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Dental Benefit Summaries
These benefit summaries are effective January 1, 2007 and thereafter.
 
When providing a benefit summary to an applicant or Blue Shield member, you must also include a Notice of Language Assistance.(PDF, 1MB)
Dental PPO plans
 Plan Name Download  Size 
 DPPO Smile Basic Voluntary
 75/1000/No Ortho/MAC
English
Spanish
Chinese
Vietnamese
 
PDF, 62KB
PDF, 31KB
PDF, 197KB
PDF, 136KB
 
 DPPO Smile Basic
 75/1000/No Ortho/MAC
English
Spanish
Chinese
Vietnamese
 
PDF,61KB
PDF, 32KB
PDF, 195KB
PDF, 125KB
 
 DPPO Smile Value
 50/1500/No Ortho/MAC
English
Spanish
Chinese
Vietnamese
 
PDF, 63KB
PDF, 30KB
PDF, 180KB
PDF, 145KB
 
 DPPO Smile
 50/1500/No Ortho/MAC
English
Spanish
Chinese
Vietnamese
 
PDF, 61KB
PDF, 30KB
PDF, 187KB
PDF, 145KB
 
 DPPO Smile Plus
 50/1500/Ortho/MAC
English
Spanish
Chinese
Vietnamese
 
PDF, 62KB
PDF, 30KB
PDF, 186KB
PDF, 145KB
 
 DPPO Smile Plus Gold
 50/1500/Ortho/U85
English
Spanish
Chinese
Vietnamese
 
PDF, 63KB
PDF, 31KB
PDF, 189KB
PDF, 143KB
 
 DPPO Smile Deluxe 2000
 50/2000/No Ortho/MAC
English
Spanish
Chinese
Vietnamese
PDF, 70KB
PDF, 139KB
PDF, 374KB
PDF, 234KB
 
 DPPO Smile Deluxe
 50/1500/Ortho/MAC
English
Spanish
Chinese
Vietnamese
 
PDF, 59KB
PDF, 138KB
PDF, 380KB
PDF, 234KB
 
 DPPO Smile Deluxe Plus 2000
 50/2000/Ortho/MAC
English
Spanish
Chinese
Vietnamese
 
PDF, 59KB
PDF, 138KB
PDF, 383KB
PDF, 196KB
 
 DPPO Smile Deluxe Gold
 50/1500/Ortho/U85
English
Spanish
Chinese
Vietnamese
 
PDF, 61KB
PDF, 140KB
PDF, 389KB
PDF, 196KB
 
Dental HMO plans
 Plan Name Download  Size 
 Dental HMO Basic           English
Spanish
Chinese
Vietnamese
PDF, 55KB
PDF, 118KB
PDF, 370KB
PDF, 169KB
 Dental HMO Voluntary          
English
Spanish
Chinese
Vietnamese
PDF, 55KB
PDF, 119KB
PDF, 353KB
PDF, 192KB
 Dental HMO Plus        English
Spanish
Chinese
Vietnamese
PDF, 55KB
PDF, 119KB
PDF, 370KB
PDF, 170KB
 Dental HMO Deluxe English
Spanish
Chinese
Vietnamese
PDF, 55KB
PDF, 118KB
PDF, 364KB
PDF, 192KB
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Brochures
Dental Brochure for Producers (PDF, 209KB)
An overview of our dental PPO and HMO plans.
Dental Brochure for Employers (PDF, 135KB)
An overview of our dental plans to give your clients.
Voluntary Dental Employee Flyer  (PDF, 59KB)
An overview of our dental, life and vision plans to give your clients.
(Updated 12/08)
Suite Deal FAQs
FAQs for Producers (PDF, 60KB)
Refer to these handy guides for questions that you may have about the Suite Deal Dental package.
FAQs for Employers (PDF, 58KB)
Refer to these handy guides for questions that your clients may have about the Suite Deal Dental package.
Rate Tables and Enrollment Forms
Download rate tables
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