Policy Documents for Small Group Qualified Health Plans
Below is a list of actual Blue Cross and Blue Shield of Oklahoma policy documents for Small Group Metallic Qualified Health Plans. These policies describe how the plans generally work and include eligible expenses, claim filing steps, appeals procedures, coverage limitations and exceptions, and more.
Help locating your policy
- Get your policy documents through your online member account.
- Get your policy document through the BCBSOK app. Learn more about the BCBSOK app.
- Contact a customer service representative at 1-866-520-2507 to get help finding or accessing your policy documents.
- If you have coverage through an employer, you may want to contact the employer's benefit administrator to get the name of your plan.
- If you know you have a Small Group Metallic Qualified Health Plan, and you know its name, find it below and download the policy.
Small Group Metallic Qualified Health Plan policy documents for the 2027 plan year are not available yet. The links below go to placeholder files. The policy documents will be available in November. Please check back then.
Platinum Plans
Blue Preferred Platinum PPO Plans
Off Exchange
- Blue Preferred Platinum PPO 401
- Blue Preferred Platinum PPO 416
- Blue Preferred Platinum PPO 420
- Blue Preferred Platinum PPO 421
Blue Advantage Platinum PPO Plans
Off Exchange
- Blue Advantage Platinum PPO 101
- Blue Advantage Platinum PPO 116
- Blue Advantage Platinum PPO 118
- Blue Advantage Platinum PPO 122
Blue Options Platinum PPO Plans
Off Exchange
Blue Choice Platinum PPO Plans
Off Exchange
BlueSolutions Platinum PPO Plans
Gold Plans
Blue Choice Gold PPO Plans
Off Exchange
Blue Preferred Gold PPO Plans
Off Exchange
- Blue Preferred Gold PPO 402
- Blue Preferred Gold PPO 403
- Blue Preferred Gold PPO 410
- Blue Preferred Gold PPO 412
- Blue Preferred Gold PPO 418
- Blue Preferred Gold PPO 423
- Blue Preferred Gold PPO 424
- Blue Preferred Gold PPO 426
- Blue Preferred Gold PPO 434
- Blue Preferred Gold PPO 435
Blue Advantage Gold PPO Plans
Off Exchange
- Blue Advantage Gold PPO 102
- Blue Advantage Gold PPO 108
- Blue Advantage Gold PPO 109
- Blue Advantage Gold PPO 110
- Blue Advantage Gold PPO 112
- Blue Advantage Gold PPO 119
- Blue Advantage Gold PPO 124
- Blue Advantage Gold PPO 126
- Blue Advantage Gold PPO 135
- Blue Advantage Gold PPO 136
Blue Options Gold PPO
Off Exchange
BlueSolutions Gold PPO
Silver Plans
Blue Choice Silver PPO Plans
Off Exchange
Blue Preferred Silver PPO Plans
Off Exchange
- Blue Preferred Silver PPO 405
- Blue Preferred Silver PPO 406
- Blue Preferred Silver PPO 413
- Blue Preferred Silver PPO 417
- Blue Preferred Silver PPO 419
- Blue Preferred Silver PPO 427
- Blue Preferred Silver PPO 429
- Blue Preferred Silver PPO 430
- Blue Preferred Silver PPO 433
Blue Advantage Silver PPO Plans
Off Exchange
- Blue Advantage Silver PPO 104
- Blue Advantage Silver PPO 105
- Blue Advantage Silver PPO 114
- Blue Advantage Silver PPO 115
- Blue Advantage Silver PPO 117
- Blue Advantage Silver PPO 121
- Blue Advantage Silver PPO 129
- Blue Advantage Silver PPO 131
- Blue Advantage Silver PPO 134
Blue Options Silver PPO
Off Exchange
BlueSolutions Silver PPO
- BlueSolutions Silver PPO 503
- BlueSolutions Silver PPO 504
- BlueSolutions Silver PPO 510
- BlueSolutions Silver PPO 511
Bronze Plans
Blue Choice Bronze PPO Plans
Off Exchange
Blue Preferred Bronze PPO Plans
Off Exchange
Blue Advantage Bronze PPO Plans
Off Exchange
Blue Options Bronze PPO
Off Exchange
BlueSolutions Bronze PPO
Platinum Plans
Blue Preferred Platinum PPO Plans
Off Exchange
- P710PFR Blue Preferred Platinum PPO 401
- P8E1PFR Blue Preferred Platinum PPO 416
- P8K4PFR Blue Preferred Platinum PPO 420
- P8K1PFR Blue Preferred Platinum PPO 421
- P8AAPFR Blue Preferred Platinum PPO 436
Blue Advantage Platinum PPO Plans
Off Exchange
- P710ADT Blue Advantage Platinum PPO 101
- P8E1ADT Blue Advantage Platinum PPO 116
- P8J6ADT Blue Advantage Platinum PPO 118
- P8K1ADT Blue Advantage Platinum PPO 122
- P8AAADT Blue Advantage Platinum PPO 137
Blue Options Platinum PPO Plans
Off Exchange
Blue Choice Platinum PPO Plans
Off Exchange
Gold Plans
Blue Choice Gold PPO Plans
Off Exchange
- G730CHC Blue Choice Gold PPO 201
- G731CHC Blue Choice Gold PPO 202
- G732CHC Blue Choice Gold PPO 203
- G8ABCHC Blue Choice Gold PPO 211
Blue Preferred Gold PPO Plans
Off Exchange
- G8AEOPT Blue Options Gold PPO 314
- G730PFR Blue Preferred Gold PPO 402
- G731PFR Blue Preferred Gold PPO 403
- G733PFR Blue Preferred Gold PPO 410
- G735PFR Blue Preferred Gold PPO 412
- G8J2PFR Blue Preferred Gold PPO 418
- G8K5PFR Blue Preferred Gold PPO 423
- G8K3PFR Blue Preferred Gold PPO 424
- G8K6PFR Blue Preferred Gold PPO 426
- G8M1PFR Blue Preferred Gold PPO 434
- G8M2PFR Blue Preferred Gold PPO 435
- G8ABPFR Blue Preferred Gold PPO 437
Blue Advantage Gold PPO Plans
Off Exchange
- G740ADT Blue Advantage Gold PPO 102
- G743ADT Blue Advantage Gold PPO 108
- G744ADT Blue Advantage Gold PPO 109
- G745ADT Blue Advantage Gold PPO 110
- G746ADT Blue Advantage Gold PPO 112
- G8J3ADT Blue Advantage Gold PPO 119
- G8K3ADT Blue Advantage Gold PPO 124
- G8K6ADT Blue Advantage Gold PPO 126
- G8M1ADT Blue Advantage Gold PPO 135
- G8M2ADT Blue Advantage Gold PPO 136
- G8ABADT Blue Advantage Gold PPO 138
Blue Options Gold PPO
Off Exchange
Silver Plans
Blue Choice Silver PPO Plans
Off Exchange
- S730CHC Blue Choice Silver PPO 204
- S8J9CHC Blue Choice Silver PPO 209
- S8ACCHC Blue Choice Silver PPO 212
Blue Preferred Silver PPO Plans
Off Exchange
- S731PFR Blue Preferred Silver PPO 405
- S732PFR Blue Preferred Silver PPO 406
- S8E1PFR Blue Preferred Silver PPO 417
- S8J5PFR Blue Preferred Silver PPO 419
- S8K9PFR Blue Preferred Silver PPO 427
- S8K0PFR Blue Preferred Silver PPO 429
- S8K5PFR Blue Preferred Silver PPO 430
- S8K8PFR Blue Preferred Silver PPO 433
- S8ACPFR Blue Preferred Silver PPO 438
- S710BSL Blue Preferred Silver PPO 503
- S8E1BSL Blue Preferred Silver PPO 504
Blue Advantage Silver PPO Plans
Off Exchange
- S730ADT Blue Advantage Silver PPO 104
- S731ADT Blue Advantage Silver PPO 105
- S8K1ADT Blue Advantage Silver PPO 114
- S702ADT Blue Advantage Silver PPO 115
- S8E1ADT Blue Advantage Silver PPO 117
- S8J4ADT Blue Advantage Silver PPO 121
- S8K9ADT Blue Advantage Gold PPO 129
- S8K5ADT Blue Advantage Silver PPO 131
- S8K8ADT Blue Advantage Silver PPO 134
- S8ACADT Blue Advantage Silver PPO 139
Blue Options Silver PPO
Off Exchange
- S710OPT Blue Options Silver PPO 304
- S8E1OPT Blue Options Silver PPO 310
- S8J0OPT Blue Options Silver PPO 312
Bronze Plans
Blue Choice Bronze PPO Plans
Off Exchange
Blue Preferred Bronze PPO Plans
Off Exchange
Blue Advantage Bronze PPO Plans
Off Exchange
Blue Options Bronze PPO
Off Exchange
Blue Solutions Bronze PPO
Platinum Plans
Blue Preferred Platinum PPO Plans
Off Exchange
- P710PFR Blue Preferred Platinum PPO 401
- P8E1PFR Blue Preferred Platinum PPO 416
- P8K4PFR Blue Preferred Platinum PPO 420
- P8K1PFR Blue Preferred Platinum PPO 421
Blue Advantage Platinum PPO Plans
Off Exchange
- P710ADT Blue Advantage Platinum PPO 101
- P8E1ADT Blue Advantage Platinum PPO 116
- P8J6ADT Blue Advantage Platinum PPO 118
- P8K1ADT Blue Advantage Platinum PPO 122
Blue Options Platinum PPO Plans
Off Exchange
Blue Choice Platinum PPO Plans
Off Exchange
Gold Plans
Blue Choice Gold PPO Plans
Off Exchange
Blue Preferred Gold PPO Plans
Off Exchange
- G730PFR Blue Preferred Gold PPO 402
- G731PFR Blue Preferred Gold PPO 403
- G733PFR Blue Preferred Gold PPO 410
- vG735PFR Blue Preferred Gold PPO 412
- G8J2PFR Blue Preferred Gold PPO 418
- G8K5PFR Blue Preferred Gold PPO 423
- G8K3PFR Blue Preferred Gold PPO 424
- G8K6PFR Blue Preferred Gold PPO 426
- G8M1PFR Blue Preferred Gold PPO 434
- G8M2PFR Blue Preferred Gold PPO 435
Blue Advantage Gold PPO Plans
Off Exchange
- G740ADT Blue Advantage Gold PPO 102
- G743ADT Blue Advantage Gold PPO 108
- G744ADT Blue Advantage Gold PPO 109
- G745ADT Blue Advantage Gold PPO 110
- G746ADT Blue Advantage Gold PPO 112
- G8J3ADT Blue Advantage Gold PPO 119
- G8K3ADT Blue Advantage Gold PPO 124
- G8K6ADT Blue Advantage Gold PPO 126
- G8M1ADT Blue Advantage Gold PPO 135
- G8M2ADT Blue Advantage Gold PPO 136
Blue Options Gold PPO
Off Exchange
Silver Plans
Blue Choice Silver PPO Plans
Off Exchange
Blue Preferred Silver PPO Plans
Off Exchange
- S731PFR Blue Preferred Silver PPO 405
- S732PFR Blue Preferred Silver PPO 406
- S8K1PFR Blue Preferred Silver PPO 413
- S8E1PFR Blue Preferred Silver PPO 417
- S8J5PFR Blue Preferred Silver PPO 419
- S8K9PFR Blue Preferred Silver PPO 427
- S8K0PFR Blue Preferred Silver PPO 429
- S8K5PFR Blue Preferred Silver PPO 430
- S8K8PFR Blue Preferred Silver PPO 433
Blue Advantage Silver PPO Plans
Off Exchange
- S730ADT Blue Advantage Silver PPO 104
- S731ADT Blue Advantage Silver PPO 105
- S8K1ADT Blue Advantage Silver PPO 114
- S702ADT Blue Advantage Silver PPO 115
- S8E1ADT Blue Advantage Silver PPO 117
- S8J4ADT Blue Advantage Silver PPO 121
- S8K9ADT Blue Advantage Silver PPO 129
- S8K5ADT Blue Advantage Silver PPO 131
- S8K8ADT Blue Advantage Silver PPO 134
Blue Options Silver PPO
Off Exchange
- S710OPT Blue Options Silver PPO 304
- S8E1OPT Blue Options Silver PPO 310
- S8J0OPT Blue Options Silver PPO 312
Bronze Plans
Blue Choice Bronze PPO Plans
Off Exchange
Blue Preferred Bronze PPO Plans
Off Exchange
Blue Advantage Bronze PPO Plans
Off Exchange
Blue Options Bronze PPO
Off Exchange
Platinum Plans
Blue Preferred Platinum PPO Plans
Off Exchange
- P710PFR Blue Preferred Platinum PPO 401
- P8E1PFR Blue Preferred Platinum PPO 416
- P8K4PFR Blue Preferred Platinum PPO 420
- P8K1PFR Blue Preferred Platinum PPO 421
Blue Advantage Platinum PPO Plans
Off Exchange
- P710ADT Blue Advantage Platinum PPO 101
- P8E1ADT Blue Advantage Platinum PPO 116
- P8J6ADT Blue Advantage Platinum PPO 118
- P8K1ADT Blue Advantage Platinum PPO 122
Blue Options Platinum PPO Plans
Off Exchange
Blue Choice Platinum PPO Plans
Off Exchange
Gold Plans
Blue Choice Gold PPO Plans
Off Exchange
Blue Preferred Gold PPO Plans
Off Exchange
- G730PFR Blue Preferred Gold PPO 402
- G731PFR Blue Preferred Gold PPO 403
- G733PFR Blue Preferred Gold PPO 410
- G735PFR Blue Preferred Gold PPO 412
- G8J2PFR Blue Preferred Gold PPO 418
- G8K5PFR Blue Preferred Gold PPO 423
- G8K3PFR Blue Preferred Gold PPO 424
- G8K6PFR Blue Preferred Gold PPO 426
- G8M1PFR Blue Preferred Gold PPO 434
- G8M2PFR Blue Preferred Gold PPO 435
Blue Advantage Gold PPO Plans
Off Exchange
- G740ADT Blue Advantage Gold PPO 102
- G743ADT Blue Advantage Gold PPO 108
- G744ADT Blue Advantage Gold PPO 109
- G745ADT Blue Advantage Gold PPO 110
- G746ADT Blue Advantage Gold PPO 112
- G8J3ADT Blue Advantage Gold PPO 119
- G8K3ADT Blue Advantage Gold PPO 124
- G8K6ADT Blue Advantage Gold PPO 126
- G8M1ADT Blue Advantage Gold PPO 135
- G8M2ADT Blue Advantage Gold PPO 136
Blue Options Gold PPO
Off Exchange
Silver Plans
Blue Choice Silver PPO Plans
Off Exchange
Blue Preferred Silver PPO Plans
Off Exchange
- S731PFR Blue Preferred Silver PPO 405
- S732PFR Blue Preferred Silver PPO 406
- S8K1PFR Blue Preferred Silver PPO 413
- S8E1PFR Blue Preferred Silver PPO 417
- S8J5PFR Blue Preferred Silver PPO 419
- S8K9PFR Blue Preferred Silver PPO 427
- S8K0PFR Blue Preferred Silver PPO 429
- S8K5PFR Blue Preferred Silver PPO 430
- S8K8PFR Blue Preferred Silver PPO 433
Blue Advantage Silver PPO Plans
Off Exchange
- S730ADT Blue Advantage Silver PPO 104
- S731ADT Blue Advantage Silver PPO 105
- S8K1ADT Blue Advantage Silver PPO 114
- S702ADT Blue Advantage Silver PPO 115
- S8E1ADT Blue Advantage Silver PPO 117
- S8J4ADT Blue Advantage Silver PPO 121
- S8K9ADT Blue Advantage Silver PPO 129
- S8K5ADT Blue Advantage Silver PPO 131
- S8K8ADT Blue Advantage Silver PPO 134
Blue Options Silver PPO
Off Exchange
- S710OPT Blue Options Silver PPO 304
- S8E1OPT Blue Options Silver PPO 310
- S8J0OPT Blue Options Silver PPO 312
Bronze Plans
Blue Choice Bronze PPO Plans
Off Exchange
Blue Preferred Bronze PPO Plans
Off Exchange
Blue Advantage Bronze PPO Plans
Off Exchange
Blue Options Bronze PPO
Off Exchange
Last Updated: Aug. 13, 2026