Dental Plan Documents
個人和家庭牙科計劃概述
| 文件 | 下載 |
|---|---|
個人BlueDental計劃概述 |
個人及家庭牙科福利手冊
| 文件 | 下載 |
|---|---|
BlueDental PPO預防 | |
BlueDental PPO經典 | |
BlueDental PPO Plus | |
BlueDental PPO選擇 | |
BlueDental Prime PPO經典款 | |
BlueDental Prime PPO Plus | |
BlueDental D HMO經典 | |
BlueDental D HMO Plus |
Employer Group Dental Plan Summaries and Riders
福利和承保範圍摘要 (SBC) 簡要描述了您的計劃涵蓋的服務以及您將為承保福利支付的費用。
| Number 100 and 124 PPO 50 1500 P2 MAC 10 Plus | |
| Number 101 and 125 PPO 25 2000 A2 MAC 10 Plus | |
| Number 102 and 126 PPO 25 2000 P2 MAC 10 Plus | |
| Number 103 and 127 PPO 50 1000 A290 10 Plus | |
| Number 104 and 128 PPO 50 1000 P290 10 Plus | |
| Number 105 and 129 PPO 50 1500 A290 10 Plus | |
| Number 106 and 130 PPO 50 1500 P290 10 Plus | |
| Number 107 and 131 PPO 25 2000 A290 10 Plus | |
| Number 108 and 132 PPO 25 2000 P290 10 Plus | |
| Number 25 and 37 PPO 50 1000 A MAC 2 to 9 | |
| Number 26 and 38 PPO 50 1000 P MAC 2 to 9 | |
| Number 27 and 39 PPO 50 1500 A MAC 2 to 9 | |
| Number 28 and 40 PPO 50 1500 P MAC 2 to 9 | |
| Number 29 and 41 PPO 25 2000 A MAC 2 to 9 | |
| Number 30 and 42 PPO 25 2000 P MAC 2 to 9 | |
| Number 31 and 43 PPO 50 1000 A90 2 to 9 | |
| Number 32 and 44 PPO 50 1000 P90 2 to 9 | |
| Number 33 and 45 PPO 50 1500 A90 2 to 9 | |
| Number 34 and 46 PPO 50 1500 P90 2 to 9 | |
| Number 35 and 47 PPO 25 2000 A90 2 to 9 | |
| Number 36 and 48 PPO 25 2000 P90 2 to 9 | |
| Number 85 and 109 PPO 50 1000 A MAC 10 Plus | |
| Number 86 and 110 PPO 50 1000 P MAC 10 Plus | |
| Number 87 and 111 PPO 50 1500 A MAC 10 Plus | |
| Number 88 and 112 PPO 50 1500 P MAC 10 Plus | |
| Number 89 and 113 PPO 25 2000 A MAC 10 Plus | |
| Number 90 and 114 PPO 25 2000 P MAC 10 Plus | |
| Number 91 and 115 PPO 50 1000 A90 10 Plus | |
| Number 92 and 116 PPO 50 1000 P90 10 Plus | |
| Number 93 and 117 PPO 50 1500 A90 10 Plus | |
| Number 94 and 118 PPO 50 1500 P90 10 Plus | |
| Number 95 and 119 PPO 25 2000 A90 10 Plus | |
| Number 96 and 120 PPO 25 2000 P90 10 Plus | |
| Number 98 and 122 PPO 50 1000 P2 MAC 10 Plus | |
| Number 99 and 123 PPO 50 1500 A2 MAC 10 Plus |
| Number 1 and 7 PPO 50 1000 A MAC for 2 to 9 | |
| Number 2 and 8 PPO 50 1500 A MAC for 2 to 9 | |
| Number 3 and 9 PPO 25 2000 A MAC for 2 to 9 | |
| Number 4 and 10 PPO 50 1000 A90 2 to 9 | |
| Number 5 and 11 PPO 50 1500 A90 2 to 9 | |
| Number 6 and 12 PPO 25 2000 A90 2 to 9 | |
| Number 49 and 61 PPO 50 1000 A MAC 10 plus | |
| Number 50 and 62 PPO 50 1500 A MAC 10 plus | |
| Number 51 and 63 PPO 25 2000 A MAC 10 plus | |
| Number 52 and 64 PPO 50 1000 A90 10 plus | |
| Number 53 and 65 PPO 50 1500 A90 10 plus | |
| Number 54 and 66 PPO 25 2000 A90 10 plus | |
| Number 55 and 67 PPO 50 1000 A2 MAC 10 plus | |
| Number 56 and 68 PPO 50 1500 A2 MAC 10 plus | |
| Number 57 and 69 PPO 25 2000 A2 MAC 10 plus | |
| Number 58 and 70 PPO 50 1000 A290 10 plus | |
| Number 59 and 71 PPO 50 1500 A290 10 plus | |
| Number 60 and 72 PPO 25 2000 A290 10 plus |
| 2018 GRP BlueDental PPO Assignment of Benefits Rider 10 plus | |
| 2018 GRP BlueDental PPO Assignment of Benefits Rider 2 to 9 | |
| 2019 GRP BlueDental PPO Assignment of Benefits Rider 10 plus | |
| 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 |