DentalandVisionIns.com
Printing Applications, Plan Descriptions and Certificates.
 
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Administration Instructions for Groups

New Employee Application/Deletion or Change Form (Adobe file)
Please use the Individual application for adding a new employee, deleting an existing employee or changing dependent status on an existing employee's coverage.

COBRA
Cal-COBRA groups will give us the members address upon termination of coverage and we will generate the Cal-COBRA election form and invoice the member directly for the coverage. 

Federal COBRA groups will need to issue a COBRA form upon the qualifying event. 
Click here for an Adobe Acrobat file of the Federal COBRA form. 
Members who extend coverage under Federal COBRA will be invoiced with the group and the individual premium collection is done by the group.

Please follow this link for a definition of Federal COBRA vs. Cal-COBRA and to notify us which COBRA regulations apply to your group.
 

Dental Plan Descriptions & Certificates

Plan Description Plan Description
in Spanish
Certificate
2000 Premier Plan 2000 Premier Plan 2000 Premier Plan
2000 Premier Plan with Ortho 2000 Premier Plan with Ortho  
Premier Plan I Premier Plan I Plan I, Premier
Premier Plan I with Ortho Premier Plan I with Ortho  
1500 Premier Plan 1500 Premier Plan 1500 Plan, Premier
1500 Premier with Ortho 1500 Premier with Ortho  
Premier Plan II Premier Plan II Plan II, Premier
Premier Plan II with Ortho Premier Plan II with Ortho  
Premier Plan III Premier Plan III Plan III, Premier
Premier Plan III with Ortho Premier Plan III with Ortho  
Premier Plan IV Premier Plan IV Plan IV, Premier
     
PPO 2000 PPO 2000 PPO 2000
PPO 2000 with Ortho PPO 2000 with Ortho  
PPO Option I PPO Option I PPO Option I
PPO Option I with Ortho PPO Option I with Ortho  
PPO Option II PPO Option II PPO Option II
PPO Option II with Ortho PPO Option II with Ortho  
PPO Option III PPO Option III PPO Option III
PPO Option III with Ortho PPO Option III with Ortho  

Vision Plan Descriptions & Certificates

Plan Description Plan Description in Spanish Certificate
VSP Vision A $20/$25 co-pay VSP Vision A $20/$25 VSP Vision A $20/$25
VSP Vision A $25 co-pay VSP Vision A $25 VSP Vision A $25
VSP Vision A $10 co-pay VSP Vision A $10 VSP Vision A $10
VSP Vision A No co-pay VSP Vision A No co-pay VSP Vision A No co-pay
VSP Vision B $10/25 co-pay VSP Vision B $10/$25 VSP Vision B $10/$25
VSP Vision B $25 co-pay VSP Vision B $25 VSP Vision B $25
VSP Vision B $10 co-pay VSP Vision B $10 VSP Vision B $10
VSP Vision B No co-pay VSP Vision B No co-pay VSP Vision B No co-pay
VSP Vision C $10/25 co-pay VSP Vision C $10/$25 VSP Vision C $10/$25
VSP Vision C $25 co-pay VSP Vision C $25 VSP Vision C $25
VSP Vision C $10 co-pay VSP Vision C $10 VSP Vision C $10
VSP Vision C No co-pay VSP Vision C No co-pay VSP Vision C No co-pay