Smile Spectrum PPO Dental Plans 2022

Smile Spectrum PPO Dental Plans

Smile Spectrum PPO Dental Plans

Plan Name Summary of Benefits Disclosure
SmileSM Spectrum 50/1000/No Ortho/MAC English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum 50/1000/Ortho/MAC English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum 50/1500/No Ortho/MAC English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum 50/1500/No Ortho/U90 English  1.1MB        Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum 50/1500/Ortho/MAC English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum 50/1500/Ortho/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Advantage 50/1000/No Ortho/U80 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Advantage 50/1500/Ortho/U80 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Advantage 50/1500/Ortho/U80/In-Network English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Advantage 50/2000/Ortho/U80 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier 50/1000/No Ortho/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier 50/1000/Ortho/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier 50/1500/Lifetime Ortho 1500/U80 English 1.1MB         Spanish 1.8MB   Disclosure 1.3MB
SmileSM Spectrum Premier 50/1500/No Ortho/MAC English 1.1MB         Spanish 1.8MB   Disclosure 1.3MB
SmileSM Spectrum Premier 50/1500/No Ortho/U90 English 1.1MB         Spanish 1.8MB     Disclosure 1.3MB
SmileSM Spectrum Premier 50/1500/Ortho/MAC English 1.1MB         Spanish 1.8MB     Disclosure 1.3MB
SmileSM Spectrum Premier 50/1500/Ortho/U90 English 1.1MB         Spanish 1.8MB      Disclosure 1.3MB
SmileSM Spectrum Premier 50/2000/Lifetime Ortho 1500/U80 English 1.1MB         Spanish 1.8MB      Disclosure 1.3MB
SmileSM Spectrum Premier 50/2000/No Ortho/MAC English 1.1MB         Spanish 1.8MB  Disclosure 1.3MB
SmileSM Spectrum Premier 50/2000/No Ortho/U90 English 1.1MB         Spanish 1.8MB  Disclosure 1.3MB
SmileSM Spectrum Premier 50/2000/Ortho/MAC English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier 50/2000/Ortho/U90 English 1.1MB         Spanish 1.8MB  Disclosure 1.3MB
SmileSM Spectrum Premier D&P Waiver 50/1500/No Ortho/U90 English 1.1MB         Spanish 1.8MB    Disclosure 1.3MB
SmileSM Spectrum Premier D&P Waiver 50/1500/Ortho/U90 English 1.1MB         Spanish 1.8MB    Disclosure 1.3MB
SmileSM Spectrum Premier D&P Waiver+Rollover 50/1500/No Ortho/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier D&P Waiver+Rollover 50/1500/Ortho/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus 25/1500/Lifetime Ortho 1500/U80 English 1.1MB         Spanish 1.8MB   Disclosure 1.3MB
SmileSM Spectrum Premier Plus 25/1500/No Ortho/U80 English 1.1MB         Spanish 1.8MB    Disclosure 1.3MB
SmileSM Spectrum Premier Plus 25/2000/Lifetime Ortho 1500/U80 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus 25/2000/No Ortho/U80 English 1.1MB         Spanish 1.8MB   Disclosure 1.3MB
SmileSM Spectrum Premier Plus 25/2500/Lifetime Ortho 2000/U90 English 1.1MB         Spanish 1.8MB    Disclosure 1.3MB
SmileSM Spectrum Premier Plus 25/2500/No Ortho/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus 25/3000/Lifetime Ortho 2000/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus 25/3000/No Ortho/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus 50/1000/No Ortho/MAC English 1.1MB         Spanish 1.8MB   Disclosure 1.3MB
SmileSM Spectrum Premier Plus 50/1000/No Ortho/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus 50/1000/Ortho/MAC English 1.1MB         Spanish 1.8MB   Disclosure 1.3MB
SmileSM Spectrum Premier Plus 50/1000/Ortho/U90 English 1.1MB         Spanish 1.8MB    Disclosure 1.3MB
SmileSM Spectrum Premier Plus 50/1500/No Ortho/MAC English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus 50/1500/No Ortho/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus 50/1500/Ortho/MAC English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus 50/1500/Ortho/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus 50/2000/No Ortho/MAC English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus 50/2000/No Ortho/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus 50/2000/Ortho/MAC English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus 50/2000/Ortho/U90 English 1.1MB         Spanish 1.8MB  Disclosure 1.3MB
SmileSM Spectrum Premier Plus 50/2500/Lifetime Ortho 2000/U80 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus 50/2500/No Ortho/U80 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus 50/3000/Lifetime Ortho 2000/U80 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus 50/3000/No Ortho/U80 English 1.1MB         Spanish 1.8MB  Disclosure 1.3MB
SmileSM Spectrum Premier Plus D&P Waiver 50/1500/No Ortho/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus D&P Waiver 50/1500/Ortho/U90 English 1.1MB         Spanish 1.8MB  Disclosure 1.3MB
SmileSM Spectrum Premier Plus D&P Waiver 50/2000/No Ortho/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus D&P Waiver 50/2000/Ortho/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus D&P Waiver+Rollover 50/1500/No Ortho/U90 English 1.1MB         Spanish 1.8MB  Disclosure 1.3MB
SmileSM Spectrum Premier Plus D&P Waiver+Rollover 50/1500/Ortho/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus Rollover 50/1500/No Ortho/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus Rollover 50/1500/Ortho/U90 English 1.1MB         Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Rollover 50/1500/No Ortho/U90 English 1.1MB         Spanish 1.8MB   Disclosure 1.3MB
SmileSM Spectrum Premier Rollover 50/1500/Ortho/U90 English 1.1MB         Spanish 1.8MB  Disclosure 1.3MB
SmileSM Spectrum Premier Rollover 50/2000/No Ortho/U90 English 1.1MB         Spanish 1.8MB  Disclosure 1.3MB
SmileSM Spectrum Premier Rollover 50/2000/Ortho/U90 English 1.1MB         Spanish 1.8MB  Disclosure 1.3MB

Non-Marketed Smile Spectrum PPO Dental Plans

Plan Name   Benefit Summary / SOB Disclosure
SmileSM Spectrum Premier 50/1000/Ortho/MAC English  1.1MB      Spanish 1.8MB Disclosure 1.3MB
SmileSM Spectrum Premier Plus D&P Waiver+Rollover 50/2000/Ortho/U90 English  1.1MB      Spanish 1.8MB Disclosure 1.3MB

Contact Us

  • Producer Services (800) 559-5905

    Employer Services (800) 325-5166

  • Blue Shield of California

    PO Box 272540

    Chico, CA 95927-2540

© California Physicians’ Service DBA Blue Shield of California 1999-2022. All rights reserved. California Physicians’ Service DBA Blue Shield of California is an independent member of the Blue Shield Association.

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