Dental Hmo Plan Sample Contracts

Evidence of Coverage and Health Service Agreement
Dental Hmo Plan • July 31st, 2013

This 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 Agreement.

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