Blue Cross Blue Shield of MassachusettsBlue Cross Blue Shield of Massachusetts

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Summary of Benefits and Coverage (SBC)

Blue Cross Blue Shield of Massachusetts provides a Summary of Benefits and Coverage (SBC) with online access to the corresponding coverage policy to all of our fully insured members and accounts.

To view your coverage policy document, select the size of your employer group, then the plan name listed at the top of your SBC. If you are not part of a group, please select "Under 50 employees."

  • Under 50 employees
  • Over 50 employees

  • 2018

    +– HMO Blue Plans

    HMO Blue $1000 Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue Basic with Dental Blue Pediatric Essential Benefits

    HMO Blue Basic Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue Essential with Dental Blue Pediatric Essential Benefits

    HMO Blue Premium with Dental Blue Pediatric Essential Benefits

    HMO Blue Select $1000 Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue Select $1000 Deductible with Copayment with Dental Blue Pediatric Essential Benefits

    HMO Blue Select $2000 Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue Select Saver $2000 with Dental Blue Pediatric Essential Benefits

    HMO Blue Select $2000 Deductible with Copayment with Dental Blue Pediatric Essential Benefits

    HMO Blue Select $3000 Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Basic Copayment with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $500 Deductible with HCCS with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $1000 Deductible with HCCS with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $1000 Deductible with Copayment with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $1500 Deductible with HCCS with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $2000 Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $2000 Deductible with HCCS with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $2000 Deductible with Copayment with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $3000 Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $3000 Deductible with HCCS with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Options Deductible II with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Options Deductible III with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Premier Value with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Premier Value with HCCS with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Basic Saver with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Saver $2000 with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Saver $3000 with Dental Blue Pediatric Essential Benefits

    +– Preferred Blue Plans

    Preferred Blue PPO Basic $2000 with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO Basic Saver with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO $500 Deductible with HCCS with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO $1000 Deductible with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO $1000 Deductible with HCCS with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO $2000 Deductible with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO $2000 Deductible with HCCS with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO $3000 Deductible with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO $3000 Deductible with HCCS with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO Options Deductible II with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO Options Deductible III with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO Saver $2000 with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO Saver $3000 with Dental Blue Pediatric Essential Benefits

    2017

    +– Access Blue Plans

    Access Blue Basic with Dental Blue Pediatric Essential Benefits

    Access Blue Basic Saver with Dental Blue Pediatric Essential Benefits

    Access Blue Select Saver $2000 with Dental Blue Pediatric Essential Benefits

    Access Blue New England Basic $2000 with Dental Blue Pediatric Essential Benefits

    Access Blue New England Basic $2000 with HCCS with Dental Blue Pediatric Essential Benefits

    Access Blue New England Basic Saver with Dental Blue Pediatric Essential Benefits

    Access Blue New England Basic Saver II with Dental Blue Pediatric Essential Benefits

    Access Blue New England Saver with Dental Blue Pediatric Essential Benefits

    Access Blue New England Saver $2000 with Dental Blue Pediatric Essential Benefits

    Access Blue New England Saver $2500 with Dental Blue Pediatric Essential Benefits

    Access Blue New England Saver $3000 with Dental Blue Pediatric Essential Benefits

    +– HMO Blue Plans

    HMO Blue Basic Copayment with Dental Blue Pediatric Essential Benefits

    HMO Blue $1000 Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue $2000 Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue Basic Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue Essential with Dental Blue Pediatric Essential Benefits

    HMO Blue Premium with Dental Blue Pediatric Essential Benefits

    HMO Blue Select $1000 Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue Select $1000 Deductible with Copayment with Dental Blue Pediatric Essential Benefits

    HMO Blue Select $2000 Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue Select $2000 Deductible with Copayment with Dental Blue Pediatric Essential Benefits

    HMO Blue Select $3000 Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Basic Coinsurance with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Basic Copayment with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $500 Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $500 Deductible with HCCS with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $1000 Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $1000 Deductible with HCCS with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $1000 Deductible with Copayment with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $1000 Deductible with Copayment and HCCS with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $1000 Deductible with Coinsurance with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $1000 Deductible with Coinsurance and HCCS with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $1500 Deductible with HCCS with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $2000 Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $2000 Deductible with HCCS with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $2000 Deductible with Copayment with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $3000 Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue New England $3000 Deductible with HCCS with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Enhanced Value with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Options Deductible with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Options Deductible II with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Options Deductible III with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Premier Value with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Premier Value with HCCS with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Premier Value with Coinsurance with Dental Blue Pediatric Essential Benefits

    HMO Blue New England Premier Value with Coin and HCCS with Dental Blue Pediatric Essential Benefits

    +– Preferred Blue Plans

    Preferred Blue PPO Basic $2000 with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO Basic $2000 with HCCS with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO Basic Coinsurance with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO Basic Copayment with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO Basic Saver with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO $500 Deductible with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO $500 Deductible with HCCS with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO $1000 Deductible with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO $1000 Deductible with HCCS with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO $2000 Deductible with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO $2000 Deductible with HCCS with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO Options with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO Options Deductible II with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO Options Deductible III with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO Saver $1500 with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO Saver $2000 with Dental Blue Pediatric Essential Benefits

    Preferred Blue PPO Saver $3000 with Dental Blue Pediatric Essential Benefits

    +– Blue Care Elect

    Blue Care Elect $3000 Deductible with Dental Blue Pediatric Essential Benefits

    Blue Care Elect $4500 Deductible with Dental Blue Pediatric Essential Benefits

  • 2018

    HMO plans

    HMO Options plans

    HMO Blue Select

    Blue Choice plans

    Preferred Blue PPO plans

    Preferred Blue PPO Options plans

    Blue Care Elect plans

    2017

    HMO plans

    HMO Options plans

    HMO Blue Select plans

    Blue Choice plans

    Preferred Blue PPO plans

    Preferred Blue PPO Options plans

    Blue Care Elect plans

You can also login to MyBlue to download documents related to your plan and to review your benefits and coverage

If you have any questions, call Member Service at the number on the front of your ID card. If you are not a member yet,
call 1-800-262-BLUE (2583).
Blue Cross Blue Shield of Massachusetts

Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association.
® Registered Marks of the Blue Cross and Blue Shield Association.
© 2015 Blue Cross and Blue Shield of Massachusetts, Inc.
101 Huntington Avenue, Suite 1300, Boston, MA 02199-7611 | 1-800-262-BLUE (2583)

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