Coverage and Health Service Agreement Sample Contracts

Evidence of Coverage and Health Service Agreement
Coverage and Health Service Agreement • October 19th, 2023

This Evidence of Coverage and Health Service Agreement (“Agreement”) is issued by California Physicians’ 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.

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Evidence of Coverage and Health Service Agreement
Coverage and Health Service Agreement • August 30th, 2022

This Evidence of Coverage and Health Service Agreement (“Agreement”) is issued by California Physicians’ 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.

Evidence of Coverage and Health Service Agreement
Coverage and Health Service Agreement • August 30th, 2022

This Evidence of Coverage and Health Service Agreement (“Agreement”) is issued by California Physi- cians' Service d/b/a Blue Shield of California ("Blue Shield"), a not for profit health care service Plan, to the Subscriber whose identification cards are issued with this Agreement. In consideration of statements made in the application and timely payment of Dues, Blue Shield of California agrees to provide the benefits of this Agreement.

Evidence of Coverage and Health Service Agreement
Coverage and Health Service Agreement • September 20th, 2021

This Evidence of Coverage and Health Service Agreement (“Agreement”) is issued by California Physi- cians' Service d/b/a Blue Shield of California ("Blue Shield"), a not for profit health care service Plan, to the Subscriber whose identification cards are issued with this Agreement. In consideration of statements made in the application and timely payment of Dues, Blue Shield of California agrees to provide the benefits of this Agreement.

EVIDENCE OF COVERAGE AND HEALTH SERVICE AGREEMENT
Coverage and Health Service Agreement • October 4th, 2010

This AGREEMENT is issued by California Physicians' Service d/b/a Blue Shield of California ("Blue Shield"), a not for profit health care service Plan, to the Subscriber whose identification cards are issued with this Agreement. In consideration of state- ments made in the application and timely payment of Dues, Blue Shield of California agrees to provide the benefits of this Agree- ment.

Evidence of Coverage and Health Service Agreement
Coverage and Health Service Agreement • October 19th, 2023

This Evidence of Coverage and Health Service Agreement (“Agreement”) is issued by California Physicians’ 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.

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