Summary of Benefits 2024

Download summary of benefits and disclosures for Blue Shield Off-Exchange Package for Small Business.

Blue Shield Off-Exchange PPO plans

Plans Summary of Benefits Disclosures Optional
benefits
Platinum Full PPO 0/0 OffEx English
Spanish
English Infertility
English
Spanish
Platinum Tandem PPO 0/0 OffEx English
Spanish
English Infertility
English
Spanish
Platinum Full PPO 0/10 OffEx English
Spanish
English Infertility
English
Spanish
Platinum Tandem PPO 0/10 OffEx English
Spanish
English Infertility
English
Spanish
Platinum Full PPO 250/10 OffEx English
Spanish
English Infertility
English
Spanish
Platinum Tandem PPO 250/10 OffEx English
Spanish
English Infertility
English
Spanish
Platinum Full PPO 250/15 OffEx English
Spanish
English Infertility
English
Spanish
Platinum Tandem PPO 250/15 OffEx English
Spanish
English Infertility
English
Spanish
Gold Full PPO 0/35 OffEx English
Spanish
English Infertility
English
Spanish
Gold Tandem PPO 0/35 OffEx English
Spanish
English Infertility
English
Spanish
Gold Full PPO 500/30 OffEx English
Spanish
English Infertility
English
Spanish
Gold Tandem PPO 500/30 OffEx English
Spanish
English Infertility
English
Spanish
Gold Full PPO 750/30 OffEx English
Spanish
English Infertility
English
Spanish
Gold Tandem PPO 750/30 OffEx English
Spanish
English Infertility
English
Spanish
Gold Full PPO 1000/35 OffEx English
Spanish
English Infertility
English
Spanish
Gold Tandem PPO 1000/35 OffEx English
Spanish
English Infertility
English
Spanish
Silver Full PPO 2000/60 OffEx

English
Spanish

English Infertility
English
Spanish
Silver Tandem PPO 2000/60 OffEx

English
Spanish

English Infertility
English
Spanish
Silver Full PPO 2350/65 OffEx

English
Spanish

English Infertility
English
Spanish
Silver Tandem PPO 2350/65 OffEx

English
Spanish

English Infertility
English
Spanish
Silver Full PPO 2550/70 OffEx

English
Spanish

English Infertility
English
Spanish
Silver Tandem PPO 2550/70 OffEx

English
Spanish

English Infertility
English
Spanish
Bronze Full PPO 5500/65 OffEx

English
Spanish

English Infertility
English
Spanish
Bronze Tandem PPO 5500/65 OffEx

English
Spanish

English Infertility
English
Spanish
Bronze Full PPO 6250/65 OffEx

English
Spanish

English Infertility
English
Spanish
Bronze Tandem PPO 6250/65 OffEx English
Spanish
English Infertility
English
Spanish
Bronze Full PPO 6500/70 OffEx English
Spanish
English Infertility
English
Spanish
Bronze Tandem PPO 6500/70 OffEx

English
Spanish

English Infertility
English
Spanish
Bronze Full PPO 7500/65 OffEx

English
Spanish

English Infertility
English
Spanish
Bronze Tandem PPO 7500/65 OffEx

English
Spanish

English Infertility
English
Spanish
Bronze Full PPO 6850/55 OffEx

English
Spanish

English Infertility
English
Spanish
Bronze Tandem PPO 6850/55 OffEx

English
Spanish

English Infertility
English
Spanish

Blue Shield Mirror PPO plans

Plans Summary of Benefits Disclosures Optional
benefits
Blue Shield Bronze 60 HDHP PPO 7500/0% + Child Dental Alt English
Spanish
English Infertility
English
Spanish
Blue Shield Silver 70 HDHP PPO 2300/30% + Child Dental Alt English
Spanish
English Infertility
English
Spanish
Blue Shield Platinum 90 PPO 0/15 + Child Dental English
Spanish
English Infertility
English
Spanish
Blue Shield Gold 80 PPO 350/25 + Child Dental English
Spanish

English

Infertility
English
Spanish
Blue Shield Silver 70 PPO 2500/55 + Child Dental English
Spanish
English Infertility
English
Spanish
Blue Shield Bronze 60 PPO 6300/60 + Child Dental English
Spanish

English

Infertility
English
Spanish

Blue Shield Off-Exchange HSA/HDHP plans

Plans

Summary of Benefits Disclosures Optional
benefits
Gold Full PPO Savings 1750/15% HDHP PrevRx OffEx English
Spanish
English Infertility
English
Spanish
Gold Tandem PPO Savings 1750/15% HDHP PrevRx OffEx English
Spanish
English Infertility
English
Spanish
Silver Full PPO Savings 2300/30% OffEx English
Spanish
English Infertility
English
Spanish
Silver Tandem PPO Savings 2300/30% OffEx English
Spanish
English Infertility
English
Spanish
Silver Full PPO Savings 2600/35% HDHP PrevRx OffEx English
Spanish
English Infertility
English
Spanish
Silver Tandem PPO Savings 2600/35% HDHP PrevRx OffEx English
Spanish
English Infertility
English
Spanish
Bronze Full PPO Savings 5700/40% OffEx English
Spanish
English Infertility
English
Spanish
Bronze Tandem PPO Savings 5700/40% OffEx English
Spanish
English Infertility
English
Spanish
Bronze Full PPO Savings 7500 OffEx English
Spanish
English Infertility
English
Spanish
Bronze Tandem PPO Savings 7500 OffEx English
Spanish
English Infertility
English
Spanish

Blue Shield Off-Exchange HMO plans

Plans Summary of Benefits Disclosures Optional
benefits
Platinum Access+ HMO® 0/20 OffEx English
Spanish
English Infertility
English
Spanish
Platinum Local Access+ HMO® 0/20 OffEx English
Spanish
English Infertility
English
Spanish
Platinum Trio HMO 0/20 OffEx English
Spanish
English Infertility
English
Spanish
Platinum Access+ HMO® 0/25 OffEx English
Spanish
English Infertility
English
Spanish
Platinum Local Access+ HMO® 0/25 OffEx English
Spanish
English Infertility
English
Spanish
Platinum Trio HMO 0/25 OffEx English
Spanish
English Infertility
English
Spanish
Platinum Access+ HMO® 0/30 OffEx English
Spanish
English Infertility
English
Spanish
Platinum Local Access+ HMO® 0/30 OffEx English
Spanish
English Infertility
English
Spanish
Platinum Trio HMO 0/30 OffEx English
Spanish

English

Infertility
English
Spanish
Gold Access+ HMO® 0/35 OffEx English
Spanish
English Infertility
English
Spanish
Gold Local Access+ HMO® 0/35 OffEx

English
Spanish

English Infertility
English
Spanish
Gold Trio HMO 0/35 OffEx English
Spanish
English Infertility
English
Spanish
Gold Access+ HMO® 500/35 OffEx English
Spanish
English Infertility
English
Spanish
Gold Local Access+ HMO® 500/35 OffEx English
Spanish
English Infertility
English
Spanish
Gold Trio HMO 500/35 OffEx English
Spanish
English Infertility
English
Spanish
Gold Access+ HMO® 1000/35 OffEx English
Spanish
English Infertility
English
Spanish
Gold Local Access+ HMO® 1000/35 OffEx English
Spanish
English Infertility
English
Spanish
Gold Trio HMO 1000/35 OffEx English
Spanish
English Infertility
English
Spanish
Gold Access+ HMO® 1500/35 OffEx English
Spanish
English Infertility
English
Spanish
Gold Local Access+ HMO® 1500/35 OffEx English
Spanish
English Infertility
English
Spanish
Gold Trio HMO 1500/35 OffEx English
Spanish
English Infertility
English
Spanish
Silver Access+ HMO® 2300/70 OffEx English
Spanish
English Infertility
English
Spanish
Silver Access+ HMO® 2750/70 OffEx English
Spanish
English Infertility
English
Spanish
Silver Local Access+ HMO® 2300/70 OffEx English
Spanish
English Infertility
English
Spanish
Silver Local Access+ HMO® 2750/70 OffEx English
Spanish
English Infertility
English
Spanish
Silver Trio HMO 2300/70 OffEx English
Spanish
English Infertility
English
Spanish
Silver Trio HMO 2750/70 OffEx English
Spanish
English Infertility
English
Spanish
Bronze Access+ HMO® 7000/70 OffEx English
Spanish
English Infertility
English
Spanish
Bronze Local Access+ HMO 7000/70 OffEx English
Spanish
English Infertility
English
Spanish
Bronze Trio HMO 7000/70 OffEx English
Spanish
English Infertility
English
Spanish

Blue Shield Mirror HMO plans

Plans Summary of Benefits Disclosures Optional
benefits
Blue Shield Access+ Gold 80 HMO® 250/35 + Child Dental English
Spanish
English Infertility
English
Spanish
Blue Shield Access+ Platinum 90 HMO® 0/20 + Child Dental English
Spanish
English Infertility
English
Spanish
Blue Shield Access+ Silver 70 HMO® 2500/55 + Child Dental English
Spanish
English Infertility
English
Spanish
Blue Shield Trio Bronze 60 HMO 7000/70 + Child Dental English
Spanish
English Infertility
English
Spanish
Blue Shield Trio Platinum 90 HMO 0/20 + Child Dental English
Spanish
English Infertility
English
Spanish
Blue Shield Trio Gold 80 HMO 250/35 + Child Dental English
Spanish
English Infertility
English
Spanish

Blue Shield Trio Silver 70 HMO 2500/55 + Child Dental

English
Spanish
English Infertility
English
Spanish

Virtual Blue plans

Plans Summary of Benefits Disclosures Optional
benefits
Virtual BlueSM Gold Tandem PPO 1500/45 OffEx English
Spanish
English Infertility
English
Spanish
Virtual BlueSM Bronze Tandem PPO 7500/75 OffEx English
Spanish
English Infertility
English
Spanish
Virtual BlueSM Platinum Tandem PPO 250/20 OffEx English
Spanish
English Infertility
English
Spanish
Virtual BlueSM Silver Tandem PPO 2700/75 OffEx English
Spanish
English Infertility
English
Spanish

© California Physicians' Service DBA Blue Shield of California 1999-2024. All rights reserved. California Physicians’ Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.

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