Help Medicare Supplement plan clients

Evidence of Coverage for open plans

Get complete descriptions of our open Medicare Supplement plans.

Evidence of Coverage for 2010 Standardized Closed Plans (closed 9/30/2019)

Get complete descriptions of our closed Medicare Supplement plans effective 10/1/2019.

Evidence of Coverage for Standardized and Pre-Standardized Closed Plans (closed prior to 5/31/2010) and specialty closed plans

Get complete descriptions of our closed Medicare Supplement plans.

* Underwritten by Blue Shield Life and Health

Closed Plan G Inspire materials

Evidence of Coverage for Dental PPO plans

Innovative plan notices

Open medical plan rates and specialty rates

Closed medical plan rates and specialty rates

Medicare Supplement plan dental PPO flyer and enrollment form

Transfer forms and other forms

The transfer application is used when a current Blue Shield of California Medicare Supplement plan member wants to transfer to a Medicare Supplement plan of equal or lesser value during their Open Enrollment Period with guaranteed acceptance, enroll into the Household Savings Program under your current plan, or enroll in a dental plan. Please note, to help with our paperless initiative the transfer application is now only available for download. There are two copies built into the document, one for Blue Shield and one for the member.

Please note, a current Blue Shield Medicare Supplement plan member interested in applying for a richer benefit plan or an equal or lesser plan outside the Open Enrollment Period must fill out the Medicare Supplement plan Enrollment Application and complete the Statement of Health.

If a current Blue Shield Medicare Supplement plan member is interested in transferring to a plan with equal or lesser benefits, please have them work with you, their broker, for assistance in completing the transfer application.

Over-The-Counter (OTC) items catalog

Medicare Supplement plans with the OTC Items Benefit:

Medicare Supplemental Plan G Extra

The company complies with applicable state laws and federal civil rights laws and does not discriminate, exclude people, or treat them differently on the basis of race, color, national origin, ethnic group identification, medical condition, genetic information, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, mental disability, or physical disability. La compañía cumple con las leyes de derechos civiles federales y estatales aplicables, y no discrimina, ni excluye ni trata de manera diferente a las personas por su raza, color, país de origen, identificación con determinado grupo étnico, condición médica, información genética, ascendencia, religión, sexo, estado civil, género, identidad de género, orientación sexual, edad, ni discapacidad física ni mental. 本公司遵守適用的州法律和聯邦民權法律，並且不會以種族、膚色、原國籍、族群認同、醫療狀況、遺傳資訊、血統、宗教、性別、婚姻狀況、性別認同、性取向、年齡、精神殘疾或身體殘疾而進行歧視、排斥或區別對待他人。

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Page last updated: 10/3/2024