For Brokers
Program Information
Benefits Program Information
New Group Setup Paperwork
New Group Setup Application and Forms
Medical Plan Information – Blue Cross Blue Shield of Arizona
2022 Plan Year
Summary of Benefit Coverages
- Statewide
- AZTC 2022 PPO 5000/100 SBC Statewide
- AZTC 2022 PPO 7900/100 SBC Statewide
- AZTC 2022 PPO 500/90 SBC Statewide
- AZTC 2022 PPO 1000/90 SBC Statewide
- AZTC 2022 PPO 500/80 SBC Statewide
- AZTC 2022 PPO 750/80 SBC Statewide
- AZTC 2022 PPO 1000/80 SBC Statewide
- AZTC 2022 PPO 1500/80 SBC Statewide
- AZTC 2022 PPO 2000/80 SBC Statewide
- AZTC 2022 PPO 2500/80 SBC Statewide
- AZTC 2022 PPO 3000/80 SBC Statewide
- AZTC 2022 PPO 4000/80 SBC Statewide
- AZTC 2022 PPO 5000/80 SBC Statewide
- AZTC 2022 PPO 6000/80 SBC Statewide
- AZTC 2022 PPO 1000/70 SBC Statewide
- AZTC 2022 PPO 2000/70 SBC Statewide
- AZTC 2022 PPO 3000/70 SBC Statewide
- AZTC 2022 Saver HSA 1500/80 SBC Statewide
- AZTC 2022 Saver HSA 3000/80 SBC Statewide
- AZTC 2022 Saver HSA 4500/80 SBC Statewide
- AZTC 2022 Saver HSA 3500/100 SBC Statewide
- AZTC 2022 Saver HSA 6900/100 SBC Statewide
- PimaConnect
- AZTC 2022 PPO 5000/100 SBC PimaConnect
- AZTC 2022 PPO 7900/100 SBC PimaConnect
- AZTC 2022 PPO 500/90 SBC PimaConnect
- AZTC 2022 PPO 1000/90 SBC PimaConnect
- AZTC 2022 PPO 500/80 SBC PimaConnect
- AZTC 2022 PPO 750/80 SBC PimaConnect
- AZTC 2022 PPO 1000/80 SBC PimaConnect
- AZTC 2022 PPO 1500/80 SBC PimaConnect
- AZTC 2022 PPO 2000/80 SBC PimaConnect
- AZTC 2022 PPO 2500/80 SBC PimaConnect
- AZTC 2022 PPO 3000/80 SBC PimaConnect
- AZTC 2022 PPO 4000/80 SBC PimaConnect
- AZTC 2022 PPO 5000/80 SBC PimaConnect
- AZTC 2022 PPO 6000/80 SBC PimaConnect
- AZTC 2022 PPO 1000/70 SBC PimaConnect
- AZTC 2022 PPO 2000/70 SBC PimaConnect
- AZTC 2022 PPO 3000/70 SBC PimaConnect
- AZTC 2022 Saver HSA 1500/80 SBC PimaConnect
- AZTC 2022 Saver HSA 3000/80 SBC PimaConnect
- AZTC 2022 Saver HSA 4500/80 SBC PimaConnect
- AZTC 2022 Saver HSA 3500/100 SBC PimaConnect
- AZTC 2022 Saver HSA 6900/100 SBC PimaConnect
- Alliance
- AZTC 2022 PPO 5000/100 SBC Alliance
- AZTC 2022 PPO 7900/100 SBC Alliance
- AZTC 2022 PPO 500/90 SBC Alliance
- AZTC 2022 PPO 1000/90 SBC Alliance
- AZTC 2022 PPO 500/80 SBC Alliance
- AZTC 2022 PPO 750/80 SBC Alliance
- AZTC 2022 PPO 1000/80 SBC Alliance
- AZTC 2022 PPO 1500/80 SBC Alliance
- AZTC 2022 PPO 2000/80 SBC Alliance
- AZTC 2022 PPO 2500/80 SBC Alliance
- AZTC 2022 PPO 3000/80 SBC Alliance
- AZTC 2022 PPO 4000/80 SBC Alliance
- AZTC 2022 PPO 5000/80 SBC Alliance
- AZTC 2022 PPO 6000/80 SBC Alliance
- AZTC 2022 PPO 1000/70 SBC Alliance
- AZTC 2022 PPO 2000/70 SBC Alliance
- AZTC 2022 PPO 3000/70 SBC Alliance
- AZTC 2022 Saver HSA 1500/80 SBC Alliance
- AZTC 2022 Saver HSA 3000/80 SBC Alliance
- AZTC 2022 Saver HSA 4500/80 SBC Alliance
- AZTC 2022 Saver HSA 3500/100 SBC Alliance
- AZTC 2022 Saver HSA 6900/100 SBC Alliance
Benefit Booklets
Plan Specific Attachments
- AZTC PPO 5000/100
- AZTC PPO 7900/100
- AZTC PPO 500/90
- AZTC PPO 1000/90
- AZTC PPO 500/80
- AZTC PPO 750/80
- AZTC PPO 1000/80
- AZTC PPO 1500/80
- AZTC PPO 2000/80
- AZTC PPO 2500/80
- AZTC PPO 3000/80
- AZTC PPO 4000/80
- AZTC PPO 5000/80
- AZTC PPO 6000/80
- AZTC PPO 1000/70
- AZTC PPO 2000/70
- AZTC PPO 3000/70
- AZTC HSA 1500/80
- AZTC HSA 3000/80
- AZTC HSA 4500/80
- AZTC HSA 3500/100
- AZTC HSA 6900/100
Medical Marketing Material
- Welcome Guide for New BCBSAZ Members
- Video: BCBSAZ’s Comprehensive Association Health Plan
- 2022 Medical and Dental Plan Product Guide
- AZTC Medical/Dental Flyer
- BlueCare Anywhere Telehealth App
- Find a Doctor Tool
- Seeking Care Away from Home
- PayForward Cash Back Rewards Program
- Mobilize AZ Diabetes: Get Smart about Diabetes
- Welvie Online Program: To guide you through the surgery decision making process
Commonly Used Forms
2021 Plan Year
Summary of Benefit Coverages
Statewide
AZTC 2021 PPO 100/5000
AZTC 2021 PPO 100/7900
AZTC 2021 PPO 90/500
AZTC 2021 PPO 90/1000
AZTC 2021 PPO 80/500
AZTC 2021 PPO 80/750
AZTC 2021 PPO 80/1000
AZTC 2021 PPO 80/1500
AZTC 2021 PPO 80/2000
AZTC 2021 PPO 80/2500
AZTC 2021 PPO 80/3000
AZTC 2021 PPO 80/4000
AZTC 2021 PPO 80/5000
AZTC 2021 PPO 80/6000
AZTC 2021 PPO 70/1000
AZTC 2021 PPO 70/2000
AZTC 2021 PPO 70/3000
AZTC 2021 HSA 80/1500
AZTC 2021 HSA 80/3000
AZTC 2021 HSA 80/4500
AZTC 2021 HSA 100/3500
AZTC 2021 HSA 100/6900
PimaConnect
AZTC 2021 PPO 100/5000 PimaConnect
AZTC 2021 PPO 100/7900 PimaConnect
AZTC 2021 PPO 90/500 PimaConnect
AZTC 2021 PPO 90/1000 PimaConnect
AZTC 2021 PPO 80/500 PimaConnect
AZTC 2021 PPO 80/750 PimaConnect
AZTC 2021 PPO 80/1000 PimaConnect
AZTC 2021 PPO 80/1500 PimaConnect
AZTC 2021 PPO 80/2000 PimaConnect
AZTC 2021 PPO 80/2500 PimaConnect
AZTC 2021 PPO 80/3000 PimaConnect
AZTC 2021 PPO 80/4000 PimaConnect
AZTC 2021 PPO 80/5000 PimaConnect
AZTC 2021 PPO 80/6000 PimaConnect
AZTC 2021 PPO 70/1000 PimaConnect
AZTC 2021 PPO 70/2000 PimaConnect
AZTC 2021 PPO 70/3000 PimaConnect
AZTC 2021 Saver HSA 80/1500 PimaConnect
AZTC 2021 Saver HSA 80/3000 PimaConnect
AZTC 2021 Saver HSA 80/4500 PimaConnect
AZTC 2021 Saver HSA 100/3500 PimaConnect
AZTC 2021 Saver HSA 100/6900 PimaConnect
Alliance
AZTC 2021 PPO 100/5000 SBC Alliance
AZTC 2021 PPO 100/7900 SBC Alliance
AZTC 2021 PPO 90/500 SBC Alliance
AZTC 2021 PPO 90/1000 SBC Alliance
AZTC 2021 PPO 80/500 SBC Alliance
AZTC 2021 PPO 80/750 SBC Alliance
AZTC 2021 PPO 80/1000 SBC Alliance
AZTC 2021 PPO 80/1500 SBC Alliance
AZTC 2021 PPO 80/2000 SBC Alliance
AZTC 2021 PPO 80/2500 SBC Alliance
AZTC 2021 PPO 80/3000 SBC Alliance
AZTC 2021 PPO 80/4000 SBC Alliance
AZTC 2021 PPO 80/5000 SBC Alliance
AZTC 2021 PPO 80/6000 SBC Alliance
AZTC 2021 PPO 70/1000 SBC Alliance
AZTC 2021 PPO 70/2000 SBC Alliance
AZTC 2021 PPO 70/3000 SBC Alliance
AZTC 2021 Saver HSA 80/1500 SBC Alliance
AZTC 2021 Saver HSA 80/3000 SBC Alliance
AZTC 2021 Saver HSA 80/4500 SBC Alliance
AZTC 2021 Saver HSA 100/3500 SBC Alliance
AZTC 2021 Saver HSA 100/6900 SBC Alliance
Benefit Booklets
Plan Specific Attachments
AZTC PPO 100/5000
AZTC PPO 100/7900
AZTC PPO 90/500
AZTC PPO 90/1000
AZTC PPO 80/500
AZTC PPO 80/750
AZTC PPO 80/1000
AZTC PPO 80/1500
AZTC PPO 80/2000
AZTC PPO 80/2500
AZTC PPO 80/3000
AZTC PPO 80/4000
AZTC PPO 80/5000
AZTC PPO 80/6000
AZTC PPO 70/1000
AZTC PPO 70/2000
AZTC PPO 70/3000
AZTC HSA 80/1500
AZTC HSA 80/3000
AZTC HSA 80/4500
AZTC HSA 100/3500
AZTC HSA 100/6900
Medical Marketing Material
- Welcome Guide for New BCBSAZ Members
- Video: BCBSAZ’s Comprehensive Association Health Plan
- 2021 Medical and Dental Plan Product Guide
- AZTC Medical/Dental Flyer
- BlueCare Anywhere Telehealth App
- Find a Doctor Tool
- Seeking Care Away from Home
- PayForward Cash Back Rewards Program
- Mobilize AZ Diabetes: Get Smart about Diabetes
- Welvie Online Program: To guide you through the surgery decision making process
Commonly Used Forms
Dental Plan Information – Blue Cross Blue Shield of Arizona
Dental Overview and Marketing Material
Vision Plan Information – VSP
Group Vision Care Policy
Life/AD&D & Disability – MetLife
Life/Supp Life/AD&D Plan Summaries
Life/Supp Life/AD&D Certificates
Long-Term Disability Plan Summaries
Short-Term Disability Plan Summaries
Short-term Disability Plan 1: 13 Weeks
Short-term Disability Plan 1: 26 Weeks
Short-term Disability Plan 2: 13 Weeks
Short-term Disability Plan 2: 26 Weeks
Short-term Disability Plan 3: 13 Weeks
Short-term Disability Plan 3: 26 Weeks
Short-term Disability Plan 4: 13 Weeks
Short-term Disability Plan 4: 26 Weeks