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Benefit Outlines
BSCA Dental Benefits
Blue Shield of California Dental Benefits 2021                              Blue Shield of California Vision Benefits 2021

Dental PPO                                                                                                          Ultimate Vision 15/25/120

Specialty Duo                                                                                                      Ultimate Vision 15/25/150

Enhanced 25/500 PPO                                                                                       Specialty Duo

Enhanced 50/1250 PPO

Enhanced 50/2000 PPO

Enhanced 50/2000

1500 Lifetime Ortho

Dental HMO *

*not available in all areas

Blue Shield of California Medical Benefits 2021

Direct Enrollment Plans

Minimum Coverage PPO

Bronze 60 HDHP PPO

Bronze 60 PPO

Silver 2600 HDHP PPO

Silver 1950 PPO

Silver 70 Off Exchange PPO

Gold 80 PPO

Platinum 90 PPO

Covered California Specialty Plans

Silver 70 PPO

Silver 73 PPO

Silver 87 PPO

Silver 94 PPO

Alaska Native and American Indian PPO Plans

Platinum 90 PPO AI-AN

Gold PPO AI-AN

Silver 70 PPO AI-AN

Bronze 60 PPO AI-AN

Bronze 60 HDHP PPO AI-AN

$0 Cost Share PPO AI-AN

BSCA Medical
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