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2020 Dental Benefit Summaries

Individual and Family Plans

The following benefit summaries for Blue Shield family dental plans are effective January 1, 2020, and must be accompanied by the Important Legal Information Booklet (PDF, 2.9MB), Spanish (PDF, 2.9MB), when presented to your clients. These dental plans can be purchased with a Blue Shield health plan or on their own.

The waiting period for new members enrolling in any Blue Shield IFP Dental plan with effective dates on or after January 1, 2020, will be waived, provided the new member can submit documentation of prior coverage from any dental carrier that meets the following criteria:

  • Prior dental plan coverage was in force for minimum of 12 months, and
  • Prior dental plan coverage included benefits for major services (basics-only plans do not meet this requirement), and
  • There is no gap between the end of prior dental plan coverage and the effective date of the new BSC plan, and
  • Subscriber on new BSC IFP Dental plan was covered on prior dental plan coverage


Any of the following documents may be used as long as it shows the above criteria have been met:

  • Certificate of prior creditable coverage from prior dental carrier may meet all of the above or
  • EOC or SOB of previous coverage showing who is covered and what type of services are covered or
  • Premium statement showing who is covered (and can include coverage end date)


The best way for you to submit a waiver request is by emailing it to Producer Services at producer.services@blueshieldca.com. You can mail it to Blue Shield of California. P.O. Box 272540, Chico, CA 95927.

 Medical Benefit Summaries | 2019 Benefit Summaries (Archive) 

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Plan name Benefit summaries
Dental HMO

English (PDF, 250KB)
Spanish (PDF, 1.7MB)

Dental Standard HMO

English (PDF, 155KB)
Spanish (PDF, 1.7MB)

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Plan name Benefit summaries
Dental PPO

English (PDF, 2MB)
Spanish (PDF, 1.7MB)

Specialty DuoSM Dental

English (PDF, 2MB)
Spanish (PDF, 777KB)

Enhanced Dental PPO 25/500

English (PDF, 145KB)
Spanish (PDF, 1.7MB)

Enhanced Dental PPO 50/1250

English (PDF, 145KB)
Spanish (PDF, 1.7MB)

Enhanced Dental PPO 50/2000

English (PDF, 2MB)
Spanish (PDF, 1.7MB)

Enhanced Dental PPO 50/2000/Lifetime Ortho 1500

English (PDF, 2MB)
Spanish (PDF, 1.7MB)

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Plan name Benefit summaries
DMHC Disclosure

English (PDF, 2MB)

CDI Disclosure

English (PDF, KB)

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Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.