EVIDENCE OF COVERAGE AND HEALTH SERVICE AGREEMENTDental Ppo Plan • October 4th, 2010
Contract Type FiledOctober 4th, 2010This AGREEMENT is issued by California Physicians' Service d/b/a Blue Shield of California ("Blue Shield"), a not for profit health care service Plan, to the Subscriber whose identification cards are issued with this Agreement. In consideration of state- ments made in the application and timely payment of Dues, Blue Shield of California agrees to provide the benefits of this Agree- ment.