Closed Dental PPO Plans - January 1, 2021: for renewing groups only

Closed Dental Plans - January 1, 2021: for renewing groups only

Plan Name Benefit Summaries Disclosures

SmileSM Basic 75/1000/No Ortho/Mac

English 
Spanish

 English
SmileSM Value 50/1500/No Ortho/MAC

English
Spanish

 English
SmileSM 50/1500/No Ortho/Mac

English
Spanish

 English
SmileSM Plus 50/1500/Ortho/Mac

English
Spanish

 English
SmileSM Plus Gold 50/1500/Ortho/U85

English
Spanish

 English
SmileSM Deluxe 2000 50/2000/No Ortho/MAC

English
Spanish

 English
SmileSM Deluxe 50/1500/Ortho/MAC

English
Spanish

 English
SmileSM Deluxe Plus 2000 50/2000/Ortho/MAC

English
Spanish

 English
SmileSM Deluxe Gold 50/1500/Ortho/U85

English
Spanish

 English
Ultimate Dental PPO for Small Business 50/2000/No Ortho/MAC

English
Spanish

 English
Ultimate Dental Plus PPO for Small Business 50/2000/Ortho/MAC

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Spanish

 English

SmileSM Basic Voluntary 75/1000/No Ortho/MAC

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Spanish

 English
SmileSM Basic Voluntary 75/1000/No Ortho/MAC - NWP

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Spanish

 English
SmileSM In-Network Only Dental Plan 50/2500/Endo-Perio 80%/Ortho

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Spanish

 English
SmileSM In-Network Only Dental Plan 50/2500/Endo-Perio 80%/No Ortho

English
Spanish

 English
SmileSM In-Network Only Dental Voluntary Plan 50/2500/Endo-Perio 50%/Ortho

English
Spanish

 English
SmileSM In-Network Only Dental Voluntary Plan 50/2500/Endo-Perio 50%/No Ortho

English
Spanish

 English
SmileSM In-Network Only Dental Plan 50/1500/Endo-Perio 80%/Ortho

English
Spanish

 English
SmileSM In-Network Only Dental Plan 50/1500/Endo-Perio 80%/No Ortho

English
Spanish

 English
SmileSM INO Dental Voluntary Plan 50/1500/EndoPerio 50%/Ortho (NWP)

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Spanish

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SmileSM INO Dental Voluntary Plan 50/1500/EndoPerio 50%/No Ortho (NWP)

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Spanish

 English
SmileSM INO Dental Voluntary Plan 50/1500/EndoPerio 50%/Ortho

English
Spanish

 English
SmileSM INO Dental Voluntary Plan 50/1500/EndoPerio 50%/No Ortho

English
Spanish

 English
SmileSM INO Dental Voluntary Plan 50/2500/EndoPerio 50%/Ortho/NWP

English
Spanish

 English
SmileSM INO Dental Voluntary Plan 50/2500/EndoPerio 50%/No Ortho/NWP

English
Spanish

 English

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-. 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.