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Medical Plan:
Summary of Benefits and Coverage

EZ Summary
Blue Shield of California is pleased to provide you with the following Medical Plan documents:
  • Evidence of Coverage (EOC) 
    This pdf contains a complete coverage description of the Medical Plan, in an easy to understand format.
  • Summary of Benefits and Coverage (SBC) 
    An easy to read, plain English summary of the CCPOA Medical Plan.
  • Summary of Benefits (SOB)
    Which shows the amount you will pay for Covered Services
2025 Blue Shield of California
CCPOA Medical Plan Medicare (PPO)

2025 Medicare Docs Coming Soon

CCPOA Medical Plan
Medicare PPO 2025 EOC

CCPOA Medical Plan
Medicare 2025 SOB


Documentation for all Trust plans and programs is available on our FORMS page. Go To Top