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Dental Benefit Summaries
The following benefit summaries are for groups of 51 or more employees. For benefit summaries prior to January 1, 2009, please contact your Blue Shield sales representative for current plan information.
 
When providing a benefit summary to an applicant or Blue Shield member, you must also include a Notice of Language Assistance(PDF, 1MB)
Core Flex Dental Plans
Plan Name Download Size
Core Flex Dental Basic PPO 75/1000/No Ortho/MAC

English
Spanish
Chinese
Vietnamese

61KB
56KB
212KB
167KB

Core Flex Dental 50/1000/No Ortho/MAC

English
Spanish
Chinese
Vietnamese

77KB
55KB
210KB
169KB

Core Flex Dental PPO 50/1000/Ortho/U90

English
Spanish
Chinese
Vietnamese

77KB
55KB
210KB
167KB

Core Flex Dental PPO Premier Plus 50/1500/Ortho/U90

English
Spanish
Chinese
Vietnamese

78KB
55KB
211KB
169KB

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Dental HMO Plans
Plan Name Download Size
Dental HMO Basic

English
Spanish
Chinese
Vietnamese

62KB
118KB
307KB
169KB

Dental HMO Voluntary

English
Spanish
Chinese
Vietnamese

62KB
119KB
353KB
192KB

Dental HMO Plus

English
Spanish
Chinese
Vietnamese

61KB
119KB
370KB
170KB

Dental HMO Deluxe

English
Spanish
Chinese
Vietnamese

62KB
118KB
364KB
192KB

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Dental PPO SmileSM Plans
Plan Name Download Size
DPPO Smile Basic Voluntary 75/1000/No Ortho/MAC

English
Spanish
Chinese
Vietnamese

62KB
138KB
196KB
135KB

DPPO Smile Basic 75/1000/No Ortho/MAC

English
Spanish
Chinese
Vietnamese

61KB
30KB
196KB
125KB

Smile Spectrum
50/1000/Ortho/U90

English
Spanish
Chinese
Vietnamese

63B
31KB
184KB
149KB

Smile Spectrum
50/1000/Ortho/MAC

English
Spanish
Chinese
Vietnamese

63B
31KB
184KB
149KB

Smile Spectrum
50/1000/No Ortho/MAC

English
Spanish
Chinese
Vietnamese

61KB
30KB
180KB
146KB

Smile Spectrum
50/1500/Ortho/U90

English
Spanish
Chinese
Vietnamese

61KB
31KB
184KB
145KB

Smile Spectrum
50/1500/Ortho/MAC

English
Spanish
Chinese
Vietnamese

62KB
30KB
180KB
146KB

Smile Spectrum
50/1500/No Ortho/U90

English
Spanish
Chinese
Vietnamese

62KB
45KB
200KB
157KB

Smile Spectrum
50/1500/No Ortho/MAC

English
Spanish
Chinese
Vietnamese

73KB
31KB
195KB
147KB

Smile Spectrum Premier
25/1500/Ortho/MAC

English
Spanish
Chinese
Vietnamese

59KB
135KB
382KB
197KB

Smile Spectrum Premier
25/1500/Ortho/U90

English
Spanish
Chinese
Vietnamese

61KB
139KB
388KB
174KB

Smile Spectrum Premier
25/2000/Ortho/U90

English
Spanish
Chinese
Vietnamese

61KB
139KB
389KB
176KB

Smile Spectrum Premier
25/1500/No Ortho/U90

English
Spanish
Chinese
Vietnamese

60KB
137KB
388KB
195KB

Smile Spectrum Premier
25/2000/No Ortho/U90

English
Spanish
Chinese
Vietnamese

60KB
123KB
388KB
195KB

Smile Spectrum Premier
50/1000/Ortho/MAC

English
Spanish
Chinese
Vietnamese

59KB
138KB
315KB
195KB

Smile Spectrum Premier
50/1500/Ortho/MAC

English
Spanish
Chinese
Vietnamese

59KB
138KB
383KB
195KB

Smile Spectrum Premier
50/2000/Ortho/MAC

English
Spanish
Chinese
Vietnamese

60KB
123KB
383KB
195KB

Smile Spectrum Premier
50/1500/Ortho/U90

English
Spanish
Chinese
Vietnamese

60KB
138KB
388KB
176KB

Smile Spectrum Premier Plus
50/1500/Ortho/U90

English
Spanish
Chinese
Vietnamese

65KB
138KB
388KB
176KB

Smile Spectrum Premier
50/2000/Ortho/U90

English
Spanish
Chinese
Vietnamese

60KB
139KB
388KB
197KB

Smile Spectrum Premier
50/1500/No Ortho/MAC

English
Spanish
Chinese
Vietnamese

70KB
138KB
374KB
188KB

Smile Spectrum Premier
50/2000/No Ortho/MAC

English
Spanish
Chinese
Vietnamese

70KB
136KB
375KB
188KB

Smile Spectrum Premier
50/1500/No Ortho/U90

English
Spanish
Chinese
Vietnamese

60KB
139KB
388KB
174KB

Smile Spectrum Premier
50/2000/No Ortho/U90

English
Spanish
Chinese
Vietnamese

60KB
139KB
381KB
174KB

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