EVIDENCE OF COVERAGE AND HEALTH SERVICE AGREEMENTPlan J • December 1st, 2014
Contract Type FiledDecember 1st, 2014This 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.