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 |
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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