Provider Summary of Benefits and Coverage

Provider Benefits List

The following is a list of the provider summary of benefits documents available to you on this site.

 

Summary of Benefits and Coverage

Network Blue New England Options v.5
Blue Choice New England 2
Blue Care Elect Preferred

 

Medical Plans

TIER 1 BENEFIT

Blue Choice© New England Plan 2 – Schedule of Benefits

Blue Cross Blue Shield POS – Benefit Description
Blue Cross Blue Shield PPO – Benefit Description

Blue Cross Blue Shield – Pharmacy Benefit Handbook

TIER 2 BENEFIT

Network Blue® New England Options – Benefit Description

 

Dental

Dental Blue – Benefit Description – For Active Members
Dental Blue Benefit Description – For Retired Members

 

Prescription Drug Benefit

Coverage Changes to BCBSMA Medical and Pharmacy Benefit
Summary of Material Modifications
Blue Cross Blue Shield Pharmacy Benefit Handbook (January 1, 2022)

NOTE: For Envision Benefits, please consult with the SMM dated October 30, 2014, where effective January 1, 2015. Pharmacy Benefits will now be administered by BCBS MA for BCBS members

Envision RX Benefit
Envision RX Benefit Formulary Change Notice

 

Life Insurance

Symetra – Full Time Benefit Plan
Symetra – Part Time Benefit Plan


 

HIPAA Notice of Privacy Practice

This notice describes how medical information about you may be used and disclosed and how you get access to this information.

View the latest privacy notice

HIPAA Notice of Privacy Practice