Home Plan Documents for Blue Shield of California PPO Plan Documents for Blue Shield of California PPO Visit Blue Shield of California's SFHSS website here. Find in-network providers within California here. Find providers outside of California using the national network of Blue Cross Blue Shield providers here and enter the prefix SFG. Blue Shield of California PPO 2023 Blue Shield of CA PPO Plan Documents Active Employees and Early Retirees (California)2023 Active and Early Retiree in CA - EOC2023 Blue Shield of CA PPO EOC (Active/Early Retiree) (1.47 MB)2023 Active and Early Retiree in CA - SOB2023 Blue Shield of CA PPO SOB (Active/Early Retiree) (258.76 KB)2023 Active and Early Retiree in CA - SBC2023 Blue Shield of CA PPO SBC (Active/Early Retiree) (275.15 KB) Active Employees and Early Retirees (Out of Area)2023 Blue Shield of CA PPO Out of Area EOC (1.42 MB)2023 Blue Shield of CA PPO Out of Area SOB (258.39 KB)2023 Blue Shield of CA PPO Out of Area SBC (277.28 KB) Blue Shield of CA PPO 20 for Medicare-Eligible Retirees Who Do Not Enroll in Medicare2023 Blue Shield of CA PPO-20 EOC (1.46 MB)2023 Blue Shield of CA PPO-20 SOB (260.11 KB)2023 Blue Shield of CA PPO-20 SBC (275.24 KB) Claim FormsBlue Shield of CA Medical Claim Form - USA Only (450.00 KB)BSC RX Claim Form US and International (217.89 KB)BSC International Medical Claim Form (133.75 KB) 2024 Blue Shield of CA PPO Plan Documents Active Employees and Early Retirees (California)2024 Blue Shield of CA PPO - Summary of Benefits (Active/Early Retiree) (207.76 KB)2024 Blue Shield of CA PPO – Summary of Benefits & Coverage (Active/Early Retiree) (384.65 KB)2024 Blue Shield of CA PPO - Evidence of Coverage/Summary of Plan Description (EOC/SPD) (Active/Early Retiree) (1.20 MB) Active Employees and Early Retirees (Out of Area)2024 Blue Shield PPO - Out of Area Summary of Benefits (Out of United States Retiree) (387.33 KB)2024 Blue Shield PPO - Out of Area Summary of Benefits & Coverage (Out of United States Retiree) (387.33 KB)2024 Blue Shield PPO - Out of Area Evidence of Coverage/Summary of Plan Description (EOC/SPD) (Out of United States Retiree) (972.86 KB) Blue Shield of CA PPO 20 for Medicare-Eligible Retirees Who Do Not Enroll in Medicare2024 Blue Shield of CA PPO-20 Summary of Benefits (Retiree-Medicare Eligible Not Enrolled) (208.76 KB)2024 Blue Shield of CA PPO-20 Summary of Benefits & Coverage (Retiree-Medicare Eligible Not Enrolled) (384.79 KB)2024 Blue Shield of CA PPO-20 Evidence of Coverage/Summary of Plan Description (EOC/SPD) (Retiree-Medicare Eligible Not Enrolled) (1.09 MB) Claim FormsBlue Shield of CA Medical Claim Form - USA Only (450.00 KB)Blue Shield of CA RX Claim Form US and International (217.89 KB)Blue Shield of CA International Medical Claim Form (133.75 KB)
