Dental Plan Documents
Individual & Family Dental Plan Overviews
| Documents | Download |
|---|---|
Individual BlueDental Plan Overview |
Individual & Family Dental Benefit Books
| Documents | Download |
|---|---|
BlueDental PPO Preventive | |
BlueDental PPO Classic | |
BlueDental PPO Plus | |
BlueDental PPO Select | |
BlueDental Prime PPO Classic | |
BlueDental Prime PPO Plus | |
BlueDental DHMO Classic | |
BlueDental DHMO Plus |
Employer Group Dental Plan Summaries and Riders
The Summary of Benefits and Coverage (SBC) provides a concise description of what services your plan covers along with what you will pay for covered benefits.
#100 #124 PPO 50 1500 P2 MAC 10+ #101 #125 PPO 25 2000 A2 MAC 10+ #102 #126 PPO 25 2000 P2 MAC 10+ #103 #127 PPO 50 1000 A290 10+ #104 #128 PPO 50 1000 P290 10+ #105 #129 PPO 50 1500 A290 10+ #106 #130 PPO 50 1500 P290 10+ #107 #131 PPO 25 2000 A290 10+ #108 #132 PPO 25 2000 P290 10+ #25 #37 PPO 50 1000 A MAC 2 to 9 #26 #38 PPO 50 1000 P MAC 2 to 9 #27 #39 PPO 50 1500 A MAC 2 to 9 #28 #40 PPO 50 1500 P MAC 2 to 9 #29 #41 PPO 25 2000 A MAC 2 to 9 #30 #42 PPO 25 2000 P MAC 2 to 9 #31 #43 PPO 50 1000 A90 2 to 9 #32 #44 PPO 50 1000 P90 2 to 9 #33 #45 PPO 50 1500 A90 2 to 9 #34 #46 PPO 50 1500 P90 2 to 9 #35 #47 PPO 25 2000 A90 2 to 9 #36 #48 PPO 25 2000 P90 2 to 9 #85 #109 PPO 50 1000 A MAC 10+ #86 #110 PPO 50 1000 P MAC 10+ #87 #111 PPO 50 1500 A MAC 10+ #88 #112 PPO 50 1500 P MAC 10+ #89 #113 PPO 25 2000 A MAC 10+ #90 #114 PPO 25 2000 P MAC 10+ #91 #115 PPO 50 1000 A90 10+ #92 #116 PPO 50 1000 P90 10+ #93 #117 PPO 50 1500 A90 10+ #94 #118 PPO 50 1500 P90 10+ #95 #119 PPO 25 2000 A90 10+ #96 #120 PPO 25 2000 P90 10+ #98 #122 PPO 50 1000 P2 MAC 10+ #99 #123 PPO 50 1500 A2 MAC 10+ #1 #7 PPO 50 1000 A MAC for 2 to 9 #2 #8 PPO 50 1500 A MAC for 2 to 9 #3 #9 PPO 25 2000 A MAC for 2 to 9 #4 #10 PPO 50 1000 A90 2 to 9 #5 #11 PPO 50 1500 A90 2 to 9 #6 #12 PPO 25 2000 A90 2 to 9 #49 #61 PPO 50 1000 A MAC 10+ #50 #62 PPO 50 1500 A MAC 10+ #51 #63 PPO 25 2000 A MAC 10+ #52 #64 PPO 50 1000 A90 10+ #53 #65 PPO 50 1500 A90 10+ #54 #66 PPO 25 2000 A90 10+ #55 #67 PPO 50 1000 A2 MAC 10+ #56 #68 PPO 50 1500 A2 MAC 10+ #57 #69 PPO 25 2000 A2 MAC 10+ #58 #70 PPO 50 1000 A290 10+ #59 #71 PPO 50 1500 A290 10+ #60 #72 PPO 25 2000 A290 10+ 2020 Effective - 2018 GRP BlueDental PPO Assignment of Benefits Rider 10+ 2020 Effective - 2018 GRP BlueDental PPO Assignment of Benefits Rider 2 to 9 2020 Effective - 2019 GRP BlueDental PPO Assignment of Benefits Rider 10+ 2020 Effective - 2019 GRP BlueDental PPO Assignment of Benefits Rider 2 to 9 Plan 1 1000 Adult and Child Plan 2 1500 Adult and Child Plan 3 2000 Adult and Child Plan 4 1000 Child Only Plan 5 1500 Child Only Plan 6 2000 Child Only BlueDental Prime PPO High 20 BlueDental Prime PPO High 50 BlueDental Prime PPO Standard 20 BlueDental Prime PPO Standard 50 BlueDental DHMO High BlueDental DHMO Low