Blue Shield of California
PPO Plan
$250 Calendar Plan Deductable
$10 Office Visit Co-Pay
90/10 Preferred Provider Coverage
70/30 Non-Preferred Provider Coverage
Plan Year: October 1, 2011 to September 30, 2012
Blue Shield Group Number
and Contact Information:
Group Number: 977986-0003Blue Shield Member Services: (800) 424-6521Website: blueshieldca.com
Prescription Drug Mail Order Center:
Group Number: 977986-0003
Member Services: (866) 346-7200
To add, delete, or change employee coverage, click the link below to download the Blue Shield Change form.
IMPORTANT NOTICE:
Forms are due to Human Resources within 30 days of the qualifying event. If the form is received on the 31st day or after; coverage is not available until open enrollment in the upcoming fiscal year.
Blue Shield Plan Documents:
.jpg "Logo")
