Closed Dental PPO Plans - 2023: for renewing groups only

Closed Dental Plans - 2023: for renewing groups only

Closed Dental Plans - 2023: for renewing groups only

Plan Names Summaries of Benefits Disclosures
SmileSM 50/1500/No Ortho/Mac

English
Spanish

English
SmileSM 50/1500/No Ortho/MAC/NR

English
Spanish

English
SmileSM Basic 50/1000/No Ortho/MAC

English
Spanish

English
SmileSM Basic 50/1000/Ortho/U85

English
Spanish

English
SmileSM Basic 75/1000/No Ortho/Mac

English
Spanish

English
SmileSM Basic 75/1000/No Ortho/Mac/NR

English
Spanish

English
SmileSM Basic Voluntary 50/1000/No Ortho/MAC

English
Spanish

English
SmileSM Basic Voluntary 50/1000/No Ortho/MAC/NR

English
Spanish

English
SmileSM Basic Voluntary 50/1000/No Ortho/U80

English
Spanish

English
SmileSM Basic Voluntary 50/1500/Ortho/U80

English
Spanish

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

English
Spanish

English
SmileSM Basic Voluntary 75/1000/No Ortho/MAC/NR

English
Spanish

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

English
Spanish

English
SmileSM Deluxe 50/1500/Ortho/MAC

English
Spanish

English
SmileSM Deluxe 50/1500/Ortho/MAC/NR

English
Spanish

English
SmileSM Deluxe Gold 50/1500/Ortho/U85

English
Spanish

English
SmileSM Deluxe Gold 50/1500/Ortho/U85/NR

English
Spanish

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

English
Spanish

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

English
Spanish

English
SmileSM Plus 50/1500/No Ortho/MAC

English
Spanish

English
SmileSM Plus 50/1500/No Ortho/MAC/WP

English
Spanish

English
SmileSM Plus 50/1500/Ortho/Mac

English
Spanish

English
SmileSM Plus 50/1500/Ortho/Mac/NR

English
Spanish

English
SmileSM Plus Gold 50/1500/No Ortho/U80

English
Spanish

English
SmileSM Plus Gold 50/1500/No Ortho/U90/ADV

English
Spanish

English
SmileSM Plus Gold 50/1500/Ortho/U80

English
Spanish

English
SmileSM Plus Gold 50/1500/Ortho/U80/ADV

English
Spanish

English
SmileSM Plus Gold 50/1500/Ortho/U85/NR

English
Spanish

English
SmileSM Plus Gold 50/1500/Ortho/U90/ADV

English
Spanish

English
SmileSM Plus Gold 50/2500/No Ortho/U90/ADV

English
Spanish

English
SmileSM Plus Gold 50/2500/Ortho/U90/ADV

English
Spanish

English
SmileSM Value 50/1500/No Ortho/MAC

English
Spanish

English
SmileSM Value 50/1500/No Ortho/MAC/NR

English
Spanish

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

English
Spanish

English
Ultimate Dental PPO for Small Business 50/2000/Lifetime Ortho/U90

English
Spanish

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

English
Spanish

English
Ultimate Dental PPO for Small Business 50/2000/No Ortho/U80

English
Spanish

English
Ultimate Dental PPO for Small Business 50/2000/No Ortho/U90

English
Spanish

English

 

 

 

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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.