Summary of Benefits and Coverage: Bronze 60 HDHP PPO ...

Bronze 60 HDHP PPO Coverage for: Individual + Family | Plan Type: PSP 1 of 8 Blue Shield of California is an independent member of the Blue Shield Association.

  Bronze, Hdhp, Bronze 60 hdhp ppo

Small Group Benefit Program Application

If HSA/HDHP is selected, provide name of HSA administrator/trustee: Vendor: Select Vendor FSA purchased: Yes No (If yes, select vendor) Vendor: Select Vendor Metallic Levels Blue Choice PPO℠ *Blue Advantage HMO℠ (select up to 6) Plan ID Plan ID BRONZE PLANS B660CHC B660ADT B661CHC B661ADT B662CHC B9E1ADT SILVER PLANS

  Bronze, Hdhp

Small Group Benefit Program Application Amendment

We are adding one (1) or more non-grandfathered PPO plans. We understand maternity care is automatically included in the coverage as required by federal law in 2014, and that coverage for maternity care will be added to our existing PPO plan.