 Summary
Dental HMO Plus
01/01/2018 Summary
Dental HMO Deluxe
01/01/2018 Summary
Dental HMO Voluntary
01/01/2018 Summary
Dental PPO Plans
Ultimate Dental PPO for Small Business 50/2000 MAC
01/01/2018 Summary
Ultimate Dental Plus PPO for Small Business 50/2000 MAC
01/01/2018 Summary
Smile Deluxe 2000 50/2000/No Ortho/MAC
01/01/2018 Summary
Smile Deluxe Plus 2000 50/2000 Ortho/MAC
01/01/2018 Summary
Smile Deluxe 50/1500 Ortho/MAC
01/01/2018 Summary
Smile Deluxe Gold 50/1500 Ortho/U85
01/01/2018 Summary
Smile 50/1500/No Ortho/MAC
01/01/2018 Summary
Smile Plus 50/1500 Ortho/MAC
01/01/2018 Summary
Smile Value 50/1500/No Ortho/MAC
01/01/2018 Summary
Smile Plus Gold 50/1500 Ortho/U85
01/01/2018 Summary
Smile Basic 75/1000/No Ortho/MAC
01/01/2018 Summary
Smile Basic Voluntary 75/1000/No Ortho/MAC
01/01/2018 Summary
Dental INO Plans
Smile INO Dental Plan 50/1500/Endo-Perio 80%/No Ortho
01/01/2018 Summary
Smile INO Dental Plan 50/1500/Endo-Perio 80%/Ortho
01/01/2018 Summary
Smile INO Dental Plan 50/2500 Endo-Perio 80%/No Ortho
01/01/2018 Summary
Smile INO Dental Plan 50/2500 Endo-Perio 80%/Ortho
01/01/2018 Summary
Smile INO Dental Voluntary Plan 50/1500 Endo-Perio 50%/No Ortho
01/01/2018 Summary
Smile INO Dental Voluntary Plan 50/1500 Endo-Perio 50%/Ortho
01/01/2018 Summary
Smile INO Dental Voluntary Plan 50/2500 Endo-Perio 50%/No Ortho
01/01/2018 Summary
Smile INO Dental Voluntary Plan 50/2500 Endo-Perio 50%/Ortho
01/01/2018 Summary
2018 Vision Plans
Enhanced Vision Plans (12/24/24)
Enhanced Vision 0/0/120
01/01/2018 Summary
Enhanced Vision 0/0/150
01/01/2018 Summary
Enhanced Vision 15/25/120
01/01/2018 Summary
Enhanced Vision 15/25/150
01/01/2018 Summary
Enhanced Vision Plus 0/0/150/120
01/01/2018 Summary
Enhanced Vision Plus 15/25/150/120
01/01/2018 Summary
Enhanced Vision Voluntary 15/25/120
01/01/2018 Summary
Preferred Vision Plans (12/12/24)
Preferred Vision 0/0/120
01/01/2018 Summary
Preferred Vision 0/0/150
01/01/2018 Summary
Preferred Vision 15/25/120
01/01/2018 Summary
Preferred Vision 15/25/150
01/01/2018 Summary
Preferred Vision Plus 0/0/150/120
01/01/2018 Summary
Preferred Vision Plus 15/25/150/120
01/01/2018 Summary
Preferred Vision Voluntary 15/25/120
01/01/2018 Summary
Ultimate Vision Plans (12/12/12)
Ultimate Vision 0/0/120
01/01/2018 Summary
Ultimate Vision 0/0/150
01/01/2018 Summary
Ultimate Vision 15/25/120
01/01/2018 Summary
Ultimate Vision 15/25/150
01/01/2018 Summary
Ultimate Vision Plus 0/0/150/120
01/01/2018 Summary
Ultimate Vision Plus 15/25/150/120
01/01/2018 Summary
Ultimate Vision Voluntary 15/25/150
01/01/2018 Summary
2018 Basic Group Term Life and AD&D Flat Benefit Plans
Basic Group Term Life and AD&D - $15,000
01/01/2018 Summary
Basic Group Term Life and AD&D - $20,000
01/01/2018 Summary
Basic Group Term Life and AD&D - $25,000
01/01/2018 Summary
Basic Group Term Life and AD&D - $30,000
01/01/2018 Summary
Basic Group Term Life and AD&D - $50,000
01/01/2018 Summary
Basic Group Term Life and AD&D - $75,000
01/01/2018 Summary
Basic Group Term Life and AD&D - $100,000
01/01/2018 Summary
Basic Group Term Life and AD&D - $150,000
01/01/2018 Summary
Form Name Effective Date Download Form
General Information
Blue Shield Sales Guide 1.19
01/01/2019 Download
Blue Shield Sales Guide 4.19
04/01/2019 Download
Blue Shield Sales Guide 7.19
07/01/2019 Download
Blue Shield Underwriting Guidelines
01/01/2019 Download
Employer Connection Plus 2018 Tool Enhancements FAQ
07/01/2018 Download
How to Access Your Benefits Online
01/01/2019 Download
Online and Mobile Tools
01/01/2019 Download
Relaxed Participation Guidelines through 12.19 Effective
01/01/2019 Download
Specialty Quick Facts
01/01/2019 Download
What's New for Small Group Q1 2019
01/01/2019 Download
What's New for Small Group Q2 2019
04/01/2019 Download
What's New for Small Group Q3 2019
07/01/2019 Download
Why Blue Shield of California
01/01/2019 Download
Why Blue Shield of California Employer Brochure
01/01/2019 Download
Medical
Access to Care Flyer
01/01/2019 Download
Away from Home Care for HMO Members
01/01/2019 Download
Blue Card Program for Care Outside California for PPO Members
01/01/2019 Download
Blue Shield HMO Network Guide
01/01/2019 Download
Diabetes Prevention Program
01/01/2019 Download
Easy Steps to Print or Order your ID Card
01/01/2019 Download
Epic Hearing Discounts
01/01/2019 Download
Fitness Your Way Flyer
01/01/2019 Download
Heal Physician Flyer for PPO Members
01/01/2019 Download
MailOrder Rx Flyer
01/01/2019 Download
Member Discount Programs
01/01/2019 Download
NurseHelp Employee Flyer
01/01/2019 Download
NurseHelp Employer Brochure
01/01/2019 Download
Pediatric Dental & Vision Infographic
01/01/2019 Download
Preventive Health Guidelines
01/01/2019 Download
Provider Search Instructions
01/01/2019 Download
Shield Concierge for Trio Members
01/01/2019 Download
Tandem PPO Member Flyer
01/01/2019 Download
Teladoc Flyer
01/01/2019 Download
Tiered Pharmacy Network Directory
01/01/2019 Download
Tiered Pharmacy Network Flyer
01/01/2019 Download
Total Health and Wellness - Programs & Services for Blue Shield Members
01/01/2019 Download
Treatment Cost Estimator PPO Member Flyer
01/01/2019 Download
Treatment Cost Estimator Step by Step for PPO Members
01/01/2019 Download
Trio HMO Brochure
01/01/2019 Download
Trio Network Guide
01/01/2019 Download
Trio Prenatal Care Flyer
01/01/2019 Download
Trio Qualification Tool
01/01/2019 Download
Urgent Care Flyer
01/01/2019 Download
Vaccines at Retail Pharmacies
01/01/2019 Download
Wellness Discounts for Blue Shield Members
01/01/2019 Download
Wellvolution flyer
01/01/2019 Download
Women's Preventive Health
01/01/2019 Download
Dental
Broker Dental Brochure 1.19
01/01/2019 Download
Broker Dental Brochure 4.19
04/01/2019 Download
Broker Specialty Bundling Flyer
01/01/2019 Download
Caries Risk Management & Assessment
01/01/2019 Download
Dental Implant FAQ
01/01/2019 Download
Dental Network Map
01/01/2019 Download
Dental Smile Rollover Rewards Program (not available on new DPPO plans as of 4.1.19)
01/01/2019 Download
Dentist Nomination Form
01/01/2019 Download
Guide to Managing your Dental Plan Online
01/01/2019 Download
Member Guide to Orthodontic Coverage
01/01/2019 Download
Vision
Broker Vision Brochure
01/01/2019 Download
Managing Your Vision Plan Online
01/01/2019 Download
Vision Network at a Glance
01/01/2019 Download
Vision Plan Information Card for CA Members
01/01/2019 Download
Vision Plan Information Card for Out-of-State Members
01/01/2019 Download
Life
Broker Life Brochure
01/01/2019 Download
Basic Life/AD&D Quick Match Program Guidelines
01/01/2019 Download
LifeReferrals 24/7 - Beneficiary Assistance Program
01/01/2019 Download
Travel Assistance Program Brochure
01/01/2019 Download
Form Name Effective Date Download Form
Contact Sheet and Processing Times
Download
Blue Shield Contact Information for Employees
01/01/2018 Download