Health Service Agreement Sample Contracts

Evidence of Coverage and Health Service Agreement
Health Service Agreement • September 2nd, 2015

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 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
Health Service Agreement • October 16th, 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 statements made in the application and timely payment of Premiums, Blue Shield agrees to provide the Benefits of this Agreement.

HEALTH SERVICE AGREEMENT CHECKLIST
Health Service Agreement • May 22nd, 2019

This agreement is a living document and can be adjusted at any time through further joint discussion between the host health service and the provider.

NOTICE TO BUYER OR NEW SUBSCRIBER
Health Service Agreement • December 1st, 2014

Please read this Agreement carefully. If you have any questions, contact the Blue Shield of California office nearest you. If you are not satisfied with the Service Agreement, you may surrender it by delivering or mailing it with the Identification (ID) Cards, within 30 days from the date it is received by you, to BLUE SHIELD OF CALIFORNIA, 50 BEALE STREET, SAN FRANCISCO, CALIFORNIA94105, or 100 N. SEPULVEDA BLVD., EL SEGUNDO, CALIFORNIA 90245, OR TO

Evidence of Coverage and Health Service Agreement
Health Service Agreement • October 5th, 2016

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 statements made in the application and timely payment of Premiums, Blue Shield agrees to provide the Benefits of this Agreement.

Evidence of Coverage and Health Service Agreement
Health Service Agreement • August 18th, 2021

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 statements made in the application and timely payment of Premiums, Blue Shield of California agrees to provide the Benefits of this Agreement.

Status: Point in time view as at 01/01/2006.
Health Service Agreement • March 14th, 2023
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