3

Document Number:

FSB25-003

Revision #:

v1.0

Date Published:

1/1/2025

2025 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Table of Contents
Page 3

Summary of Benefits for the Blue Cross and Blue Shield Service Benefit Plan Standard Option – 2025 - 163
Summary of Benefits for the Blue Cross and Blue Shield Service Benefit Plan Basic Option – 2025 - 165
2025 Rate Information for the Blue Cross and Blue Shield Service Benefit Plan - 170

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