Contract Booklet

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2022 Contract Books

13100 00004 0122 GF Group HMO
13100 00027 0122R GF Group HMO POS
13100 00027D 0122R GF Group LABI HMO POS
13100 01336 0122R GF Small Business Group HMO POS
131HR 01321 0122R NGF Large Group HMO
131HR 01323 0122R NGF Large Group Blue Connect HMO POS
131HR 01324 0122R Large Group Community Blue HMO POS
131HR 01325 0122R NGF Large Group Blue POS
131HR 01350 0122 NGF Blue Connect HMO POS
131HR 01356 0122 NGF Small Business Group POS
131HR 01428 0122 NGF Large Group Signature Blue POS
131HR 01431 0122 NGF Large Group Blue Connect Savings Plus
131HR 01478 0122R Bridge Blue POS
131HR 01480 0122R Bridge Community Blue POS
131HR 01482 0122R Bridge Blue Connect POS
131HR 01499 0122R NGF Large Group Precision Blue POS
131HR 01501 0122R Bridge Precision Blue POS
13100 00284 0122R GF Individual HMO POS
19636EX-022 R01/22 NGF Individual Blue POS
19636EX-023 R01/22 NGF Individual Community Blue HMO POS
19636EX-024 R01/22 Individual Blue Connect POS – NGF Blue Connect HMO POS 
19636EX-025 R01/22 NGF Small Group Blue HMO POS
19636EX-059 R01/22 NGF Individual Signature Blue POS
19636OFF-026 R01/22 NGF Small Group Community Blue HMO POS
19636OFF-027 R01/22 NGF Small Group Blue Connect POS
19636OFF-058 R01/22 NGF Blue Connect Savings Plus
19636OFF-060 R01/22 NGF Small Group Signature Blue POS
19636EX-061 R01/22 NGF Individual Precision Blue POS
19636OFF-062 R01/22 NGF Small Group Precision Blue POS
23XX9632 R0122 GF Individual CSD Plan G Contract
23XX9978 R0122 GF Individual CSD Plan F Contract
40XX0500 R01/22 GF Individual Blue Value
40HR1796 R0122 NGF Large Group BlueSaver
40HR1797 R0122 NGF Large Group PPO Group Care
40HR1797E R0122 NGF Large Group PPO Group Care LADA
40HR1798 R0122 NGF Large Group Premier Blue
40HR1909 R0122 Small Business Funding NGF PPO Group Care
40HR1911 R0122 Small Business Funding NGF BlueSaver
40HR1913 R0122 Small Business NGF Group Premier Blue
40XX0492 R0122 GF PPO Group Care
40XX0492E R0122 GF LADA PPO Group Care
40XX0503 R0122 GF Group LABI Blue Chip
40XX0551 R01/22 GF Individual Blue Max
40XX0778 R01/22 GF Individual BlueSaver
40XX0779 R0122 GF Group Blue Saver
40XX1172 R0122 Individual VIP
40XX1224 R0122 GF Group True Blue
40XX1278 R01/22 GF Individual Blue Select
40XX1326_R0122 GF Group LABI BlueSaver
40XX1375 R0122 GF Group Premier Blue
40XX1663_R01/22 Group Vision 
40XX1893 R0122 Small Business Funding GF PPO Group Care
40XX1895 R0122 GF Small Group BlueSaver
40XX1897 R0122 GF Premier Blue
40XX1899 R0122 GF True Blue
40XX1980_R01/22 Plans A-C Ortho
40XX1984_R01/22 Traditional Blue Dental Preferred and Essential
40XX1992_R01/22 Traditional Blue Dental Value
97176EX-034 R01/22 NGF Individual Blue Max
97176EX-035 R01/22 NGF Individual BlueSaver
97176EX-036 R01/22 NGF Small Group PPO Group Care
97176EX-037 R01/22 NGF Small Group BlueSaver
97176EX-038 R01/22 NGF Small Group Premier Blue
97176EX-039 R01/22 Individual Blue Dental (UCD)
97176EX-040 R01/22 Group Blue Dental

2021 Contract Books

13100 00004 0121 GF Group HMO
13100 00027 0121R GF Group HMO POS
13100 00027D 0121R GF Group LABI HMO POS
13100 00284 0121R GF Individual HMO POS
13100 01336 0121R GF Small Business Group HMO POS
131HR 01321 0121R NGF Large Group HMO
131HR 01323 0121R NGF Large Group Blue Connect HMO POS
131HR 01324 0121R Large Group Community Blue HMO POS
131HR 01325 0121R NGF Large Group Blue POS
131HR 01428 0121 NGF Large Group Signature Blue POS
131HR 01431 0121 NGF Large Group Blue Connect Savings Plus
131HR 01478 0121R Bridge Blue POS
131HR 01480 0121R Bridge Community Blue POS
131HR 01482 0121R Bridge Blue Connect POS
131HR 01499 0121R NGF Large Group Precision Blue POS
131HR 01501 0121R Bridge Precision Blue POS
131HR 01350 0121 NGF Blue Connect HMO POS
131HR 01356 0121 NGF Small Business Group POS
13LG0043 R01/21 Eligibility and Termination Amendment for School Board Groups 
19636EX-022 R01/21 NGF Individual Blue POS
19636EX-023 R01/21 NGF Individual Community Blue HMO POS
19636EX-024 R01/21 Individual Blue Connect POS – NGF Blue Connect HMO POS
19636EX-025 R01/21 NGF Small Group Blue HMO POS
19636EX-059 R01/21 NGF Individual Signature Blue POS
19636EX-061 R01/21 NGF Individual Precision Blue POS
19636OFF-026 R01/21 NGF Small Group Community Blue HMO POS
19636OFF-027 R01/21 NGF Small Group Blue Connect POS
19636OFF-058 R01/21 NGF Blue Connect Savings Plus
19636OFF-060 R01/21 NGF Small Group Signature Blue POS
19636OFF-062 R01/21 NGF Small Group Precision Blue POS
23XX9632 R0121 GF Individual CSD Plan G Contract
23XX9978 R0121 GF Individual CSD Plan F Contract
40HR1611 R07/21 Basic Blue
40HR1796 R01/21 NGF Large Group BlueSaver
40HR1797 R01/21 NGF Large Group PPO Group Care
40HR1797E R0121 NGF Large Group PPO Group Care LADA
40HR1798 R01/21 NGF Large Group Premier Blue
40HR1909 R0121 Small Business Funding NGF PPO Group Care
40HR1911 R0121 Small Business Funding NGF BlueSaver
40HR1913 R0121 Small Business NGF Group Premier Blue
40XX0492 R01/21 GF PPO Group Care
40XX0492E R0121 GF LADA PPO Group Care
40XX0500 R01/21 GF Individual Blue Value
40XX0503 R01/21 GF Group LABI Blue Chip
40XX0551 R01/21 GF Individual Blue Max
40XX0778 R01/21 GF Individual BlueSaver
40XX0779 R0121 GF Group Blue Saver
40XX1172 R0121 Individual VIP
40XX1224 R01/21 GF Group True Blue
40XX1278 R01/21 GF Individual Blue Select
40XX1326_R01/21 GF Group LABI BlueSaver
40XX1375 R01/21 GF Group Premier Blue
40XX1439_R07/21 Student Group Health Insurance Networks
40XX1663_R01/21 Group Vision
40XX1893 R0121 Small Business Funding GF PPO Group Care
40XX1895_R0121 GF Small Group BlueSaver
40XX1897 R0121 GF Premier Blue
40XX1899 R0121 GF True Blue
40XX1980_R01/21 Plans A-C Ortho
40XX1984_R01/21 Traditional Blue Dental Preferred and Essential
40XX1992_R01/21 Traditional Blue Dental Value
40XX2160_R01/21 Smart Basics BP
97176EX-034 R01/21 NGF Individual Blue Max
97176EX-035 R01/21 NGF Individual BlueSaver
97176EX-036 R01/21 NGF Small Group PPO Group Care
97176EX-037 R01/21 NGF Small Group BlueSaver
97176EX-038 R01/21 NGF Small Group Premier Blue
97176EX-039 R01/21 Individual Blue Dental (UCD)
97176EX-040 R01/21 Group Blue Dental

2020 Contract Books

13100 00004 0120 GF Group HMO
13100 00027 0120R GF Group HMO POS
13100 00027D 0120R GF Group LABI HMO POS
13100 00284 0120R GF Individual HMO POS
13100 01336 0120R GF Small Business Group HMO POS
131HR 01321 0120R NGF Large Group HMO
131HR 01323 0120R NGF Large Group Blue Connect HMO POS
131HR 01324 0120R Large Group Community Blue HMO POS
131HR 01325 0120R NGF Large Group Blue POS
131HR 01350 0120 NGF Blue Connect HMO POS
131HR 01356 0120 NGF Small Business Group POS
131HR 01428 0120 NGF Large Group Signature Blue POS
131HR 01431 0120 NGF Large Group Blue Connect Savings Plus
131HR 01478 0120 Bridge Blue POS
131HR 01480 0120 Bridge Community Blue POS
131HR 01482 0120 Bridge Blue Connect POS
131HR 01499 0120R NGF Large Group Precision Blue POS
131HR 01501 0120 Bridge Precision Blue POS
19636EX-022 R01/20 NGF Individual Blue POS
19636EX-023 R01/20 NGF Individual Community Blue HMO POS
19636EX-024 R01/20 Individual Blue Connect POS – NGF Blue Connect HMO POS
19636EX-025 R01/20 NGF Small Group Blue HMO POS
19636EX-059 0120 NGF Individual Signature Blue POS
19636EX-061 0120 NGF Individual Precision Blue POS
19636OFF-026 R01/20 NGF Small Group Community Blue HMO POS
19636OFF-027 R01/20 NGF Small Group Blue Connect POS
19636OFF-058 0120 NGF Small Group Blue Connect Savings Plus
19636OFF-060 R0120 NGF Small Group Signature Blue POS
19636OFF-062 R0120 NGF Small Group Precision Blue POS
23XX9632 R0120 GF Individual CSD Plan G Contract
23XX9978 R0120 GF Individual CSD Plan F Contract
40HR1611 R07/20 Basic Blue
40HR1796 R01/20 NGF Large Group BlueSaver
40HR1797 R01/20 NGF Large Group PPO Group Care
40HR1797E R01/20 NGF Large Group PPO Group Care LADA
40HR1798 R01/20 NGF Large Group Premier Blue
40HR1861 R01/20 NGF Women's Contraceptive Services
40HR1909 R0120 Small Business Funding NGF PPO Group Care
40HR1911 R0120 Small Business Funding NGF BlueSaver
40HR1913 R0120 Small Business NGF Group Premier Blue
40XX0492 R01/20 GF PPO Group Care
40XX0492E R0120 GF LADA PPO Group Care
40XX0500 R01/20 GF Individual Blue Value
40XX0503 R01/20 GF Group LABI Blue Chip
40XX0551 R01/20 GF Individual Blue Max
40XX0778_R01/20 GF Individual BlueSaver
40XX0779 R0120 GF Group Blue Saver
40XX1172 R0120 GF Individual VIP
40XX1224 R01/20 GF Group True Blue
40XX1278 R01/20 GF Individual True Blue
40XX1326_R01/20 GF Group LABI BlueSaver
40XX1439_R07/20 Student Group Health Insurance Networks
40XX1663_R01/20 Group Vision
40XX1893 R0120 Small Business Funding GF PPO Group Care
40XX1895_R0120 GF Small Group BlueSaver
40XX1897 R0120 GF Premier Blue
40XX1899 R0120 GF True Blue
40XX1980_R01/20 Plans A-C Ortho
40XX1984_R01/20 Traditional Blue Dental Preferred and Essential
40XX1992_R01/20 Traditional Blue Dental Value
97176EX-034 R01/20 NGF Individual Blue Max
97176EX-035 R01/20 NGF Individual BlueSaver
97176EX-036 R01/20 NGF Small Group PPO Group Care
97176EX-037 R01/20 NGF Small Group BlueSaver
97176EX-038 R01/20 NGF Small Group Premier Blue
97176EX-039_R01/20 Individual Blue Dental (UCD)
97176EX-040_R01/20 Group Blue Dental (UCD)

2019 Contract Books

13100 00004 0119 GF Group HMO
13100 00027 0119R GF Group HMO POS
13100 01336 0419R GF Small Business Group HMO POS
13100 00284 0119R GF Individual HMO POS
131HR 01321 0119R NGF Large Group HMO
131HR 01323 0119R NGF Large Group Blue Connect HMO POS
131HR 01324 0119R NGF Large Group Community Blue HMO POS
131HR 01325 0119R NGF Large Group Blue POS
131HR 01350 0119 NGF Blue Connect HMO POS
131HR 01356 0119 NGF Small Business Group POS (Jan. 1-March 30)
131HR 01356 0419 NGF Small Business Group POS
131HR 01428 0119 NGF Large Group Signature Blue POS
131HR 01431 0119 NGF Large Group Blue Connect Savings Plus
131HR 01478 0119 Bridge Blue POS
131HR 01480 0119 Bridge Community Blue POS
131HR 01482 0119 Bridge Blue Connect POS
13LG0043 R0119 School Board Benefit Plan Amendment
19636EX-022 R01/19 NGF Individual Blue POS
19636EX-023 R01/19 NGF Individual Community Blue HMO POS
19636EX-024 R01/19 Individual Blue Connect POS – NGF Blue Connect HMO POS
19636EX-025 R01/19 NGF Small Group Blue HMO POS
19636EX-059 0119 NGF Individual Signature Blue POS
19636OFF-026 R01/19 NGF Small Group Community Blue HMO POS
19636OFF-027 R01/19 NGF Small Group Blue Connect POS
19636OFF-058 0119 NGF Small Group Blue Connect Savings Plus
19636OFF-060 R0119 NGF Small Group Signature Blue POS
23XX9632 R0119 GF Individual CSD Plan G Contract
23XX9978 R0119 GF Individual CSD Plan F Contract
40HR1611 R0719 Basic Blue
40HR1796 R01/19 NGF Large Group BlueSaver
40HR1797 R01/19 NGF Large Group PPO Group Care
40HR1798 R01/19 NGF Large Group Premier Blue
40HR1861 R08/19 NGF Women's Contraceptive Services
40HR1909 R0419 Small Business Funding NGF PPO Group Care
40HR1911 R0119 Small Business Funding NGF BlueSaver
40HR1913 R0119 Small Business NGF Group Premier Blue 
40XX0492 R0119 GF PPO Group Care
40XX0500 R01/19 GF Individual Blue Value Contract
40XX0503 R01/19 GF Group LABI Blue Chip
40XX0551 R01/19 GF Individual Blue Max
40XX0778_R01/19 GF Individual BlueSaver
40XX0779 R0119 GF Group Blue Saver
40XX1172 R0119 Individual VIP
40XX1224_R01/19 GF Group True Blue
40XX1278 R01/19 GF Individual True Blue
40XX1326_R01/19 GF Group LABI BlueSaver
40XX1375_R01/19 GF Group Premier Blue
40XX1439 R0719 Student Group Health Insurance Needlestick 
40XX1663_R01/19 Group Vision
40XX1893 R0119 Small Business Funding GF PPO Group Care
40XX1895_R0119 GF Small Group BlueSaver
40XX1980_R01/19 Plans A-C Ortho
40XX1984_R01/19 Traditional Blue Dental Preferred and Essential
40XX1992_R01/19 Traditional Blue Dental Value
40XX2160_R01/19 Blue Dental Smart Basics
97176EX-034 R01/19 NGF Individual Blue Max
97176EX-035 R01/19 NGF Individual BlueSaver
97176EX-036 R01/19 NGF Small Group PPO Group Care
97176EX-037 R01/19 NGF Small Group BlueSaver
97176EX-038 R01/19 NGF Small Group Premier Blue
97176EX-039_R01/19 Individual Blue Dental (UCD)
97176EX-040_R01/19 Group Blue Dental (UCD)

Supplemental Contracts

Current
31SN0111A R02/16 Group Term Life Insurance Policy with Accelerated Benefits
31SN0112A R02/16 Group Term Life Insurance Certificate
40XX0422 R01/06 BlueChoice65 Plan C
40XX0428 R01/06 BlueChoice65 Plan I
40XX0722 R03/06 BlueChoice65 Plan C Select
40XX1488 01/20 BlueChoice 65 - Plan A
40XX1489 01/20 BlueChoice 65 - Plan B
40XX1490 01/20 BlueChoice 65 - Plan F
40XX1491 0120 BlueChoice 65 - Plan N
40XX1492 0120 BlueChoice 65 Select- Plan B
40XX1493 0120 BlueChoice 65 Select- Plan F
40XX1494 0120 BlueChoice 65 Select- Plan N)
40XX2429 0120 Medicare Supplement Plan G
40XX2430 0120 Medicare Supplement Plan G Select

Past
40XX1488 06/10 BlueChoice 65 - Plan A
40XX1489 06/10 BlueChoice 65 - Plan B
40XX1490 0610 BlueChoice 65 - Plan F
40XX1491 0610 BlueChoice 65 - Plan N
40XX1492 0610 BlueChoice 65 Select- Plan B
40XX1493 0610 BlueChoice 65 Select- Plan F
40XX1494 0610 BlueChoice 65 Select- Plan N)
40XX2429 0118 Medicare Supplement Plan G
40XX2430 0118 Medicare Supplement Plan G Select

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