Medicare Supplement Agreement Sample Contracts

Evidence of Coverage and Health Service Agreement

Medicare Supplement Agreement • January 15th, 2016

• Contract Type
  Medicare Supplement Agreement
• Filed
  January 15th, 2016

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