The following summary of benefits are for groups of 101 or more employees.
When providing a summary of benefit to an applicant or Blue Shield member, you must also include a Disclosure and a Notice of Language Assistance. (PDF, 1MB)
Plan Name | Summary of Benefits | Disclosure |
---|---|---|
SmileSM Spectrum 50/1000/No Ortho/MAC | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum 50/1000/Ortho/MAC | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum 50/1500/No Ortho/MAC | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum 50/1500/No Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum 50/1500/Ortho/MAC | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum 50/1500/Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Advantage 50/1000/No Ortho/U80 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Advantage 50/1500/Ortho/U80 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Advantage 50/1500/Ortho/U80/In-Network | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Advantage 50/2000/Ortho/U80 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier 50/1000/No Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier 50/1000/Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier 50/1500/Lifetime Ortho 1500/U80 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier 50/1500/No Ortho/MAC | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier 50/1500/No Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier 50/1500/Ortho/MAC | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier 50/1500/Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier 50/2000/Lifetime Ortho 1500/U80 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier 50/2000/No Ortho/MAC | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier 50/2000/No Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier 50/2000/Ortho/MAC | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier 50/2000/Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier D&P Waiver 50/1500/No Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier D&P Waiver 50/1500/Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier D&P Waiver+Rollover 50/1500/No Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier D&P Waiver+Rollover 50/1500/Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 25/1500/Lifetime Ortho 1500/U80 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 25/1500/No Ortho/U80 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 25/2000/Lifetime Ortho 1500/U80 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 25/2000/No Ortho/U80 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 25/2500/Lifetime Ortho 2000/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 25/2500/No Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 25/3000/Lifetime Ortho 2000/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 25/3000/No Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 50/1000/No Ortho/MAC | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 50/1000/No Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 50/1000/Ortho/MAC | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 50/1000/Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 50/1500/No Ortho/MAC | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 50/1500/No Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 50/1500/Ortho/MAC | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 50/1500/Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 50/2000/No Ortho/MAC | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 50/2000/No Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 50/2000/Ortho/MAC | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 50/2000/Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 50/2500/Lifetime Ortho 2000/U80 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 50/2500/No Ortho/U80 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 50/3000/Lifetime Ortho 2000/U80 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus 50/3000/No Ortho/U80 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus D&P Waiver 50/1500/No Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus D&P Waiver 50/1500/Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus D&P Waiver 50/2000/No Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus D&P Waiver 50/2000/Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus D&P Waiver+Rollover 50/1500/No Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus D&P Waiver+Rollover 50/1500/Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus Rollover 50/1500/No Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Plus Rollover 50/1500/Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Rollover 50/1500/No Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Rollover 50/1500/Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Rollover 50/2000/No Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
SmileSM Spectrum Premier Rollover 50/2000/Ortho/U90 | English 362KB Spanish 370KB | Disclosure 632KB |
Plan Name | Summary of Benefits | Disclosure |
---|---|---|
Dental HMO Basic | English 354KB Spanish 359KB | Disclosure 618KB |
Dental HMO Standard | English 354KB Spanish 359KB | Disclosure 618KB |
Dental HMO Plus | English 354KB Spanish 359KB | Disclosure 618KB |
Dental HMO Deluxe | English 354KB Spanish 359KB | Disclosure 618KB |
Dental HMO Elite 75 | English 354KB Spanish 359KB | Disclosure 618KB |
Dental HMO Elite 100 | English 354KB Spanish 359KB | Disclosure 618KB |
Plan Name | Summary of Benefits | Disclosure |
---|---|---|
SmileSM D&P In-Network Only Dental PPO | English 325KB Spanish 330KB | Disclosure 632KB |
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Chico, CA 95927-2540
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