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Medical Plan:
Summary of Benefits and Coverage

EZ Summary

Blue Shield of California is pleased to provide you with the Summary of Benefits and Coverage (SBC), an easy to read, plain English summary of the CCPOA Medical Plan.

You can also view the complete Evidence of Coverage (EOC). 
This pdf contains a complete coverage description of the Medical Plan,in an easy to understand format.

You can also view the Summary of Benefits (SOB) which shows the amount you will pay for Covered Services

2023 Blue Shield of California
Summary of Benefits and Coverage

An easy to read, plain English “Summary of Benefits & Coverage” (SBC) for the CCPOA Medical Plan.

CCPOA Medical Plan 2023 SBC

CCPOA Medical Plan
Medicare Supplement 2023 SBC

(Document To Come)

2023 CCPOA Medical Plan “Evidence Of Coverage”

This booklet is the complete “Evidence of Coverage” (EOC) including comprehensive coverage descriptions.

CCPOA Medical Plan 2023 EOC

CCPOA Medical Plan
Medicare Supplement 2023 EOC

(Document To Come)

2023 Medicare Prescription Drug Plan

Application

(Document To Come)

Evidence of Coverage

(Document To Come)

2023 Summary of Benefits

This "Summary of Benefits" (SOB) shows the amount you will pay for Covered Services under this Blue Shield of California Plan.

CCPOA Medical Plan 2023 SOB

Prescription Drug Plan 2023 SOB

Chiropractic Plan 2023 SOB


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CCPOA Benefit Trust Fund
2515 Venture Oaks Way
Suite 200
Sacramento, CA 95833

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