Blue Shield Open Enrollment Kit

Blue Shield of California is an independent member of the Blue Shield Association A49471-CORE-A (6/17) €3IqbR3G&Ro+ €E:&^*vUYn€_V aaaa!!!aa!a!!!a! F40723114A+1--1 / 1 Owl Companies

Plan information

Effective Date: 1/1/2018

l Trio HMO ® Facility Deductible 30-30%/2000

Active Choice ® 500 80/50


l Full PPO Savings Embedded Deductible 5500 l Smile Spectrum Premier 50/1500/No Ortho/MAC

Blue Shield of California | 50 Beale St., San Francisco, CA 94105

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