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Common Contracts

2 similar Medicare Supplement Plan G contracts

Evidence of Coverage and Health Service Agreement
Medicare Supplement Plan G • December 13th, 2021

This Evidence of Coverage and Health Service Agreement (“Agreement”) is issued by California Physicians’ Service dba Blue Shield of California (“Blue Shield”), a health care service plan, to the Subscriber whose name, group number, Subscriber identification number, and Effective Date shall appear on his or her identi- fication card.

Standard Contracts

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EVIDENCE OF COVERAGE AND HEALTH SERVICE AGREEMENT
Medicare Supplement Plan G • August 27th, 2020

This Evidence of Coverage and Health Service Agreement (“Agreement”) is issued by California Physicians’ Service dba Blue Shield of California ("Blue Shield"), a health care service plan, to the Subscriber whose name, group number, Subscriber identification number, and Effective Date shall appear on his or her identi- fication card.