Blue Shield of California Plan Documents

The following Plan Documents explain the benefits, coverage and out-of-pocket costs associated with CVT PPO and HDHP Plans using the Blue Shield of California network of providers. These documents pertain to the plans available to both active and retired employees as well as COBRA participants. 

• Plan 1 (PDF)
• Plan 2 (PDF)
• Plan 3 (PDF)
• Plan 4 (PDF)
• Plan 5 (PDF)
• Plan 6 (PDF)
• Plan 7 (PDF)
• Plan 8 (PDF)
• Plan 9 (PDF)
• Plan 10 (PDF)
• Wellness Plan (PDF)
• Bronze Plan (PDF)
• Plan HDHP 1 (PDF)
• Plan HDHP 2 (PDF)
• Plan HDHP 3 (PDF)
• Medicare Supplement 1 (PDF)
• Medicare Supplement 2 (PDF)

The following Plan Documents also known as “Evidence of Coverage” (EOC) are documents that explain the benefits, coverage and out-of-pocket costs associated with CVT HMO Plans using the Blue Shield of California network of providers.  These documents pertain to the plans available to both active and retired employees as well as COBRA participants.

• HMO Plan 1 (PDF)
• HMO Plan 2 (PDF)
• HMO Plan 3 (PDF)
• HMO Plan 4 (PDF)
• HMO Plan 1 Trio (PDF)
• HMO Plan 2 Trio (PDF)
• HMO Plan 3 Trio (PDF)

For any questions regarding these documents please contact CVT Member Services by emailing MemberServices@CVTrust.org or calling 800.288.9870.