Common Contracts

Evidence of Coverage and Health Service Agreement

Medicare Supplement Plan D • October 19th, 2023

• Contract Type
  Medicare Supplement Plan D
• Filed
  October 19th, 2023

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 identification card.

Evidence of Coverage and Health Service Agreement

Medicare Supplement Plan D • January 15th, 2016

• Contract Type
  Medicare Supplement Plan D
• Filed
  January 15th, 2016

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