Dental Ppo Plan 1500 Sample Contracts

Evidence of Coverage and Health Service Agreement
Dental Ppo Plan 1500 • August 30th, 2022

This Evidence of Coverage and Health Service Agreement (“Agreement”) is issued by California Physi- cians' 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 statements 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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Evidence of Coverage and Health Service Agreement
Dental Ppo Plan 1500 • November 5th, 2024

This Evidence of Coverage and Health Service Agreement (“Agreement”) is issued by California Physi- cians' 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 statements 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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