Summary of benefits and coverage
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 aren't part of a group, please select "Under 50 employees".
2023
HMO Blue Copayment with Dental Blue Pediatric Essential Benefits
HMO Blue Deductible with Copayment 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 Saver 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 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 $1500 Deductible with Copayment 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 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 $4500 Deductible with Dental Blue Pediatric Essential Benefits
HMO Blue New England $5000 Deductible with Dental Blue Pediatric Essential Benefits
HMO Blue New England Total Deductible with Rx 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 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
HMO Blue New England Saver $3000 with Dental Blue Pediatric Essential Benefits
HMO Blue New England Saver $3000 with HCCS with Dental Blue Pediatric Essential Benefits
HMO Blue New England Saver $4500 with Dental Blue Pediatric Essential Benefits
Preferred Blue PPO Saver with Copayment with Dental Blue Pediatric Essential Benefits
Preferred Blue PPO $1500 Deductible with Dental Blue Pediatric Essential Benefits
Preferred Blue PPO $2500 Deductible with Dental Blue Pediatric Essential Benefits
Preferred Blue PPO $3000 Deductible with HCCS with Dental Blue Pediatric Essential Benefits
Preferred Blue PPO $4500 Deductible 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
Preferred Blue PPO Saver $4500 with Dental Blue Pediatric Essential Benefits
2022
HMO Blue Copayment with Dental Blue Pediatric Essential Benefits
HMO Blue Deductible with Copayment 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 Saver 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 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 $4500 Deductible with Dental Blue Pediatric Essential Benefits
HMO Blue New England $5000 Deductible with Dental Blue Pediatric Essential Benefits
HMO Blue New England Total Deductible with Rx 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 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
HMO Blue New England Saver $3000 with HCCS with Dental Blue Pediatric Essential Benefits
HMO Blue New England Saver $4500 with Dental Blue Pediatric Essential Benefits
Preferred Blue PPO Deductible with Coinsurance with Dental Blue Pediatric Essential benefits
Preferred Blue PPO $1500 Deductible with Dental Blue Pediatric Essential Benefits
Preferred Blue PPO $2500 Deductible with Dental Blue Pediatric Essential Benefits
Preferred Blue PPO $3000 Deductible with HCCS with Dental Blue Pediatric Essential Benefits
Preferred Blue PPO $4500 Deductible 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
Preferred Blue PPO Saver $4500 with Dental Blue Pediatric Essential Benefits
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).